Inspection on 18/08/09 for The Moorings

This inspection was carried out on 18th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Moorings 29/08/07

The Moorings 05/06/06

The Moorings 11/10/05

The Moorings 04/05/05

The Moorings 24/11/04

The Moorings 20/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Moorings, The Egypt Hill Cowes Isle Of Wight PO31 8BP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Annie Kentfield     Date: 1 8 0 8 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 27 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 27 Information about the care home Name of care home: Address: Moorings, The Egypt Hill Cowes Isle Of Wight PO31 8BP 01983297129 01983293386 office@themoorings.demon.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Janet Holmes care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Physical disability - PD Date of last inspection Brief description of the care home The Moorings is an attractive period house set in its own grounds and close to Cowes sea front, with good views of the Solent from some of the upper floor windows. The home is registered to provide care for up to 25 older people. The accommodation is arranged over three floors with the sitting and dining rooms on the first floor. There is a passenger lift between the floors and one part of the building that requires access via a short flight of steps; these five bedrooms would not be suitable for anyone who is Care Homes for Older People Page 4 of 27 Over 65 0 25 0 25 0 25 Brief description of the care home not fully mobile. There is a large conservatory on the ground floor that provides an additional sitting room for residents to enjoy a view of the garden and Egypt Hill. The building is accessible. Fees vary and details of fees and any additional charges, are available from the home. Care Homes for Older People Page 5 of 27 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: We made an unannounced visit on 18 August 2009, this was with one inspector who was in the home between 11.30 am and 4.30 pm. The registered manager was not working on that day but we were assisted by the duty manager and the registered provider. We spoke with eight residents, five members of staff and one visitor during the visit. We looked at some of the homes records including care plans, medication records and some of the health and safety records. We received the Annual Quality Assurance Assessment from the home. This is a selfassessment that gives us some information about the home and information about what the home does well and where further improvement is planned. We sent surveys to 10 residents and 6 were returned. All of the feedback about the home was positive. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The registered manager must ensure that arrangements are made for the safe administration of medication to ensure that residents receive their medication, as prescribed, at all times. We found that the records of residents medication did not provide a clear audit trail of medication received into the home, dispensed, or returned because the medication records had some gaps and omissions. The practice of secondary dispensing from the original paharmacy supplied packaging into another container is unsafe and poor practice and could lead to errors. Staff do not have a written policy and procedure for the safe management of controlled drugs in the home. Hand written medication records had not been checked and witnessed as correct. This means that errors could be made when transcribing from the original prescribing instructions. It is recommended as good practice that Temazepem be recorded as a controlled drug in the controlled drug register. We were not able to look at records of staff recruitment, training or supervision because they were safely locked away and no-one in the home had access to them. Care Homes for Older People Page 7 of 27 Arrangements must be made for all records to be available for inspection. The Statement of Purpose/Service User Guide contained out of date information about how to contact the Care Quality Commission. The information for residents and their families and friends must be regularly reviewed and kept up to date. 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 27 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 27 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 do not move into the home until the home has made an assessment of individual care and support needs and the home is confident those needs can be met. Residents and/or their representatives receive information about the home. However, some of the information is out of date. Evidence: We looked at a copy of the homes service user guide that was available to people in the main entrance hall. This sets out what people can expect from The Moorings and provides information about fees, additional charges, staffing etc. Some of the information in the service user guide is out of date because there are references to the National Care Standards Commission and this has not been in existence since 2004. This means that people do not have correct information about how to contact the Care Quality Commission when required. For new or prospective residents, the home has a process of assessment to decide if Care Homes for Older People Page 10 of 27 Evidence: the home is able to meet the needs of prospective residents. Previous inspections have demonstrated that the manager is clear about the level of care needs the home can accommodate and consideration would be given to peoples mobility and the suitability of the rooms available. The person in charge on the day we visited told us that the rooms currently available are only suitable for people who are independently mobile because the rooms are only accessible via a short flight of steps. Prospective residents and/or their representatives are always encouraged to visit the home and look around. The Annual Quality Assurance Assessment told us that visits to the home may incorporate a meal or short stay, before people make the decision to move into the home. We spoke to some residents who told us that they had chosen to live at The Moorings after looking around or because they had already visited someone else in the home. We also spoke to a visitor who told us that The Moorings was chosen as a home for their relative after looking at several other homes, because they liked the friendly and homely atmosphere. The Annual Quality Assurance Assessment confirmed that people moving into the home receive a contract following a one month trial period. Care Homes for Older People Page 11 of 27 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. Peoples health, personal and social care needs are set out in an individual plan of care that is regularly reviewed. The systems for the administration of residents medication do not follow current good practice guidelines. This may place people at risk of not receiving their medication, as