Inspection on 30/01/09 for No. 1 Northbourne

This inspection was carried out on 30th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

No. 1 Northbourne 31/08/07

No. 1 Northbourne 05/07/06

No. 1 Northbourne 20/09/05

No. 1 Northbourne 02/12/04

No. 1 Northbourne 21/07/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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: No. 1 Northbourne Durham Road Low Fell Gateshead Tyne & Wear NE9 5AR     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: Elizabeth Gaffney     Date: 0 1 0 2 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 31 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 31 Information about the care home Name of care home: Address: No. 1 Northbourne Durham Road Low Fell Gateshead Tyne & Wear NE9 5AR 01914914643 F/P01914914643 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) : Community Integrated Care care home 5 Number of places (if applicable): Under 65 Over 65 0 3 1 learning disability physical disability sensory impairment Additional conditions: 5 0 0 The maximum number of service users who can be accommodated is 5 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 need on admission to the home are within the following categories: Learning Disability, Code LD, maximum number of places 5 Physical Disability, Code PD, maximum number of places 3 Sensory Impairrment, over 65, Code SI(E), maximum number of places 1 Date of last inspection Brief description of the care home No 1 Northbourne provides personal care for up to five people with a learning disability. Nursing care is not provided. The home is situated in the Low Fell area of Gateshead and is close to local shops, main bus routes and other community facilities. The home is a purpose built bungalow attached to a care home for older people. No 1 Northbourne is managed by Community Integrated Care although Anchor Trust owns the premises. People using the service are able to access all parts of the bungalow. Care Homes for Older People Page 4 of 31 Brief description of the care home Single bedroom accommodation is provided and there is a range of communal space. Service users have use of a large lounge and dining area, a kitchen and a separate smaller lounge. A range of aids and adaptations are provided such as specialist bathing facilities and hoisting equipment. The scale of charges for the home is between 411.00 and 599.00 pounds per week. Copies of Commission reports are available on request from the office. Care Homes for Older People Page 5 of 31 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: How the inspection was carried out: Before the visit: The quality rating for this service is 1 stars. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. Care Homes for Older People Page 6 of 31 In future, if a requirement is repeated, it is likely that enforcement action will be taken. We looked at:- information we have received since the last key inspection visit on the 26 February 2007; how the service dealt with any complaints and concerns since the last visit; any changes to how the home is run; the managers view of how well they care for people; the views of people who use the service and their relatives, staff and other professionals. The Visit: An unannounced visit was made on the 30 Janruary 2009. During the visit we:- talked with people who use the service, some of the staff and the manager; looked at information about the people who use the service and how well their needs are met; looked at other records which must be kept; checked that staff had the knowledge, skills and training to meet the needs of the people they care for; looked around the building to make sure it was clean, safe and comfortable; checked what improvements had been made since the last visit. We told the manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: Ensure that medication is kept secure at all times. This will help to ensure that people are protected from harm. This will help to ensure that people benefit from receiving appropriate nutrition that helps to keep them healthy. Ensure that all staff receive safeguarding training. This training helps to make sure staff take appropriate action to protect people from abuse. Ensure that the homes furnishings and fittings are kept in a safe and reasonable condition at all times. Repair or replace the homes dining chairs and the broken bedroom furniture. Repair the automatic closure device on the door leading into laundry. This will help to ensure that people are able to benefit from living in a safe and well-maintained home. Ensure that personnel records contain identification photographs and that staff provide Care Homes for Older People Page 8 of 31 full employment histories. This will help to ensure that only suitable staff are employed at the home. Ensure that sufficient permanent staff are employed to cover the homes rota. This will help to ensure consistency of care for people using the service. Ensure that staff receive supervision at the frequency referred to in the National Minimum Standards. This will mean that people using the service are able to benefit from being cared for by staff that receive appropriate support and supervision. Ensure that the home completes and submits an AQAA when requested to do so by the Commission. This will help the Commission to form a picture of how well the service is operating and what action the provider intends to take to improve the service. 