Inspection on 30/04/09 for Nightingale House

This inspection was carried out on 30th April 2009.

CQC 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nightingale House 02/04/08

Nightingale House 24/04/07

Nightingale House 26/05/06

Nightingale House 02/12/05

Nightingale House 08/02/05

Nightingale House 12/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nightingale House 69-71 Crowstone Road Westcliff On Sea Essex SS0 8BG     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: Carolyn Delaney     Date: 0 1 0 5 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: Nightingale House 69-71 Crowstone Road Westcliff On Sea Essex SS0 8BG 01702338552 01702331788 xassist@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Abi Oduyelu care home 30 Number of places (if applicable): Under 65 Over 65 30 30 dementia old age, not falling within any other category Additional conditions: 0 0 One named person known to the CSCI who is under 65 years of age. Personal care may be provided for up to 30 people over the age of 65. Personal care may be provided for up to 30 service users with dementia over the age of 65. The number of service users for whom personal care is to be provided should not exceed 30 (total number not to exceed 30). Date of last inspection Brief description of the care home Nightingale House is registered to care for both older people over the age of 65 and those over 65 who may have dementia. At the current time the home is primarily caring for people with dementia. The home is situated near Southend seafront. It is close to the shops and local bus routes. The home has a small car park to the front and a garden at the rear. The fees are £431.00 to £455.00. Additional charges would be made for hairdressing, chiropody etc. The home has information available for prospective residents. A copy of the latest inspection report is readily available in the Care Homes for Older People Page 4 of 30 Brief description of the care home reception area. 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: This was a routine unannounced inspection, which included a visit made to the home between the hours of 10.00 and 18.00 on 30th April 2009 and 10.00 to 13.30 on 1st May . The last inspection was carried out on 4th April 2008. As part of the inspection process we reviewed information we had received about the service over the last twelve months including notifications sent to us by the manager of any event in the home, which affects residents such as injuries, deaths and any outbreak of infectious diseases. We also looked at the information the manager provided us with in the homes Annual Quality Assurance Assessment. This document is a self-assessment, which the registered provider or owner is required by law to complete and tell us what they do well, how they evidence this and the improvements Care Homes for Older People Page 6 of 30 made within the previous twelve months. We also looked at the improvement plan that we asked the manager to send us following the last inspection. This plan described how the manager was to address the issues as identified at the last inspection. We sent surveys each to the home to distribute to residents and staff and to complete and tell us what they think about the home. At the time of writing this report we had received surveys from four residents living in the home. We did not receive any surveys from staff members. During the inspection we spoke with four residents relatives, one visiting health care professional and three members of staff. The views and comments expressed by these people were reflected in the report. When we visited the home we looked at residents care plans and information available to staff to help them support residents. We looked at how staff were recruited to work in the home and how they were trained to support residents. We looked at how the home was managed and how residents were involved in this. We also observed how staff interacted with residents when supporting them with activities such as meals and providing recreation and stimulation. As a number of residents living in the home had communication problems due to their dementia we used an observation tool to help us assess the outcomes and experiences for these people. This observation is called a Short Observation Framework for Inspection (SOFI). We observed five people in sessions of five minutes over a two hour period. We looked peoples state of being (whether they were displaying a positive, neutral or negative state). We observed any interaction or engagement between these residents and other people in the room including staff. We made observations on how staff carried out tasks and their engagement with residents. We also observed the impact this had on residents and whether this was positive or negative. A brief tour of the premises was carried out and communal areas including lounge and bathrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 8 of 30 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 who move into the home know that their assessed needs will be met. Evidence: The manager told us in the Annual Quality Assurance Assessment that information about the home was regularly updated and made available to residents. They told us that the most recent inspection reports were available to all visitors. She told us that before a person was admitted to the home that an assessment of their needs was carried out and that they would only be offered a place to someone once it was determined that the home would meet their needs. Four residents completed surveys and they told us that they had received enough information about the home before they moved in so that they could decide if it was the right place for them. They also told us that when they moved into the home they received