prescribed, at all times. Evidence: The home has developed a way of producing plans of care for each resident using a computerised programme and we looked at this with a member of staff. The system is comprehensive and organised and staff said they found it easy to use and very helpful. We also looked at care plans for three people and these are also kept as paper records. The care plans provide guidance for staff on how care needs are to be met and cover all areas of healthcare, psychological, and social support needs. The care plans include risk assessments in relation to peoples risk of falling, the risk of developing pressure areas, and specific risk assessments relating to individual risks, with guidance on how risks are to be minimised or events managed, for example, the risk of someone going out and getting lost. Care plans also include details of how people may need help with moving and mobility. Staff demonstrated that the new Care Homes for Older People Page 12 of 27 Evidence: system is able to produce an immediate report of relevant information to accompany people in the event they are admitted to hospital. This ensures that important information about peoples health care is communicated easily to health care professionals, when required. Care plans are reviewed each month with the resident and their key worker and we looked at records to confirm this. The care plan review also includes a quality review and is an opportunity for residents to feedback any comments, and for staff to do a maintenance check of residents rooms. Staff told us that any changes to care or issues to be resolved are fed back to the registered manager. The Annual Quality Assurance Assessment told us that peoples privacy and dignity is respected at all times. Bedroom and bathroom doors are lockable. The home has a call alarm system. We spoke to some of the residents who told us that staff always respond if they use the call bell alarm. The home has a laundry service. One person told us in the surveys that the home could improve the way that laundry is organised and returned to residents. The registered provider told us that problems with returning personal items to residents has been reviewed and improved. We looked at the systems for making sure that residents receive their medication. Medication is stored in a locked trolley that is secured when not in use. Some of the medicines are received in monitored dosage systems (blister packs) and some in the original pharmacy supplied packaging. We observed that some of the medication is being taken out of the original packaging and put into dispensing boxes by a member of staff, to be dispensed later in the day, sometimes to be dispensed by a different member of staff. This is secondary dispensing and is poor practice and can lead to accidental errors. Guidance from the Royal Pharmaceutical Society says that if the care worker giving the medicine does not have the original container with the label they cannot be sure that each person receives the right doses of the right medicine at the right time, as prescribed. A controlled medicine prescribed for two residents was being stored as a controlled drug but was not recorded in the controlled drug register (this is a good practice recommendation). The medication administration record for one resident for a controlled drug, recorded the number of tablets dispensed but did not record the number received into the home. Staff in the home could not find a copy of the written policy and procedures for the safe management of controlled drugs in the home. This Care Homes for Older People Page 13 of 27 Evidence: means that there is not a clear audit trail of medication received into the home, dispensed, or returned to the pharmacy. Staff do not have clear guidance on the safe management of controlled drugs in the home. Controlled drugs are stored in a separate cupboard that is kept locked. The legal requirements for the way that controlled drugs are stored have been amended. The registered person needs to confirm that the current storage meets current regulatory requirements. Some of the medication administration records were hand written onto the medication charts but had not been checked and witnessed by someone qualified to do this. This means that there is a risk of error if information is incorrectly transcribed from the original packaging to the medication chart. Care staff told us that training in the safe administration of medication is updated each year with in house training from the registered manager. However, we were not able to look at the records to confirm this. Following the inspection visit we wrote to the registered persons with an immediate requirement letter. This letter asked for written confirmation of the action being taken to protect residents from the risk of harm and to ensure that medication procedures in the home are safe and organised. We also recommended as good practice that the registered persons review their medication policies and procedures in line with the good practice guidance in The Safe Handling of Medicines in Social Care, produced by the Royal Pharmaceutical Society of Great Britain. This is available to download from the commission website www.cqc.org.uk Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of daily living and activities are flexible and varied to suit different needs. Family and friends are able to visit. People receive wholesome and appealing meals in pleasant surroundings. Evidence: We spoke to a group of residents in one of the sitting rooms and comments confirmed satisfaction with the routines of daily living in the home such as meals and mealtimes and opportunities for social and leisure activities. We saw a programme of daily activities for the home and this included some kind of organised activity such as games or entertainment and also the opportunity for weekly outings outside of the home. Residents that we spoke to felt able to join in with activities if and when they chose to. We also saw photographs on display of residents enjoying events such as garden parties or christmas and birthday parties. The Annual Quality Assurance Assessment from the home told us that residents have access to a small in-house shop that sells sweets and snacks. Residents are able to arrange appointments with a visiting hairdresser and a chiropodist. Comments from residents told us that generally the meals are good; we were told that Care Homes for Older People Page 15 of 27 Evidence: the home has a new cook and there have been some changes to the menus. People told us that they are happy with the choices of meals available and the portions are good. We were told that hot and cold drinks are offered throughout the day and evening and residents can request drinks or snacks at other times if they want to. We spoke to the member of staff who was preparing the tea-time meal. It was evident that people had made choices about what they would like and there was hot or cold snacks