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for making sure that peoples needs are assessed before they receive a service are good. This means that people using the service can feel confident that staff will know about their needs and how to meet them. Evidence: Peoples needs are assessed by experienced social services professionals before they move into the home. Access to this information helps the home to reach a decision as to whether it will be able to offer a suitable placement that will meet a persons needs. The homes practice in this area has previously been assessed as good and as there have been no further admissions into the service since the last inspection, the quality rating remains unchanged. Care Homes for Older People Page 11 of 31 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. The arrangements for meeting peoples health and personal care needs are not fully satisfactory. Because of this, people using the service are not always able to benefit from living in a home where staff are clear about how to meet their healthcare needs. Evidence: Staff have devised a range of care plans for each person living at the home. Peoples care plans cover such areas as support needed with morning and night time routines, bathing and maintaining independence. However, peoples care plans do not always cover each of the areas referred to in the National Minimum Standards. For example, care plans covering the support that people need with managing their money and medication have not been devised. Also, for one person using the service, care plans have not been devised to meet identified areas of need as identified at their social services review. In some care plans, peoples needs are not clearly defined and some do not contain desired outcomes. Comprehensive care plans will help staff to meet peoples assessed needs and provide them with good quality care. Peoples care plans Care Homes for Older People Page 12 of 31 Evidence: are generally being reviewed every three months. Although peoples care plans include helpful pictorial aids, they are not always available in formats that can be more easily understood by the people using the service. Easy to read care plans will help people to better understand how staff intend to meet their needs. The home operates a key worker system which enables staff to develop good working relationships with people using the service and their families. One person said that they knew which member of staff acted as their key worker. They also said that they are satisfied with the support they receive from the home and their key worker. Where appropriate, the home obtains copies of any relevant risk assessments carried out by other professionals. For example, a copy of a specialist healthcare assessment carried out by a speech and language professional has been obtained and placed in one persons care records for staff to refer to. The home also completes its own inhouse assessments covering the risks associated with people falling and developing pressure sores. However, there are a number of concerns. One persons pressure sores risk assessment has not been updated since June 2006. The persons moving and handling risk assessment has not been reviewed in line with the guidance referred to in the assessment. Also, moving and handling, falls and pressure sores risk assessments have not been completed for each person. Failure to carry out appropriate risk assessments could lead to staff not being clear about the actions that need to be taken to keep people healthy and comfortable. Some risk assessments have not been dated or signed. None of the care records looked at contain a copy of the persons Health Action Plan (HAP.) Obtaining a copy of each persons HAP will provide staff with a historical overview of their healthcare needs and what action needs to be taken to meet identified healthcare needs. During the inspection, staff were observed supporting one person to take bed rest. An examination of this persons care notes showed that they receive regular bed rest on a daily basis. For example, on one day, staff supported this person to take bed rest between 1:30pm and 6:00pm. However, the records looked at did not show who had made the decision to provide this level of bed rest. Also, the persons care records do not contain a care plan to tell staff how they should meet the persons needs in this area. People are registered with a local GP practice and receive medical intervention when they require it. Arrangements are in place to ensure that people receive regular chiropody care. However, it was not clear from their care notes when each person last received a sight or dental health check. Regular weight checks are not being carried Care Homes for Older People Page 13 of 31 Evidence: out for some people. The majority of medication is kept in a locked cabinet. However, medication requiring cold storage had been placed on a shelf in the fridge. Access to the fridge is not restricted. Staff administer medication in a safe and professional manner. Records are kept showing how medicines are handled within the home. All staff administering medication have received accredited training. Staffs competency to administer medication is assessed on a regular basis. However, there are some concerns. One persons Medication Administration Record (MAR) did not include an identification photograph and the handwritten MAR did not specify the routes of administration or the start date. The person had been prescribed for Paracetamol. However, staff had not recorded the maximum amount of tablets that could be taken over a 24 hour period. Also, staff