Inspection on 15/01/09 for Morton Cottage Residential Care Home

This inspection was carried out on 15th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Morton Cottage Residential Care... 17/07/08

Morton Cottage Residential Care... 30/01/08

Morton Cottage Residential Care... 06/09/07

Morton Cottage Residential Care... 19/07/06

Morton Cottage Residential Care... 04/12/05

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: Morton Cottage Residential Care Home 210 Wigton Road Carlisle Cumbria CA2 6JZ     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: Diane Jinks     Date: 1 5 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 30 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Morton Cottage Residential Care Home 210 Wigton Road Carlisle Cumbria CA2 6JZ 01228515757 01228521876 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Morton Cottage Residential Care Home Ltd Name of registered manager (if applicable) Mrs Amanda Jane Longford 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: The registered person may provide the following category of service only: Care home only - Code 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 - Code OP Dementia - Code DE (maximum number of places: 6) The maximum number of service users who can be accommodated is: 32 Date of last inspection Brief description of the care home Morton Cottage is owned and operated by Mrs April Dixon with Mrs Amanda Longford as the registered manager. The home is registered to provide accommodation for up to 32 older people. The property is a large detached house on the outskirts of Carlisle. Accommodation for the residents is on two floors with a passenger lift accessing the first floor. There are 24 rooms for single occupation and four that can be shared by two people. All the bedrooms have en-suite toilet and washbasin facilities and there are Care Homes for Older People Page 4 of 30 6 0 Over 65 0 32 care home 32 Brief description of the care home communal toilet and bathing facilities throughout the home. There are two lounges, one lounge/dining room and a separate dining room on the ground floor. A guide to the services and facilities provided by the home is available on request from the manager. The scale of charges range from £386.00 to £449.00 per week (July 2008). Care Homes for Older People Page 5 of 30 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 of this service took place over several months. Over a period of time we have monitored the information the home has sent to us as required, including their plan for making improvements to the service. As part of this inspection we made a visit to the home. We spent six hours there and during this time we spoke to some of the people that live at Morton Cottage, some of their visitors and some of the staff that were on duty, including the owner and manager. This helped us to understand the views of people living and working at the home. We looked at a selection of records relating to the care of people that use this service, staff recruitment and training and the general organisation of the home. The manager and the owner gave us all of the information and documents we asked to Care Homes for Older People Page 6 of 30 see. They were very open with us and worked well with us during our visit to Morton Cottage. What the care home does well: What has improved since the last inspection? What they could do better: The manager ensures that risk assessments are undertaken and kept up to date. They cover a variety of situations and include some information for staff when helping people to mobilise and when working with people that may have difficult behaviour at times. There are some gaps in the assessments, which may leave people at risk from injury or inappropriate support at times. We have asked the manager to review the risk assessment process and records to help ensure that people living and working at the home are safe and protected from harm or injury. Staff are provided with training to help them do their job properly and safely. We observed staff working with people living in the home and they generally used safe practices. However, we found that there has been a reduction in training recently. The manager is aware of this shortfall and she has told us of her plans to address this matter within a specified timescale. Although we have noted some improvements in the way medicines are managed at the home, we found that there are some areas that need further work. This was particularly noticed in the way administration of medicines is recorded. Staff do not always complete these records accurately. This means that people may not always receive their medicines safely or as the doctor intended. We have asked the manager to make sure that this is attended to quickly. Care Homes for Older People Page 8 of 30 At our last visit to the home an activities co-ordinator had been employed. However, this person has now left. There are some opportunities for people to participate in social and leisure activities but these are fairly limited and provided by the care staff. The manager needs to review this important area and ensure that people living at Morton Cottage have access to stimulating social and leisure activities of their choice. 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.