Inspection on 10/12/09 for Murley House Nursing Home

This inspection was carried out on 10th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Murley House Nursing Home 24/02/10

Murley House Nursing Home 07/04/09

Murley House Nursing Home 28/04/08

Murley House Nursing Home 05/12/07

Murley House Nursing Home 03/08/07

Murley House Nursing Home 26/04/07

Murley House Nursing Home 10/01/07

Murley House Nursing Home 09/05/06

Murley House Nursing Home 12/01/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Murley House Nursing Home Wyvern Road Taunton Somerset TA1 4RA     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Poole     Date: 1 0 1 2 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 30 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 30 Information about the care home Name of care home: Address: Murley House Nursing Home Wyvern Road Taunton Somerset TA1 4RA 01823337674 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: murley.house@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited care home 105 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: A Nurse (RMN) on sub-part 1, RN3 or RNHM, of the current NMC register must be on duty at all times when nursing beds occupied exceed 34. Up to 45 places for Service Users requiring personal care only in the categories OP and DE(E) to be accommodated on Rose Wing. Up to 60 places for Service Users requiring nursing care in the categories DE(E) and MD(E) to be accommodated on Redwood Wing. Date of last inspection Brief description of the care home Murley House Care Home is purpose built and is situated in a residential development on the outskirts of Taunton. The registered provider is Ashbourne (Eton) Ltd a subsidiary of Southern Cross Ltd. The home is registered with the Care Quality Commission (CQC) to provide a service for up to 105 people with dementia to include Care Homes for Older People Page 4 of 30 Over 65 105 105 105 0 0 0 0 8 0 4 2 0 0 9 Brief description of the care home personal and nursing care. Murley House consists of four areas, Upper and Lower Redwood provides nursing care for older people with dementia care needs. Corner House provides nursing care for up to 22 people who have more complex needs associated with their dementia. Rose provides personal care only for older people, including those who have dementia care needs. There is ample car parking to the front of the home and secure garden areas. The main entrance is kept locked at all times for security of the home and the people. There is a bell on the front door for visitors to make staff aware they are there. 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for people and measures the quality of the service under four general headings. These are:- excellent, good, adequate and poor. This inspection was carried out by two inspectors over a one day period. During this time We, The Commission, were able to speak with people living and working at the home, tour the building, view records and observe care practices. We were given unrestricted access to all areas of the home and all records requested were made available. Care Homes for Older People Page 6 of 30 There is currently no registered manager but a project manager is currently based at the home, who was available throughout the day. Many of the people who live at the home are unable to fully express their opinions, therefore much of this inspection was spent observing care practices and interactions. At the time of this inspection there were 64 people living at the home. 44 people were receiving nursing care and 20 were receiving personal care only. Fees at the home currently (17/12/09) Range from 550 to 850 pounds per week. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: There has been no registered manager at the home for some time and a lack of consistent management for the past few years. There are no clear lines of accountability or responsibility leading to a lack of leadership and direction within the home. Care plans viewed at this inspection appeared up to date but there was evidence that staff are not always following the care plans for individuals. For example the care plans for two people said that to minimise pressure damage the people should be assisted to change position two hourly, but this was not being done. Dietary intake was being recorded for some people but where this was poor there was no care plan to address the issue in place and no evidence that referrals had been made to professionals outside the home. Intake charts recorded when meals were refused but there was no evidence that alternatives or additional snacks had been offered. Observations within the areas that provide nursing care showed a lack of social interaction between the staff and people living at the home. Although care plans contain life history stories completed by family members, staff were observed to be very task focused and not person centred. In many instances tasks were performed without explanation or reassurance to the person. This appeared disrespectful and did not promote peoples dignity. Although the home provides care to people who have a dementia staff seen did not have the appropriate skills, experience or understanding to provide a good quality Care Homes for Older People Page 8 of 30 service to people with these specialist needs. The training matrix demonstrated that 38 of the care staff team had not received even basic training in dementia awareness. Some staff were observed hoisting a person from a wheelchair to a lounge chair. They were not confident in using the equipment and no reassurance was given to the person, resulting in very undignified care in a communal area. Again the training matrix shows that some staff have not received up to date training in moving and handling. Although the quality of food in the home appeared good, meal times were not seen to be a pleasant or social occasion. Menus are not displayed in each area of the home and it was observed that although there was two main meals the majority of people were not offered a choice. The company has its own quality assurance systems in place which include visits to the home by the registered provider and monthly internal audits. It is concerning that these systems have not highlighted and addressed issues of concern raised at this inspection. 