or home-made soup available. The home was last inspected for food safety and food hygiene in July 2008. We noted that the home has a five star (maximum) rating and there were no requirements from the last food hygiene inspection by the Environmental Health Department. Residents have the opportunity to feedback their comments about any aspect of the daily routines of the home in the residents meetings or in the one to one care reviews between residents and their key worker that take place each month. Visitors are welcome to visit the home at any time; within agreed limits, and there is information for visitors in the main entrance to the home. Comments from some of the residents and one visitor confirmed that staff are helpful and welcoming to any visitors to the home. Care Homes for Older People Page 16 of 27 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. Comments received from people living in the home and their representatives confirmed that they are confident that their comments or complaints are listened to and taken seriously. The home has a written complaints procedure and this needs updating. Evidence: People we spoke to during our visit told us that they felt able to speak to staff or the manager in the event of having any comments or complaints. The surveys that we received confirmed that five out of the six people who returned surveys knew how to make a formal complaint, one person said they did not know. The home has a complaints procedure in place and there is some information about this in the main entrance to the home. However, the information in the service user guide is out of date (about how to contact the Care Quality Commission). The Annual Quality Assurance Assessment told us that the home has received two complaints in the last 12 months and one of these is awaiting an outcome. The complaints records were not available for us to look at to assess how well complaints are dealt with and what the outcomes were. The registered provider confirmed that the home are aware of the action they must take to ensure that people are protected from the risk of abuse; and we were told that Care Homes for Older People Page 17 of 27 Evidence: staff receive appropriate training in safeguarding awareness. However, we were not able to verify this because staff training records were not available for us to look at. However, records show that there have been two instances of concern about residents in the home, but we were able to confirm that following investigation by Social Services Safeguarding Team, the concerns were not substantiated and no action was taken. The home took appropriate action and worked in consultation with Social Services. The registered provider told us that the manager and staff are aware of the Mental Capacity Act and how this may affect people living in the home, particularly with regard to deprivation of liberty safeguards. The registered provider was able to give us an example of where a referral was made for relevant professionals to assess someones capacity to make important decisions about their lives. This demonstrates that the home are aware of how the Mental Capacity Act will affect people living in the home, in practice. When we looked at three plans of care for people in the home, there was evidence that any risks to people are assessed with a plan of how risks will be minimised or events managed. The home has told us that residents are protected from the risk of harm by the homes staff recruitment procedures and pre-employment checks. However, we were not able to verify this because staff recruitment records were not available to look at. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a pleasant and homely environment. Generally the home is clean and hygienic although some areas of the home had not received recent attention to dusting. Evidence: The home is a detached period property set back from the road and with a large garden containing a range of mature trees, shrubs and lawn. Several residents commented on the good views of the Solent that are enjoyed from the upper floors. We spoke to some residents in the conservatory and they enjoy having a good view of the garden all year round. One relative of a resident told us the home has superb views of sailing in Cowes and there is always something of interest for the residents to see from their windows. It is the custom and practice of the home for residents and visitors to be able to freely access the home from the main entrance and there is a notice asking visitors to make themselves known to staff on the first floor where the office and communal rooms are located. The home has a passenger lift to access the upper floors. Residents have access to a dining room and sitting room on the first floor with pleasant aspects towards the sea, and a conservatory/sitting room on the ground floor. There is an assisted bath on the Care Homes for Older People Page 19 of 27 Evidence: first floor and toilets are available on each floor. Bedrooms have en-suite facilities. There is a bathroom on the ground floor that is used by the visiting hairdresser. The person in charge on the day of our visit told us that the home currently has 20 residents and although two rooms are currently vacant, the home is aware that these rooms are only suitable for people who are independently mobile because they need to be accessed by a step. At the previous inspection the manager told us that the home is not suitable for people who self-propel a wheelchair due to the layout of the home and the size of the corridors. We received six surveys from people living in the home and we also spoke to residents during our visit. Comments confirmed that people found the home to be clean and pleasant. When we reviewed the service in 2008 we received a comment that indicated that the home was providing less cleaning hours. During our visit we noted that the window sills in the conservatory were covered in cobwebs. This was brought to the attention of the registered provider who told us that cleaning staff have a programme to follow for cleaning all areas of the home and this would be addressed. The Annual Quality Assurance Assessment stated that the home has an action plan for good practice in the prevention and control of infection and also told us that all staff have received training in infection control procedures. Staff were seen to have access to gloves and aprons as part of the infection control procedures in the home. Staff and visitors are asked to use anti-bacterial spray when they enter or leave the home and there is a spray dispenser in the main entrance of the home. We looked at some of the bathrooms and toilets and these contained suitable hand washing facilities. We noted that the ground floor toilet had a broken toilet seat. The registered provider told us that the manager keeps a maintenance book for the home and all repairs are noted and then checked off when completed. The home employs a part-time maintenance