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 9 of 30 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 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service have their care and support needs assessed before they move into the home. This helps to ensure that the home will be able to meet their requirements and expectations appropriately. Evidence: The manager has produced information about the home. This is made available to people thinking of moving into Morton Cottage to help them with their decision to move there. People are able to visit the home for afternoon tea or for the whole day. This also helps people to make a decision about choosing this home. We looked at a sample of three care files during our visit to the home. We found that people have their care and support needs assessed prior to moving into the home. This helps to make sure that the home will be suitable. It also helps to make sure that the home will be able to provide the services to meet the needs and expectations of people considering Morton Cottage as a home. Prospective residents and their families, if they Care Homes for Older People Page 11 of 30 Evidence: choose, are involved in the assessment process. Where people are referred to the home by a social worker or from hospital, the manager obtains copies of those assessments too. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service generally have plans of their care and support needs and how those needs will be met. There are gaps in some of the recording processes, which may mean that people do not consistently receive the support they need. Evidence: We looked at a sample of three care records. We found that people have up to date plans of their care needs and the things that they need support with in their daily lives. The plans include individualised instructions for staff to follow to help ensure people get the support they need, when they need it. The plans are written in a way that respects peoples privacy, dignity and independence and clearly identify where people need assistance, including details of the things they can manage to do for themselves. Care plans contain an element of risk assessment to help make sure that people are supported safely. Risk assessments identify if people are at risk or susceptible to falling, but they do not provide staff with any special instructions of how to manage such matters and this could place staff and residents at risk from harm or injury. Where necessary, care plans do contain assessments of peoples nutritional needs, Care Homes for Older People Page 13 of 30 Evidence: including monitoring records of body weight and nutritional intake. Not everyone living at the home has had a nutritional assessment and it would be good practice for the manager to include this in each care plan to help ensure that people using this service are receiving the nutritional support they need. Care plans are generally reviewed each month and changed or updated as peoples needs change. Some of the people we spoke to during our visit told us that the staff are very good and always help them when they need it. One of the visitors we spoke to said, my relative is well looked after. They have been here two years, if I wasnt happy with the care I wouldnt leave them here. Daily records show that people living at Morton Cottage have access to other healthcare professionals when needed, for example, their doctor, district nurse, optician or chiropodist. Where people need to attend hospital appointments, they are supported in doing this if they require. We looked at some of the medication practices at the home. The manager has recently changed the provider of medicines to the home to help make medication administration safer. The manager said that the home gets good support and advice from the new pharmacist. The policies and procedures in place at the home have been updated to reflect these changes. Record keeping in respect of medicines entering and leaving the home has been reviewed. Staff responsible for the administration of medication are regularly supervised and have their practice monitored. These changes have been discussed at staff meetings to help ensure that all staff are aware of the changes. The way in which medicines are stored have been improved. The manager has purchased a secure cupboard for storing special medicines and the designated medication fridge has been thoroughly cleaned and defrosted. The new system has meant that recording codes for the administration of medication have changed and staff are not always adhering to the new codes, particularly where medicines have not been given or have been refused. We looked at a sample of the medication records. One person had not been given their antibiotic the previous night and there was no record on the medication administration record (MAR) sheet. Another person had not had one of their medications for two days as it had run out. These errors can place people using this service at risk. We checked a sample of the controlled drugs kept at the home. The records were correct and corresponded with the amount of medication administered and left in the cupboard. We noted that the home did not have any care plans for any medications that can be administered as and when needed. However, when they are administered they are recorded together with the time of administration. Dates of opening of packets of tablets, creams, medicines, lotions and drops are now recorded on the medicine packets. Medication records clearly identify any medications that are not supplied in the sealed blister packs. The manager told us that a weekly check is carried out on all aspects of medication and bi-monthly staff supervision and observation of the medication round is undertaken. Care Homes for Older People Page 14 of 30 Care Homes for Older People Page 15 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are provided with some social and leisure activities. This could be improved upon to help ensure that people enjoy a range of stimulating activities suited to their