had not recorded the amount of each item of medication that had been received into the home. Hand wash facilities are not available in the medication room. Care Homes for Older People Page 14 of 31 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. Arangements for meeting peoples social care needs are not fully satisfactory. This could mean that people are not able to benefit from living in a home which meets their need for social support and preferred choices and decisions about how they wish to live their lives. Evidence: Care records show that the home obtains information about peoples social lives and personal histories before they move into the home. A social profile, including pictorial aids, has been completed for some people. In two of the three care records checked, care plans telling staff how to support people to access the community have been devised. People living at No 1 Northbourne are supported to access and use local community facilities. During the inspection, one person was supported to visit the Metro Centre and go to the cinema. Every day, staff complete a record of the activities each person participates in. On some days, staff have recorded limited information about the activities that people have been supported to engage in. For example, on the day of the inspection, staff had recorded in one persons activity planner that they had engaged in the following Care Homes for Older People Page 15 of 31 Evidence: activities: morning/very alert; afternoon - inspectors visit. For another person, over a two day period, staff had recorded: Wednesday - scrap book; Thursday - watched TV and read the newspaper. For a third person, over three days staff recorded: Friday, Saturday and Sunday - rested on bed. However, one person said that staff are always friendly and willing to talk with them. This person said you are free to do the things you like. During the inspection, there was evidence that staff respected this persons right to have quiet time in their own bedroom. Staff demonstrated understanding and patience with people using the service and were attentive at all times. Staff personnel files do not contain evidence that they have completed training in how to help service users engage in appropriate activities. People are supported to develop and maintain important personal and family relationships. No restrictions have been placed on visitors attending the home. People are able to see their visitors in the lounge areas or in the privacy of their bedroom. A person living at the home said that staff respect their privacy and treat them well. They also said that staff listen to them and take time to talk with them. Staff knock on bedroom and bathroom doors and help with personal care and individual support is provided in private. Information about peoples dietary needs and the assistance they require with eating and drinking is obtained before they move into the home. At the time of the inspection, the new manager confirmed that set menus are not used. Since starting work at the home, Mrs Rowell has asked staff to complete a more detailed record of the food and beverages that are provided to service users. However, the records examined did not always include the following details: the vegetables served at each meal time; the types of soups and deserts being provided; the types of snacks and beverages available throughout the day and night. This lack of detail makes it more difficult for the Commission to reach a judgement as to whether people are receiving healthy nutrition and hydration. A person using the service said that they are happy with the meals served. In two of the three care records looked at, care plans covering the support that people require to eat and drink had been devised. However, nutritional risk assessments have not been completed for any of the people whose care records were checked. Care Homes for Older People Page 16 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for listening to peoples complaints and keeping people safe are good. This means that people using the service are able to benefit from living in a home where staff know how to protect them from abuse. Evidence: The Service User Guide and Statement of Purpose contain summaries of the homes complaints procedure and are available in easy to read versions. This helps to provide people using the service, and their families, with the information they need to make a complaint. One person using the service said that staff always listen to what they have to say. They also said that they felt sure that staff would deal with any complaints they might have. This person said that they had never had cause to make a complaint. The provider has produced a policy and procedural guidance advising staff how to respond to allegations of abuse. Previous inspections have confirmed that the homes safeguarding policies and procedures accord with the local authoritys safeguarding protocols. The majority of staff have received training in how to keep people using the service safe. However, one member of staff said that they had not received safeguarding training. Staff demonstrated a good understanding of how they would protect people from abuse and harm. Care Homes for Older People Page 17 of 31 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 standard of the environment is generally good providing people with an attractive and homely place to stay in. However, failure to keep furnishings and fittings in a good state of repair has the potential to place people at risk. Evidence: No. 1 Northbourne is a purpose built home designed to accommodate a small group of older people who also have learning and physical disabilities. The home is close to local shops and other amenities, as well as to local transport routes. Good access is provided into, and out of, the building. Each person is able to access all parts of the home. This is important as people use a range of disability aids to help them mobilise within the home. There is a specialist bathing facility to promote independent use by those who are capable of doing so. All the bedrooms and toilets have suitable locks on the doors. This provides the opportunity for service users to remain independent and enjoy their privacy. Generally, the premises are well-maintained. However, it was concerning to note that most of the homes dining chairs are in a poor state of repair and could cause injury to people using the service. Following feedback from the inspector, the new manager immediately dealt with this concern by making temporary repairs to the chairs. Although this situation is not ideal, the dining chairs are now safe to use whilst the Care Homes for Older People Page 18 of 31 Evidence: home takes steps to replace them. The Commission is concerned that the provider allowed the homes dining chairs to get into such a dangerous and poor state of repair. A number of other concerns were also identified. The automatic closing device on the door leading into the laundry is broken. This represents a potential fire hazard. The manager agreed to resolve this situation immediately following the inspection. Also, sets of drawers in some bedrooms are in a poor state of repair. Restrictors have been fixed to all windows and radiators have suitable coverings. Checks of hot water supplied to areas used by service users confirmed that temperatures do not exceed 43 degrees. These safety measures help to keep people safe. The provider has produced a set of health and safety policies and procedures that staff are expected to follow. Although staff have completed infection control training, documentary evidence confirming this is not available. The home is clean and free from offensive odours. This helps to enhance the self-esteem of people living at the home. The homes washing machines have facilities for sluicing and washing foul linen at very high temperatures to avoid the spread of infection. However, the Department of Health Infection Control Self-Assessment checklist for residential care homes has not been completed. Care Homes for Older People Page 19 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing the home are not fully satisfactory. Because of this, people using the service are not always able to benefit from living in a home where staff are appropriately trained and supported. This means that people using the service are not always able to benefit from living in a home that is run in their best interests. Evidence: There are usually three staff on duty between 7:30am and 9:30pm. Staff said that this level of staffing makes it easier to help people participate in activities outside of the home. Occasionally, only two staff are rostered on duty. All catering and domestic tasks are carried out by support staff with the involvement of service users where this is possible and appropriate. In the homes last inspection report, it was recommended that the provider carry out regular reviews of the appropriateness of night staff levels given the age and frailty of people using the service. The home continues to roster one member of staff to cover the night time shift between 9:30pm and 07:30am. The staff rotas do not include all of the information needed by the Commission to reach a clear judgement about the appropriateness of staffing levels. For example, the rotas do not include details of staffs designations, the identified senior for each shift or Care Homes for Older People Page 20 of 31 Evidence: a key explaining the hours worked by staff. Staff rotas show that bank staff are regularly used to cover shifts within the home. In one weeks rota, 20 shifts had been covered by bank staff. The number of bank hours used is considered high given the size of the home. This has the potential to have a detrimental effect upon the continuity and consistency of care delivered within the home. The level of staff turnover is low. The providers has recruitment and selection policies and procedures to help make sure that only suitable staff are employed within the home. A sample of staff personnel records were looked at. This showed that staff are required to complete an application form and at least two written references are obtained before staff appointments are confirmed. A Criminal Records Bureau disclosure check is obtained for each staff member and the home seeks clarification that staff are fit to do the work for which they are being employed. However, two staff files do not contain identification photographs or full employment histories. This could lead to unsuitable staff working at the home and this has the potential to place people using the service at risk. Seven of the eight staff working at the home have obtained a NVQ in Care at Level 2. One member of staff is currently working towards achieving a NVQ in Care at level 3. Staff receive opportunities to complete training that is relevant to their jobs. For example, all staff have completed training in first aid, food hygiene and safe moving and handling. However, the moving and handling training for some staff is out of date. Staff have not completed