a contract. Care Homes for Older People Page 11 of 30 Evidence: When we visited the home we looked at the information about the home, which was made available to people who were looking for a care home. The information was detailed and described the services provided at the home, staffing levels and a summary of staff skills and experience. There was a service users guide available which described routines in the home and the arrangements for meals, laundry etc. While this information was detailed it was not suitable for some of the residents living in the home as they would not be able to understand it due to their dementia. The manager told us that this information was generally given to relatives where residents. We looked at the way a persons needs were assessed before they moved into the home. We looked at the assessments for two people. We saw that the manager visited people either in their homes or hospital to complete the assessment. Where possible individuals or their families were involved in the assessment to help gain accurate information about the persons needs. Assessments we looked at covered activities of daily living such as eating and drinking, communication and mobility etc. There was also informaton recorded about specific risks to each person such as risks of injuries from falls, developing pressure sores etc. There was limited information recorded in some assessments about the level of support that people required and the manager told us that at times it is difficult to obtain this information when assessing people in hospital as it this not always available. We saw that when people move into the home a more detailed assessment of their needs was completed and from this care plans were developed. The manager ensured that before a person moved into the home that any appropriate equipment would be available such as pressure relieving mattresses so as to ensure that assessed risks would be minimised. We looked at the records that staff complete when a person moved into the home and we saw that people were introduced to staff and residents or allowed to settle into their new environment according to their wishes. 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. Residents are well cared for but risks to their health and safety are not always well managed. Evidence: The manager told us that residents needs are met as set out in their individual care plans and that residents relatives were informed of any changes. They told us that residents needs and how staff were to support them was clearly recorded in the care plan. She also told us that a lot of work had been done to ensure that staff handle medicines properly and wherever it was appropriate that residents could retain control of their medicines. When we last visited the home we found irregularities in the way that staff recorded and handled medicines. We asked the manager to tell us in an improvement plan how these issues were to be addressed. The manager told us in the plan that staff would receive training and that checks would be carried out to ensure that medicines were handled and recorded correctly. Four people living in the home completed surveys and Care Homes for Older People Page 13 of 30 Evidence: they told us that they receive the care and support they need. One person told us that they were very happy with the care and the home could not be better. Residents told us that they received the medical support they need. One person commented I get my medicines on time. When we visited the home we looked at the care plans for four people. Each persons plan had detailed information about their needs and what support staff were to provide. Care plans were updated regularly and they were generally amended where there had been changes to the persons needs. Care plans did not always include details of what residents could do either independently or with support. This would help staff to promote independence for as long as possible. We saw that staff monitored residents health and that they acted promptly if residents became unwell and ensured that they contacted the persons doctor when it was appropriate to do so. Relatives we spoke with told us that staff always kept them up to date with any changes to residents condition or treatment. We looked at how risks to residents health and safety were identified and what measures were in place to minimise these. Residents whose mobility was reduced were assessed for risks of developing pressure sores. Where risks were identified staff sought the advice of the local district nursing team and followed their instructions. During the inspection we spoke with a visiting district nurse. They told us that staff listen to advice. We looked at accident records and care plans and saw that a number of people were at risk of injures from falls. Two residents had suffered serious injuries including fractures as a result of falls within the previous twelve months. We looked at the arrangements in place for minimising risks to residents. Each person had a risk assessment. The manager told us that they sought the advice of the falls clinic. However when we looked at care plans and other documents there was no information regarding this or advice as to how risks might be minimised. During the inspection we saw one person spent the majority of time confined to bed. We saw that a chair had been placed against the bed. The manager told us that this was to prevent the person falling out of bed. They told us that bed rails were not appropriate as the resident would try to climb over them . There was no assessment as to the risks posed by the use of the chair in this way. We discussed the implications and dangers associated with this practice with the manager. We looked at the arrangements for handling medicines. We