person. Care Homes for Older People Page 20 of 27 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 needs of the residents are met consistently by a team of staff who receive appropriate training and supervision for the work they do. However, staff recruitment, training and supervision records were not available for inspection to verify this. Evidence: Comments from residents and visitors in the surveys confirmed that people are very satisfied with the care and support provided by the staff team. One person told us: friendly, kind and supportive staff and the home is well organised and there are good routines. Another person commented on the kindness and patience of the care staff. We spoke individually to three members of staff who confirmed that they receive sufficient training and supervision for the work they do. One person told us that they receive regular supervision and work appraisals. The Annual Quality Assurance Assessment (AQAA) told us that the home operates thorough staff recruitment practice to ensure that staff are suitable to work in the home. However, the AQAA did not provide any information about staffing numbers and staff training and qualifications as this section had not been completed. We were not able to look at the records for staff training and staff recruitment because the records cannot be accessed when the manager is not there. Therefore we were not able to verify some of the information from the AQAA. Care Homes for Older People Page 21 of 27 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 run by a person who has the necessary skills, experience and qualifications to manage the home. Attention is paid to promoting the health, safety and welfare of residents and staff. However, medication procedures are unsafe and this has the potential to place residents at risk of harm. There are quality assurance systems in place, these could be developed. Evidence: The manager has been registered as manager of The Moorings for 17 years and has the necessary qualifications and experience to effectively manage the home. Comments from residents, visitors and staff confirm that the manager has an open and hands on approach that is appreciated and valued. One person told us the home and its management could hardly be bettered. The registered provider told us that the home does not act as financial or legal appointee for anyone and people are encouraged to either manage their own finances or with independent support. Care Homes for Older People Page 22 of 27 Evidence: The home has a number of ways of seeking feedback and comments from people about the service provided by the home: care plan reviews, residents meetings and comment forms. At the last visit to the home the manager told us that the home would look at ways of summarising and presenting the outcomes of their quality reviews. This still needs to be developed. The manager was not working in the home on the day that we visited. Some of the records that must be available for inspection were not accessible. Although there are arrangements for senior staff to be in charge of the home in the absence of the manager, the home has not made arrangements for the registered provider to access some of the records. This means that we were not able to verify what the home has told us about staff training and staff recruitment procedures. We looked at some of the homes records for maintaining equipment safely and ensuring that health and safety is promoted. Records were up to date for the servicing and weekly checks of fire safety equipment. The Annual Quality Assurance Assessment confirmed that equipment and services in the home are regularly serviced and maintained for the safety of people living in the home. The inspection found that care plans and risk assessments provide guidance for care staff on how care is to be provided and to protect residents from risks to their safety and well being. However, the systems for the administration of medication are not safely organised and have the potential to place people at risk. We did not find evidence that medication systems are regularly audited and reviewed to ensure that practice in the home is safe and meets current good practice guidance and legal requirements. We received the Annual Quality Assurance Assessment from the home. There were some gaps in the information provided; for example, the appendix section on staffing had not been completed. The AQAA provided us with some information about equality and diversity but more information could have been provided about how equality and diversity are promoted and incorporated into the practice of the home. For example the AQAA said we promote an open outlook and encourage diversity where possible, but the AQAA did not provide further detail of how this is promoted in practice. The AQAA told us that the home has changed the menus as a result of listening to people who live in the home, and changed the activities programme. The AQAA did not provide any detail about how the results of the quality reviews of the home are summarised and made available for people to read. Care Homes for Older People Page 23 of 27 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 24 of 27 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 6 The Statement of Purpose/Service User Guide must be regularly reviewed and updated. People using the service must have access to up to date information about the home and the services provided in order to make an informed choice about moving into the home. 16/10/2009 2 9 13 In the interests of safe 30/09/2009 medication handling all medicines must be administered directly from the original labelled container to the service user and not be placed into any secondary container for later administration. Residents must receive their medication as prescribed, at all times. Care Homes for Older People Page 25 of 27 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 9 13 The registered person must 30/09/2009 make suitable arrangements to ensure that residents medication is safely stored, dispensed and returned. Staff must have clear policies and procedures for the safe administration of medication received into the home. This must include a policy and procedure for the storage, administration and recording of any controlled drugs. 4 37 17 Records relating to the management and organisation of the home must be available at all times for inspection. The registered person must ensure that all records are available when the registered manager is not in the home. 30/09/2009 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 9 It is good practice for hand written entries on the medication administration record sheet to be checked and witnessed by someone qualified to do this. It is recommended as good practice for Temazepam to be recorded as a controlled drug. 2 9 Care Homes for Older People Page 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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