training in malnutrition or supporting people who need assistance with eating. Staff are provided with opportunities to complete an in-house induction as well as a specialist induction for staff who work with people who have a learning disability. Two of the staff files looked at contain documentary evidence that they have completed a specialist induction. However, a third file does not contain any evidence that the staff member has completed their specialist induction. Arrangements are in place to ensure that staff receive formal supervision. However, some staff have not received supervision at the frequency set out in the National Minimum Standards during the past 12 months. Care Homes for Older People Page 21 of 31 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 arrangements for managing the home are not fully satisfactory. This means that people are not always able to benefit from living in a home where their health, safety and welfare is promoted and protected. Evidence: A new manager has recently been appointed and has yet to forward an application to register with the Commission. Mrs Rowell has completed the Registered Managers Award and has obtained a NVQ in Care at Level 4. She has substantial experience of working in a residential setting with people who have learning disabilities. Mrs Rowell has completed extra management training, but has not updated her certificated fire training or accredited medication training. She is a hands-on manager and spends time caring for people as well as carrying out management related tasks. Mrs Rowell displays a positive and professional approach to her work. Arrangements are in place to monitor the quality of care, facilities and services Care Homes for Older People Page 22 of 31 Evidence: provided at No 1 Northbourne. For example, the provider has recently introduced a detailed monthly Care Standards Review document which requires managers to assess how well the home complies with internal policies and procedures and the National Minimum Standards. Mrs Rowell had just completed the new review format for the first time. The provider carries out regular monitoring visits to the home. People using the service and their families, staff working at the home and those professionals who have contact with the home, have not been asked to complete quality satisfaction surveys. Also, the service did not return its Annual Quality Assurance Assessment when asked to do so by the Commission. This document provides the Commission with useful information about how the service operates and helps with forming a judgement about the quality of care provided within the home. The AQAA was submitted shortly following the completion of the site visit. There is a robust system for managing peoples money. Receipts for purchases made on peoples behalf are kept in their financial records. Withdrawals or deposits are counter-signed by the service users, their relatives or a staff member. The amount of money held on behalf of each person corresponds with the balance recorded in their financial records. Staff are provided with formal supervision. However, some staff have not received supervision at the frequency set out in the National Minimum Standards during the past 12 months. The homes AQAA showed that some of its policies and procedures have not been updated within the last 12 months. The homes Sexuality and Relationships policy has not been updated since 1997. This means that people are not able to benefit from being cared for by staff who have access to the latest guidance and advice. The provider has devised comprehensive health and safety policies. These provide staff with guidance about how to keep people safe. The homes hoisting equipment has been tested during the last 12 months. A range of fire prevention safety checks is carried out. For example, the homes fire extinguishers are regularly checked and serviced. The home has an up to date fire risk assessment. Checks of the fire alarm system are generally carried out each week although there are some gaps. Staff take part in regular fire drills. However, the actual date of each drill is not recorded. Personal Emergency Evacuation Plans (PEEP) have not been devised for any of the people using the service. Ensuring that each person has a PEEP will help staff to keep people safe in the event of a fire. The homes electrical equipment has not been tested during the last 12 months. This has the potential to place people at risk of harm. Care Homes for Older People Page 23 of 31 Care Homes for Older People Page 24 of 31 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 31 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 10 13 Ensure that medication is kept secure at all times. This will help to ensure that people are protected from harm. 01/04/2009 2 15 17 Ensure that the homes menus contain sufficient detail to demonstrate that people who use the service have an appropriate diet. This will help to ensure that people benefit from receiving appropriate nutrition that helps to keep them healthy. 04/05/2009 3 18 13 Ensure that all staff receive safeguarding training. This training helps to make sure staff take appropriate action to protect people from abuse. 04/05/2009 4 19 23 Ensure that the homes furnishings and fittings are 04/05/2009 Care Homes for Older People Page 26 of 31 kept in a safe and reasonable condition at all times. Repair or replace the homes dining chairs and the broken bedroom furniture. Repair the automatic closure device on the door leading into laundry. This will help to ensure that people are able to benefit from living in a safe and well-maintained home. 5 27 18 Ensure that sufficient permanent staff are employed to cover the homes rota. This will help to ensure consistency of care for people using the service. 