saw that staff had received training. We looked medication records and saw that staff signed these to evidence that they had administered medicines as prescribed. We carried out an audit of three medicines. This involved checking the number of tablets received, administered and Care Homes for Older People Page 14 of 30 Evidence: those available to see if they matched. Of the three we sampled we could only determine that one was correct. Staff showed us their procedure for checking medicines when they are received into the home. Staff record the number or quantity of medicines received and sign to indicate that they have checked these. However we saw that numbers recorded did not match with what was actually available and staff told us that they do not check medicines but rather record what is stated on medicine packets. This is poor practice and could result in insufficient medicines being available for residents. 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 living in the home do not always have access to a range of activities which reflect their choices or specific needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that there were was a planned daily and weekly range of activities, which suited the people who live in the home. They told us that a member of staff and some relatives were involved in planning and developing activities. When we last visited the home we found that there were limited opportunities for residents to participate in activities which reflected the things they liked to do and took into account the affects of dementia. We asked the owner to tell us in an improvement plan how they were going to put these things right. They told us that an activities coordinator was employed to plan and arrange a weekly programme of activities. Four residents completed surveys and they told us that there were usually activities arranged by the home that they could participate in. When we visited the home we discussed the arrangements for providing activities for Care Homes for Older People Page 16 of 30 Evidence: residents. The manager told us that there was no activities coordinator employed at the home but that someone had been interviewed for the post. During the inspection we looked at the activities planned for residents. There was a weekly plan which included some games, music and exercises. Some residents went out with staff but this was limited. Each person had a care plan and within these there was some information recorded about the things they like to do. It was recorded for two people that they enjoy watching television and for one person that they were used to spending time outdoors and the importance of supporting then to do so. We saw that this person went out some days with staff or the manager to buy their newspapers or sweets etc. We observed some of the more able residents participating in a quiz with staff, which they appeared to enjoy. As part of the inspection we carried out an observation called a Short Observation for Inspection. We observed five residents who had dementia over a period of two hours. During this time we observed each persons state of being, whether this was positive, withdrawn or whether the person was asleep. We observed any interaction between residents and other people in the room. We observed how staff interacted and engaged with residents and the impact this had, if any on the person. We saw that while staff were generally attentive that they did not spend enough time with some residents when supporting them (for example when assisting people with taking refreshments). Staff asked residents questions and did not wait for a response and on some occasions walked away before the person had the opportunity to answer. Staff did not engage in eye contact with residents when speaking to them. Some staff carried out tasks such as feeding residents drinks from their cups without any discussion or engagement with residents. One one occasion staff continued to carry out tasks when the resident had said and indicated that they did not wish for this. Some staff were observed to focus on the residents who were able to communicate more easily and to spend less time supporting those who needed more time and support to communicate their needs. We discussed the findings of our observation with the manager and she agreed that more work was needed in enabling staff to support people who had dementia better. We saw that residents had a choice of meals from a daily menu and the manager showed us that following on from comments made at the last inspection that value foods had been replaced with better quality ones. We saw that residents were supported at mealtimes. Those more abvle residents took their meals in the conservatory dining room, where they sat in groups and enjoyed each others company and conversation. People who needed more assistance were supported by staff. Residents we spoke with said that they enjoyed the meals provided. One person who completed a survey told us The meals are a lovely choice, they are always hot and Care Homes for Older People Page 17 of 30 Evidence: well cooked. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are protected from harm and complaints are investigated appropriately. Evidence: The manager told us in the Annual Quality Assurance Assessment that the complaints policy and procedure was displayed in the home where residents and visitors can access it. We observed this when we visited the home. Four residents completed surveys and they told us that they knew who to speak with if they were unhappy and how to make a complaint. The manager told us that two complaints had been received within the previous twelve months. Both had been investigated and responded to and neither had been upheld. When we visited the home we looked at the complaints procedure and details of the complaints which had been investigated. We saw that the manager had investigated these fully and responded to complainants in line with the procedure. Relatives we spoke with during the inspection told us that the manager was very approachable and that should they have any concerns they felt confident that they would be dealt with promptly and to their satisfaction. We had not received any complaints about the home. When we visited we looked at the homes safeguarding policy. This described how staff Care Homes for Older People Page 19 of 30 Evidence: were to respond if they witnessed or suspected any ill treatment of people living in the home. There was also a whistle blowing policy. This helped to assure staff that they would not be subject to harassment should they need to report any concerns. In addition all staff had received training to help them recognise signs of abuse and to reinforce their responsibilities in reporting anything untoward. We spoke to staff and the manager and they could demonstrate that they understood the policy and were aware of the local safeguarding teams policy and how to report any allegations or incidents. Residents, their families and visitors to the home indicated that residents were well treated and that staff listened to them and acted on what they said. During the visit we observed staff to treat residents with respect when supporting them. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a home which is comfortable and generally well maintained. Evidence: The manager told us in the Annual Quality Assurance Assessment that there had been some significant improvements made to the home since the last inspection including improved lighting, redecoration and improved measures to make the home secure. Four residents who completed surveys told us that the home was always fresh and clean and relatives we spoke with also confirmed that they found the home to be clean and free from unpleasant odours. When we visited the home we looked at the improvements made to the environment since the last inspection. Communal areas such as the lounge had been redecorated and new carpets and curtains had been purchased. The home looked brighter and generally cleaner. The carpets in some areas of the home including residents bedrooms were in need of cleaning. The manager said that there was no cleaner employed in the home at this time but that they were looking to employ someone as a cleaner. Some of the residents bedroom furniture was old and handles were missing from some wardrobes and bedroom furniture. Some paintwork in the home was chipped. This detracted somewhat from the overall ambiance of the home. The manager said that there were plans to provide new furniture and to redecorate all areas of the home as Care Homes for Older People Page 21 of 30 Evidence: part of an ongoing programme of refurbishment. Other areas of the home were not clean including one bathroom where there was faeces on a toilet seat. We observed that there was no hand washing soap and hand towels in one bathroom / toilet. The manager said that this room was not used often but confirmed that it was used. She was advised that soap and hand towels should be provided so as to promote good hand washing practices and minimise the spread of infection. 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 who have dementia are not always supported by staff who understand their specific needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that there was a good staff skill mix and a robust recruitment policy, which was adhered to. They told us that staff were encouraged and trained in all aspects of care work and attended relevant courses. When we last visited the home we found that staffing levels were insufficient for supporting residents at mealtimes and that staff were not always recruited robustly. We asked the manager to tell us in an improvement plan how they were going to address these issues. When we carried out this inspection we looked at whether the issues had been dealt with. We looked at how staff were recruited, trained and the numbers employed to support residents. We looked at the recruitment files for two people who had been employed since the last inspection. We saw that both persons had completed application forms with details of their previous employment, their skills and experience. The manager had obtained satisfactory references for both people from their previous employers Care Homes for Older People Page 23 of 30 Evidence: and had carried out checks including Criminal Records Bureau disclosures. These checks helped to ensure that only people who are suited to work with older and vulnerable people are employed in the home. Once a person started work in the home they completed a three day induction, which included a period of time shadowing more experienced members of staff. This helped to ensure that staff got to know residents and the homes policies and procedures. The induction was not in line with the Skills for Care Common Induction Standards. These are nationally recognised standards, which help to ensure that staff carry out care in a consistent and effective way. Residents we spoke with told us that staff were available when they needed them. We observed how people were supported and assisted during the lunchtime meal. We saw that residents received the level of support they needed. The home employed four staff during the day and three waking staff at night. The manager offers hands on support where this is needed. We looked at staff duty rotas and saw that staff were employed in numbers as advised by the manager. Staff had at least one day off per week and did not work too many hours without a break. This helped to ensure that staff were fit to carry