wishes and lifestyle. Evidence: We did not see any social or leisure activities taking place on the day of our visit. Some people were actively watching television and some people asked for certain programmes to be put on for them. Other people were reading books or newspapers or sat chatting together. Daily records show that some activities do take place but these are not planned or consistently regular. The activities co-ordinator that was employed at the home has left and activities are part of care staff duties now. One member of staff told us that some activities take place in the afternoons during the week, for example, quizzes and puzzles, board games, cards, dominoes, chats, singing and dancing. The manager told us that some of the people that live at the home attended a Christmas concert at the Sands Centre and Tuille House museum have visited the home with reminiscence activities. More recently some people went on a minibus trip for afternoon tea out. The home has purchased new televisions for two of the communal lounge areas and Care Homes for Older People Page 16 of 30 Evidence: these have subtitle facilities if needed. Some people choose to have newspapers and magazines delivered to the home. Religious services are held at the home each week and again people are able to choose whether they attend or not. Religion is very important to some of the people that live at Morton Cottage and this is noted in their care files. They have brought religious items into the home with them and keep them in their own rooms. People are able to have visitors to the home and may see them in one of the communal areas or in the privacy of their own room. Visitors are made welcome and are offered refreshments. Some people have brought some of their own possessions into the home and a record is generally kept of these items in their individual records. One person has been able to bring her pet cat into the home with her, but there are some restrictions on how this is managed to help ensure that everyone is safe. We spoke to some of the people that live at the home. They told us that the staff are very good, helpful and friendly. They said that the staff come when called and help when needed. They have all lived at the home for quite a while. One person said they miss their bacon sandwiches and dont get bacon very often. They told us that breakfast is toast and cereal but then added; you can have what you want. People told us that the meals are generally alright and that there is always a choice. They said if you dont like something you can always have something else. We saw staff working with some of the people that live at Morton Cottage. Staff were attentive, chatty and friendly. Where manual handling procedures were carried out good techniques were used and people were told what was going to happen and when, they were encouraged to help themselves as much as possible. People were offered plenty of drinks throughout the day and one person told us I only have to ask and they bring me my tea. Some people at the home are able to have keys to their room and like to keep their door locked. This is done on a risk assessed basis to help ensure people are safe. We noted that the housekeeper came to check with one person about locking their room once she had finished cleaning it. We observed the serving of the lunchtime meal. People were offered a choice from two main courses and two puddings. Some people didnt want either and staff ensured that alternatives were offered. Cold and hot drinks were available during the meal and staff made sure people had everything they needed. Milk and sugar were on the table for people to help themselves to. Staff asked people if they wanted to wear an apron to protect their clothes from possible spills, some people chose not to. We saw one person with a pureed meal. This had been pureed separately, served attractively and served in a special plate with a spoon so that the person could be as self managing as possible. Staff kept a discreet eye out and checked that they were managing to eat their lunch. Care Homes for Older People Page 17 of 30 Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policies and procedures in place at the home in relation to complaints and abuse generally help to ensure that people are protected from harm and the risk of abuse. Evidence: At our last visit to this service we told the manager that there must be a robust process in place to help protect people using this service from harm or the risk of harm. The manager has reviewed these matters and made improvements to the way in which social workers and CSCI are notified of any event which may adversely affect someone living at Morton Cottage. Some of the staff have received formal training in safeguarding adults (abuse). New staff have had some training, which has been covered in their induction. We have not received any complaints about the service and the manager tells us that she has not had any complaints. There is a process in place for raising, recording and monitoring complaints. The people we spoke to during our visit to Morton Cottage knew about the complaint process. Some people told us that they would speak to the staff if they had a problem, they thought staff would listen and act upon their concerns. There is a copy of the local authoritys guidelines on reporting abuse and keeping people safe, available in the home for reference if needed. The manager provided evidence that concerns are reported to social workers where necessary and in the case of one person, assistance and advice has been sought from other relevant health care professionals. Care Homes for Older People Page 19 of 30 Care