6 29 17 Ensure that personnel 04/05/2009 records contain identification photographs and that staff provide full employment histories. 04/05/2009 This will help to ensure that only suitable staff are employed at the home. 7 30 18 Ensure that staff receive 03/08/2009 supervision at the frequency referred to in the National Minimum Standards. This will mean that people using the service are able to benefit from being cared for by staff that receive appropriate support and supervision. Care Homes for Older People Page 27 of 31 8 33 24 Ensure that the home completes and submits an AQAA when requested to do so by the Commission. This will help the Commission to form a picture of how well the service is operating and what action the provider intends to take to improve the service. 13/04/2009 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 7 Ensure that peoples care plans:- cover the areas referred to in the National minimum Standards; include clear desciptions of peoples needs and information about desired outcomes. Peoples care plans should be available in easy to read versions that meet their individual needs. - Are available in individually tailored easy to read versions; Address equality and diversity issues relevant to each person. Ensure that a care plan is devised to provide staff with clear guidance on how to manage the bed rest required by one of the people living at the home. Ensure that: - Falls and pressure sore preventative healthcare risk assessments are carried out for each person; - The home obtains a copy of each persons Health Action Plan; - All risk assessments are signed and dated by staff, and where possible, by the service user themselves. 2 8 3 8 4 9 Ensure that: - Each persons Medication Administration Record includes an identity photograph; - The start date and route of administration for each item of medication are recorded; The maximum number of Paracetamol that can be given Care Homes for Older People Page 28 of 31 over a 24 hour period are detailed; - Hand wash facilities are provided in the area in which medicines are handled. 5 12 Ensure that: - Peoples care records contain evidence of how they have been supported to make decisions about the in-house activities they wish to engage in; - Each person has an individual activity planner which shows in advance what activities support staff will provide and at what times. The planner should show where the activity will take place, whether this will be inside or outside, and who else will be involved; - Each persons individual activity planner shows what opportunities they have for engaging in personal daily living tasks as part of their daily activities. 6 12 Ensure that staff are provided with training in how to help people choose appropriate social activities which take account of any age related needs, disabilities and personal choices. Ensure that each persons weight is monitored monthly. Compile a set of menus for use within the home. Any menus devised should take account of: what foods people can and cant eat; the times at which they want to eat; peoples personal preferences. Ensure that a nutritional risk assessment is completed for each person living at the home. The Commission recommends the use of the MUST nutritional risk assessment. Update the homes safeguarding policies and procedures to ensure that they cover the Mental Capacity Act and the introduction of the new Independent Safeguarding Authority. Complete the Department of Health Self-Assessment Infection Control checklist. Address any shortfalls in practice identified. Update the homes infection control risk assessment. Ensure that the homes rotas include the following information: staffs designations; the senior member of staff responsible for each shift; a key explaining the duration of each shift. Carry out an assessment of peoples night time support needs and ensure that each person has a night time care plan. Where peoples night time care plans show that their night time care needs cannot be safely met, extra staffing must be provided. Page 29 of 31 7 8 15 15 9 15 10 18 11 26 12 27 13 27 Care Homes for Older People 14 15 30 30 Ensure that staff receive awareness training in managing malnutrition and supporting people with eating. Ensure that staff update their moving and handling training every 12 months where they are involved in such tasks on a regular basis. Where possible, ensure that people using the service and their families, staff and professionals who have contact with the home, are invited to complete quality satisfaction surveys. Ensure that the homes policies and procedures are updated every 12 months. Ensure that the homes electrical equipment is tested every 12 months. The manager should update their accredited medication and certificated fire safety training. Ensure that: - The homes fire alarms are checked each week; - Fire training records specify the exact date on which staff take part in fire drills; - A Personal Emergency Evacuation Plan is completed for each person living at No 1 Northbourne. Seek advice from the homes fire officer about how to complete this task. 16 33 17 18 19 20 37 38 38 38 Care Homes for Older People Page 30 of 31 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. 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