out their duties. On occasions the manager used a local temporary agency to cover unexpected staff absences. Where agency staff were used the manager had information about the persons experience and training and the checks carried out such as references and Criminal Records Bureau disclosures. This helped to ensure that the use of agency staff did not put residents at risk. We looked at the arrangements for training and supporting staff. We spoke with two members of staff and they told us that they received training to help them look after residents. One person told us We have a lot of training here. Staff told us they had received training in moving and handling people, safeguarding and caring for people with dementia and managing medicines. However during the inspection we saw that staff did not always support people in a way which showed that they understood the affects of dementia on a persons communication, interaction or the time it can take the person to respond to verbal prompts and questions. We also saw that staff did not fully manage medicines in line with the homes policies and procedures or training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the interests of the people who live there. Evidence: The manager told us in the Annual Quality Assurance Assessment that they are well qualified with a number of years experience in care home management and that they have a team of dedicated staff including newly appointed team leaders to help ensure that residents are cared for properly. People who completed surveys told us that they were happy with the way that the home was managed and that they had confidence in the manager. One relative told us The manager is very good. When we last visited the home we found areas that required improvement and we asked the manager to tell us in an improvement plan how these issues were to be addressed. The manager had provided this plan and when we during the inspection we saw that some improvements had been made, including better staff support for residents at mealtimes and improvements in the way that staff Care Homes for Older People Page 25 of 30 Evidence: were recruited to work in the home. There were areas where improvement was still needed, such as the provision of training and support to help staff fully understand the needs of people who have dementia, better opportunities for activities and stimulation. We looked at how the home was maintained and saw certificates and other documents which showed us that the equipment such as hoists, lifts, heating and hot water systems were regularly checked and serviced. There was a risk assessment in place to identify secific risks around fire safety and there was fire detection and fighting equipment in place. This was regularly checked to ensure that it was in good working order. We looked at how the views of people who live in the home, their friends and people who involved in their care were obtained and acted upon. The manager showed us the questionnaire that was sent to relatives and given to residents to complete to make comment and suggestions about how the home was managed. The questionnaire asked people what things were important to them such as environment, staff and food etc. People were then asked how they felt the home. We looked at an analysis of the most recent survey which had been completed earlier in the year. The results were positive an people indicated that they were happy with the home and how it was managed. The questionnaire used to obtain the views of residents was not in a format which would make it easy for residents to understand and so reflect their views. 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 13(2) Procedures for checking all 30/06/2008 medicines received, administered and disposed of must be reviewed so as to ensure that residents receive medicines which have been prescribed for them and to minimise the risk or errors and mishanding 31/07/2008 2 12 16 (m and n). A meaningful programme of activities for residents must be provided in the home both on an individual and group basis, to ensure that residents? needs are met. This is requirement is outstanding from the last inspection. 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 8 13 Where risks are identified to a persons health or safety, measures must be put in place to minimise these. This will help to minimise injury to residents. 30/06/2009 2 9 13 Staff must handle and 30/06/2009 maintain accurate records in respect of medicines in the home, in accordance with homes policies and current regulatory requirements. This is to ensure that medicines are handled appropriately and the risks of misuse or error are minimised. 3 12 16 Activities must be provided 28/08/2009 which take into account the specific needs of people who have dementia and staff must be trained to be able to support these residents. This will help to improve the experiences of people living Care Homes for Older People Page 28 of 30 in the home and enable them to enjoy activities and keep them stimulated. 4 26 23 The home must be kept clean and facilities must be available to promote good hand washing practices. This will help to minimise the risk of the spread of infection. 31/07/2009 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 2 1 7 Information about the home could be provided in a more user friendly format to aid understanding. Care plans should reflect the things that residents can do to help promote and maintain their independence wherever this is possible. The quality monitoring process should be developed so that the questions ask residents about the things that are important to them and are put in a more user friendly way. 3 33 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). 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!