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 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments are carried out with people wishing to move to the home, but no information about their first few days is recorded to ensure that any care plan is reflective of their current abilities and preferred routines. Intermediate care is not provided. Evidence: We looked at the information relating to a person who had moved into the home three days before the inspection. A basic pre admission assessment had been completed which gave some information about the persons likes as well as their needs.The assessment stated that the person had short term memory difficulties but it did not state how this affected the person or the support that they required. No care plan had been put in place and daily records were minimal, they gave no indication of how the person had settled into the home or the assistance that had been offered. There was no indication of the persons mood since moving in and no information about how they Care Homes for Older People Page 11 of 30 Evidence: were managing to orientate themselves around the home. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans give guidance about how peoples needs should be met but this is not always followed by staff working at the home. There are safe procedures and practices in place for the administration of medication. The lack of interaction and explanation when staff carry out tasks is disrespectful to people living at the home. Evidence: Everyone living at the home has a care plan that is personal to them. As part of this inspection we looked at 5 care plans. These were for people receiving nursing care and those receiving personal care only. Care plans contained assessments of need and details of how needs would be met. Life histories had been completed for people but care plans were not fully reflective of these and gave limited information about peoples likes, dislikes or preferred routines. Three care plans seen were for people who had very limited mobility or were being cared for in bed. Care plans in respect of skin care and the prevention of pressure damage all stated that the person should be Care Homes for Older People Page 13 of 30 Evidence: assisted to change position every two hours and that this should be recorded. In two of the three cases there were no records in place and the nurse in charge said that they did not assist people to change position on a regular basis as this was not required due to the pressure relieving equipment in place. In the third instances the person was being assisted to change position and full records of this were maintained. For people receiving nursing care, and others assessed as high risk, records are kept of food and fluid intake. For two people these records showed a minimal intake but no care plan had been created to address this. Food intake charts stated when people had refused meals but there was no evidence that alternatives or additional snacks had been offered. There was no evidence that people who had a very poor dietary intake had been referred to an appropriate professional outside the home. For one person who had skin damage a care plan had been put in place outlining the treatment that was required every three days. The records of the treatment given did not reflect a consistent approach and gave no evidence that the wound was being attended to on a three daily basis. The care plan did not give details of the size and status of the wound therefore it was difficult to monitor the healing process. One person had a care plan in respect of diabetes. This was clear and personal to the individual giving details of signs and symptoms that staff should be alert to and the action to take if the person became unwell. We observed one person being hoisted from a wheelchair to a lounge chair. Staff did not appear confident in the procedure and there was no interaction with the person being hoisted. It was noted that the hoist and sling were those identified in the care plan as being needed to meet the persons needs. At no point did the carers explain to the person what they were doing and no reassurance was offered, although the persons care plan clearly stated Explain clearly to X what you are going to do. One person had a care plan in respect of challenging behaviour. It was stated that all behaviour identified in the care plan should be recorded for a two week period. After the two week period there was no details of the findings and no action plan had been put in place. There was no evidence that privacy was not respected by people working at the home, but the lack of interaction when preforming tasks for people, in some areas of the home, showed a lack of respect for people. It was observed that large quantities of incontinence pads were stored in peoples bedrooms. These were not put away and in clear view to the person and any visitors which does not promote personal dignity. Care Homes for Older People Page 14 of 30 Evidence: The home employs both male and female staff but no care plans seen showed if people were able to make a choice about the gender of the person who assisted them with intimate personal care. The home is registered to care for people who require care due to a dementia. Although some staff said that they had received training in the care of people who have a dementia, some care practices observed did not give evidence that staff had the skills, experience or understanding to provide a good quality service to people with these specialist needs. The home uses a monitored dosage system for medication and there is appropriate storage for drugs, including controlled drugs and medication that requires refrigeration. Medication is administered by qualified nurses or senior care staff. The project manager stated that all carers who administer medication have received training in this area, but there is no record of this on the training matrix. One carer said that they had received training from another senior carer. All medication is signed for when received into the home and when administered or refused, this gives a clear audit trail. Since the last inspection the home have put protocols in place for when medication prescribed on an as required basis should be given. One error in medication recording was noted during the inspection and this was information was passed to the project manager currently in charge of the home. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are unable to occupy themselves or initiate activities receive extremely limited social stimulation. There is a variety of well cooked food in the home but meals times are not regarded as pleasant social occassions. Evidence: The home employs two activity workers to assist people to occupy their time and receive social stimulation. There are photographs in the entrance hall of activities that people have taken part in and trips out. Regular activities in the home are listed as aromatherapy, a visiting hairdresser, a card and sweet trolley, visits from the local vicar and weekly visits from canine concern. At the time on the inspection some people took part in cake baking and singing. Both these activities took place in the part of the home that does not provide nursing care. In one part of the home which provides nursing care an activity worker dressed a Christmas tree but people living there were not actively involved. As many of the people living at the home are unable to fully express their views or Care Homes for Older People Page 16 of 30 Evidence: initiate occupation we spent a large portion of the inspection observing care practices. In one lounge the television was on although no one was watching it. For over an hour the only time staff entered the lounge was to perform a task and there was extremely limited interaction with people living at the home. There was no social interaction and nothing in the room to provide stimulation. One person repeatedly put themselves on the floor and began to crawl across the room. Staff responded by placing the person back in a chair and at no point did anyone attempt to engage with the person or offer them any form of occupation. In another part of the home people were seen walking up and down corridors without staff interaction. In all lounges in the home many people were asleep in chairs. Although the home is registered to provide specialist care for people who have a dementia, the home is fairly bare and there are limited objects around for people pick up or interact with. Some people have a newspaper delivered. People are able to have visitors at anytime. The home has a four week menu that is displayed in the entrance hall which is not accessible to the majority of people who live at the home. The menu is small and difficult to read. The menu of the day is not displayed in each part of the home. The menu provides a wide variety of food with a choice at each meal. The food seen appeared well cooked and nutritious. Lunch was observed in two areas of the home. In neither area did meal time appear a social occassion. The majority of people ate in the chairs that they had sat in all morning but some people were assisted to a dining table. In one area the table was not laid and people only received cutlery once there meal was given to them. Only people who were able to understand and respond to verbal communication were offered a choice of main meal but there was no choice of vegetables or condiments. Aprons were put onto some people but in only a few instances did the staff member explain what they were doing or why. Many people living at the home require physical assistance to eat their meals. In one area this assistance was given in a dignified manner, with staff sitting with the person requiring help and chatting. In another area of the home staff stood by the person and assistance was given without social interaction. Care Homes for Older People Page 17 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. Complaints received are dealt with using the homes complaints policy. Appropriate policies are in place to minimise the risk of abuse to people living at the home but some staff have not yet received training in this area. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. Since the last key inspection the home has received four complaints. There was evidence that these had been investigated and responded to within the agreed timescales. Records provided show that the majority of staff have received training in recognising abuse and the protection of vulnerable adults. There is information on the main notice board about reporting abuse. The home does not act as a power of attorney or financial appointee for anyone who lives at the home. There is a facility for people to deposit small amounts of money for safekeeping. Records were seen of monies deposited, these were clear and receipts had been retained. The administrator gave assurances that personal finances were audited by people outside the home. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Murley House provides safe accommodation but is not homely in appearance. The lack of signage and points of reference does not make it an enabling environment for the people who live there. Evidence: Murley House is able to accommodate up to 105 people in single rooms. All areas are fitted with a fire detection and call bell system. The home is located in a residential area away from shops or other community facilities. The home is divided into 4 areas, Rose, Upper and Lower Redwood and the Corner House. All areas except Rose provide nursing care and are locked by an electronic keypad. All areas have their own communal facilities including lounges and bathrooms. Communal lounges are furnished with comfortable furniture but some are sparse and do not provide a homely environment. Some areas require decoration to ensure that they provide a high standard of accommodation and the project manager stated that there are plans to refurbish the the Corner House. Care Homes for Older People Page 19 of 30 Evidence: We toured the building and noted that there was limited signage to assist people to orientate themselves around the building or maintain independence. Some bedroom doors have names written on but others do not. Bedrooms do not have any pictorial information to assist people to identify their personal room. There are very few points of interest or reference around the home and many areas appear sparse. There is a commercial type laundry which is appropriate for the needs of the people who live at the home. The main communal areas were clean and tidy but some malodours were noted in personal rooms. Care Homes for Older People Page 20 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. Some staff do not have the appropriate skills, experience or understanding to provide a specialist service to the people who live at the home. Staff are task focused and not person centred in their work. There is a robust recruitment procedure in place. Evidence: The home supplied a copy of the staff training matrix. This shows that the home employs 11 registered nurses and 37 carers. 16 carers (43 ) have a National Vocational Qualification (NVQ) in care at level 2 or above. The training matrix shows that the majority of staff undertake regular training in health and safety issues and some staff undertake training in subjects relevant to the care of the people who live at the home. As previously mentioned the home is registered to provide a service to people who require care because of a dementia. Some staff asked said that they had received some training in dementia care, one said they May have done but dont remember and another responded by asking What is dementia? The training matrix shows that 14 care staff have received no training in this area. Observation of care practice demonstrated that some staff had limited skills, experience or understanding of working with people with a dementia. Care Homes for Older People Page 21 of 30 Evidence: Throughout the home staff appeared task focused and did not work in a person centred manner, which lead to some physical interventions being disrespectful and undignified. At the time of the inspection there were 64 people living at the home, there were 3 registered nurses on duty and 10 carers. There was also 2 activity workers and a team of ancillary staff. Duty rotas were not available at the time of the inspection but the project manager agreed to forward these to the Commission after the inspection. 