Homes for Older People Page 20 of 30 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. The home provides a warm, comfortable and safe environment for people to live in. Evidence: There is a maintenance plan in place to help ensure that the home is kept in a good state of repair and provides a nice, homely environment for the people that live there. It has not been possible to carry out some aspects of the maintenance plan at the present time. However, rooms have been re-decorated as they become empty or as needed. Some of the flooring and carpeting has been replaced in some areas and rooms at the home too. We looked around the home during our visit. We found that it was clean, tidy and smelled fresh on the day of our visit. The manager told us that some work to further improve the toilet areas at the home is scheduled to go ahead soon and there are plans to redecorate one of the communal lounge areas. There is a choice of communal areas for people to sit in if they wish. This consists of three lounge areas and two dining areas. The home is nicely furnished and decorated to a reasonable standard. Bedrooms have en-suite toilet and wash basin facilities. There are some shared bed rooms at the home and people using these rooms have chosen to share. People living at Morton Cottage are able to bring items from their previous home to help personalise and make their bedroom more comfortable and homely. We looked at the laundry facilities at the home. This is quite a small, very warm area, Care Homes for Older People Page 21 of 30 Evidence: but it is kept in a tidy and organised manner. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are generally supported and cared for by staff that are recruited safely. Staff receive some specialist training which helps to make sure that they understand the special needs and conditions of some of the people living at Morton Cottage. Evidence: During our visit to the home there appeared to be a sufficient number of staff on duty in order to meet the care needs of the people living at the home. There is a staff rota in place that indicates which staff are on duty and when. We did note that for a short period of time during the morning, we could not find a staff member in any of the communal areas. This left one person particularly, without the support they needed. We looked at a sample of recruitment records for staff that have recently been employed at the home. We found that the manager carries out all of the required checks, including Criminal Record Bureau (CRB), Protection of Vulnerable Adults (POVA) checks and obtains two written references. At least one of the references are obtained from the persons previous employers. These checks help to make sure that people are supported by staff that are suitable to work with vulnerable adults. The manager has started to develop a training plan for staff working at the home and this needs to be updated for the coming year to help make sure staff receive the training they need. The manager told us that she plans to do this by the end of March Care Homes for Older People Page 23 of 30 Evidence: 2009. We looked at a sample of staff training records. A large proportion of the staff working at Morton Cottage have gained, or are working towards a National Vocational Qualification (NVQ) in care at level 2 or 3. This helps to make sure that staff are competent and have an understanding of the care and support needs of older people. Other training has taken place on a regular basis to help ensure that staff keep up to date with good practice guidelines. The training records show that most staff have attended manual handling training, fire prevention and evacuation training, food safety, Mental Capacity Act awareness training and some staff have attended first aid training. Many of the staff at the home have undertaken training to increase their awareness and understanding of dementia related conditions and working with people who may sometimes demonstrate behaviour that can be challenging. This type of training helps to make sure that people using this service are supported safely and by confident, competent staff. We found that the most recently recruited staff have not been provided with formal induction training. They did spend some time working directly alongside one of the managers at the home before they worked alone. This period of time also included reading and discussing some of the policies and procedures at the home and new staff having their care practices directly observed and appraised. This is an area where the manager needs to make improvements to ensure that new staff are provided with sufficient information, training and support in their new roles at Morton Cottage. The dates of training and the names of attendees are kept but the duration of the course attended is not consistently recorded. The staff training records that are kept could be improved upon to help the manager assess whether staff receive the recommended amount of training each year. Care Homes for Older People Page 24 of 30 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 manager tries to run the home in the best interests of the people that live there. Improvements to the service continue to be made to help ensure that people using this service are protected and safe from harm. Evidence: There is an experienced manager in place at the home. She has recently been absent but the owner notified us of this absence and of the alternative arrangements that would be put in place. We found during our visit to the home that the owner and manager have continued to make improvements to the service in line with the requirements and recommendations we made at our last inspection of Morton Cottage. The manager produced and improvement plan to help her deal with these matters in a planned and organised way. We looked at a selection of staff supervision records. They show that this is carried out every two or three months and includes direct observation of practices, meetings with manager and staff meetings. Records also show that various topics are covered during Care Homes for Older People Page 25 of 30 Evidence: supervision sessions including discussions of the policies and procedures in place at the home, job roles and the administration of medication. The supervision of new staff could be improved upon to help ensure they get the support and guidance they need. Their records show they received their first supervision sessions at least two months after commencing work. We looked at a wide variety of the records kept in the care home. They are generally up to date but there are a few gaps in some of the records and entries are not always clear. This was particularly evident in staff training records and medication administration records. The manager has started to carry out regular audits of the medication in the home and directly supervises or observes staff with the responsibility for the administration of medication to help ensure their practices are safe. The manager ensures that risk assessments are carried out and reviewed at regular intervals. Copies of them are kept in the care plan records and in the persons own room. This helps staff to check that they are providing the right support in a safe way. During our visit to the home we observed staff working with some of the people that live at the home. We noted that good manual handling techniques were used and that they explained procedures clearly so that the people they were helping knew what to expect and could assist where necessary. We saw staff using handling equipment competently and safely. The manager could make further improvements to the risk assessments of some people by including greater details and safe working strategies for staff to follow, particularly where people have been identified as needing extra support with behaviour issues or where they have been identified at risk of falling or of poor nutrition. All areas of the home were clean and tidy on the day of our visit. Staff are provided with some instruction on the control of infection and have access to protective clothing when needed. Some staff have received first aid training and there is always one trained member of staff on duty. The manager has maintained the staff fire training records and they indicate that staff receive training at the required intervals. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 17(1) Records for receipt, administration and disposal of medicines must be accurate to protect people from errors. 01/09/2008 2 9 13(2) Medicines must be checked 01/09/2008 and given as prescribed, and changes to medication must be accurately recorded and implemented promptly so that residents receive safe and effective treatment. Care Homes for Older People Page 27 of 30 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 Records for the administration of medications must be maintained accurately. Accurate recording helps to protect people from errors. 31/01/2009 2 9 13 People must receive their medication as prescribed and as the doctor intended. Medicines must not be allowed to run out as this places people at risk from harm. 31/01/2009 3 38 13 Risk assessments must be reviewed and update to ensure that there are safe systems of work for staff to follow. Risk assessments must provide staff with sufficient information and instructions to help them manage situations safely. This is particularly important where people may demonstrate 01/02/2009 Care Homes for Older People Page 28 of 30 behaviour that can be challenging or people who have been identified at risk of falling. 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 7 It is good practice to include detailed nutritional assessments on admission to the home and to review periodically. This will help to identify nutritional concerns at an early stage and ensure that people using this service are supported appropriately with their nutritional needs. It is good practice to include detailed care plans for people who may need medications as and when required (PRN). This will help to ensure that staff know when and how to administer these medicines correctly and protect people using this service from harm. People using this service should be consulted about their leisure and social interests. A stimulating and interesting programme of activities should be developed at the home. This will help ensure that people using this service have access, if they choose, to a variety of social activities and experiences. Newly recruited staff should receive proper training to ensure that they are fully aware of what constitutes abuse and how they should deal with and report concerns, suspicions or allegations. You should ensure that the staff training and development plan is reviewed and updated as necessary. This should include the arrangements for new staff to receive suitable induction training. it is recommended that when staff training is undertaken, clear and detailed records are maintained; including the type of training, the names of attendees, dates of training and the duration. This will help the manager monitor staff training and development and help ensure that staff receive the specified amount of at least three training days per year. 2 7 3 12 4 18 5 30 6 30 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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