4 recruitment files, for staff recently employed, were viewed. These demonstrated a robust recruitment procedure which included seeking references and carrying out appropriate checks. Some staff are employed by the company and not by a specific home within the company. Files seen did not show that people had experience in working with people who had a dementia and there was no evidence that they had received any training when they arrived at the home. Care Homes for Older People Page 22 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no clear management structure resulting in a lack of leadership and direction for the home. Quality Assurance monitoring is not robust and does not effectively address areas that require improvement. Equipment is well maintained but some staff are not confident in its use resulting in poor moving and handling practices. Evidence: There is no registered manager at the home and management arrangements over the past few years have been inconsistent. This has led to a lack of leadership and direction for the home. There is no clear management structure. A project manager, from the company that owns Murley House, has been based in the home since May 2009 and there is a clinical lead for the home. The clinical lead works Care Homes for Older People Page 23 of 30 Evidence: as a registered nurse and does not have supernumerary time to monitor or evaluate practices throughout the home. The area that does not provide nursing care has a team leader but other areas do not. The company has its own quality assurance systems to monitor the quality of care. Monthly visits to the home in line with regulation 26 and numerous monthly audits, based on the National Minimum Standards, are undertaken. It is however concerning that audits and visits have not highlighted the shortfalls in the service identified at this inspection. The home has recently held meetings for people living at the home and their representatives, and for staff. It is planned that staff meetings will take place every two months. The project manager is looking at developing a system of satisfaction questionnaires that can be sent out to gauge the views of people using the service and other interested parties. As previously stated the home does not act as a power of attorney or financial appointee for anyone at the home. It holds small amounts of money for safekeeping and clear records are kept of all transactions. To ensure the health and safety of people living and working at the home, regular safety checks are carried out. Fire alarms, emergency lighting, water temperatures and equipment are all checked and clear records are kept of these. The home has adequate lifting equipment but the training matrix shows that not all staff have received training in moving and handling practices. We observed three carers hoisting a person, no one appeared confident with the procedure or the equipment, resulting in a person receiving very undignified care in a communal area. The home records all accidents and the project manager sees all reports to enable them to establish any patterns and take action to address. Care Homes for Older People Page 24 of 30 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 25 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 7 12 (1) The registered person 31/12/2009 must ensure that staff follow the guidance in the care plan. This includes guidance relating to physical and mental healthcare needs. To ensure that people receive appropriate care and the effectiveness of care plans can be evaluated. 2 8 12 (1) [a] The registered 31/12/2009 person must ensure that peoples nutritional needs are addressed and advice sought from appropriate professionals. To ensure that people have an adequate diet. 3 8 18 (1) [a] The registered person must ensure that staff working in the home have the skills and experience to provide a specialist service. 31/01/2010 Care Homes for Older People Page 26 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that care and support given meets the specialist needs of people living at the home. 4 10 12 (4)[a]The registered person must ensure that people are treated with respect at all times. To make sure that peoples dignity is promoted. 5 12 16 (m)(n) The registered person must ensure that there is a programme of activities which is able to include people with all interests and abilities. To ensure that everyone receives social stimulation and is able to take an active part in daily life. 6 19 23 (2) [a] The registered provider must ensure that there is adequate signage and points of reference around the home. To enable people to move easily around the home and maintain independence. 7 31 10 (1) The registered person must ensure that there is a clear management structure. 15/02/2010 31/03/2010 31/12/2009 31/12/2009 Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To give clear leadership and direction to the home and ensure that care and support is of a high standard and appropriate to the needs of people living there. 8 33 24 (1) Quality Assurance systems must be more robust. To ensure that shortfalls in the service are identified and action is taken to address them. 9 38 13 (5) The registered person must ensure that all staff are competent in moving and handling practices. To ensure the safety and dignity of people who live at the home and the safety of staff. 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 31/01/2010 31/12/2009 1 2 9 15 The registered person should ensure that medication is only administered by staff who have received specific training. Easy to read menus should be displayed in each area of the home and everyone should be offered a choice of food. Support with meals should be given in a way that respects peoples dignity. The home should ensure that all staff receive training in the Page 28 of 30 3 18 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations protection of vulnerable adults and that this training is clearly understood. 4 26 The registered person should monitor and address malodours within the home. Care Homes for Older People Page 29 of 30 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. 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