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Inspection on 05/08/09 for Northfield Nursing Home

Also see our care home review for Northfield Nursing Home for more information

This inspection was carried out on 5th August 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People were assessed before moving into the home. This made sure that staff had the information they needed to make a judgement about whether or not they could meet people`s needs. People told us their health care needs were met. The home employed an activities coordinator. People told us they had some opportunity to take part in various activities. Contact with family and friends was encouraged. If people wanted to they were able to develop and maintain links with people locally and use facilities in the local community. People told us they were able to make choices about how they spent their day. Staff told us they encouraged people to make choices by giving them information and offering assistance when needed. They also added they were able to make some choices for people based on the information they had about them. The home was well maintained clean and hygienic. People told us they were able to comment on the standard of the service. The service was monitored by a representative of the organisation and a report prepared on the outcome of the visit. This included details of action to be taken. There were procedures in place to make sure people`s financial interests were safeguarded. Staff were able to tell us the steps they took on a daily basis to promote the health safety and welfare of people using the service. We observed some good practice, regarding safe moving and handling.

What has improved since the last inspection?

Since the last inspection there had been some improvements in the quality of care plans and daily recording. However there was further development needed. Although we received mixed comments about the food. Some people told us there had been some improvement in the quality, variety and standard of the meals provided. At the last inspection there was a new manager in post. Since that inspection she has been registered with us.

What the care home could do better:

Although each person had a care plan and there had been some improvements. There were examples of care plans not including some people`s obvious needs. Written evidence of care plan reviews was insufficient. This could lead to people`s needs not being met. There was some poor practice regarding medication procedures. This could place people at unnecessary risk of harm. Staff were able to tell us how they promoted people`s rights and choices. However some people using the service and some relatives told us there were shortfalls in some staff`s practice. 3 people using the service and 4 relatives told us they did not always feel their concerns and comments were taken seriously and acted upon. Records were kept of some complaints, some verbal complaints were not recorded. There had been some shortfalls in care practice which meant that people were not always protected from harm. There was one outstanding safeguarding referral at the time of writing this report. There had been shifts where there had not been enough staff on duty. This was due to staff changes, staff sickness and the use of agency staff. This meant, people experienced inconsistencies in the standard of care. Some relatives told us they did not feel listened to by the manager. They felt there could be improvements regarding this relationship and communication. Some substances hazardous to health were not stored appropriately and staff had not received all the training they needed to do their job.

Key inspection report Care homes for older people Name: Address: Northfield Nursing Home 2a Roebuck Road Sheffield South Yorkshire S6 3GP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shirley Samuels     Date: 0 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Northfield Nursing Home 2a Roebuck Road Sheffield South Yorkshire S6 3GP 01142687827 01142679591 northfield@palmsrow.co.uk www.palmsrow.co.uk Palms Row Health Care Limited care home 63 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) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The service may admit persons between the ages of 60 to 65 years. Date of last inspection Brief description of the care home Northfield is a care home providing personal and nursing care. Accommodation is provided for 63 people. The home is owned by Palms Row Health Care and is situated in the residential area of Crookesmoor. It is close to the main bus route and is a short walk away from the Upperthorpe shopping area. The home is purpose built with accommodation provided on two floors, which are accessed, by a lift. There is a garden area that is safe and private for people to enjoy. The grounds are accessible and well laid out, the garden sitting areas are attractive and well maintained. The manager confirmed that the weekly range of fees charged for accommodation and care was from £373-£649 Additional charges are made for services such as chiropody, newspapers and hairdressing. Further information about the home can be obtained by contacting the Manager. The inspection reports are available in the entrance to the home. Care Homes for Older People Page 4 of 29 Over 65 63 0 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 key inspection carried out by Shirley Samuels on 5/8/09 from 9am-6:30pm. The last key inspection was completed 01/04/08. As part of this visit we sought the views of the people using the service, their relatives, professional visitors and staff. Some people completed questionnaires before the inspection, others were spoken to on the day of the visit. Before the inspection we received four staff questionnaires and three from professional visitors. On the day of the inspection we spoke to four staff, seven people using the service, five relatives and the manager of the home. We spoke to a further two staff following the inspection. Case tracking was used during the inspection visit to look at the quality of care received by people living at the home. 3 people were selected and the quality of the care they received was assessed by speaking to them, observation, reading their records, and talking to staff. Care Homes for Older People Page 5 of 29 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 the report as recommendations- but only when it is considered that people using the service or not being put at significant risk of harm. In future if requirement a is repeated, it is likely that enforcement action will be taken. We checked a selection of documents regarding peoples care and support staff records and records that showed evidence of compliance with regulations and standards. Before the inspection the manager completed an Annual Quality Assurance Assessment (AQAA). This information provided by the manager told us how the service had developed since the last inspection and what was planned to further develop the service over the next 12 months. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Although each person had a care plan and there had been some improvements. There were examples of care plans not including some peoples obvious needs. Written evidence of care plan reviews was insufficient. This could lead to peoples needs not being met. There was some poor practice regarding medication procedures. This could place people at unnecessary risk of harm. Staff were able to tell us how they promoted peoples rights and choices. However some people using the service and some relatives told us there were shortfalls in some staffs practice. 3 people using the service and 4 relatives told us they did not always feel their concerns and comments were taken seriously and acted upon. Records were kept of Care Homes for Older People Page 7 of 29 some complaints, some verbal complaints were not recorded. There had been some shortfalls in care practice which meant that people were not always protected from harm. There was one outstanding safeguarding referral at the time of writing this report. There had been shifts where there had not been enough staff on duty. This was due to staff changes, staff sickness and the use of agency staff. This meant, people experienced inconsistencies in the standard of care. Some relatives told us they did not feel listened to by the manager. They felt there could be improvements regarding this relationship and communication. Some substances hazardous to health were not stored appropriately and staff had not received all the training they needed to do their job. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not move into the home without having their needs assessed. This made sure staff had the information they needed. Evidence: We checked three files for people using the service. All included assessments carried out before people moved in and included details of peoples needs. Staff told us they always had the information they needed before people moved in. Where there were gaps they were able to contact social workers and other professionals to get further information. This made sure staff had the information they needed to make judgement about whether or not they were able to meet peoples needs. Care Homes for Older People Page 10 of 29 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. There was some evidence of good practice however there were some shortfalls in practice regarding care planning, medication and ensuring peoples dignity. This meant that some people did not always receive the care they needed. Evidence: We checked three care plans as part of our case planning methodology. Since the last inspection there has been a review of the care plan format. This format gave clearer guidance to staff about what needed to be recorded, where and when. There was a separate sheet for each care plan area. This detailed the persons needs and what action staff were to take and what the outcome should be for the person. Each care plan area also had a review page to be completed each month, which detail any changes to the care plan. There were some good examples of peoples needs being identified and good record keeping of the care provided on a daily basis. There were however some gaps in information. For example a person who often refused pain relief medication and continued to complain of pain had no care plan around medication and the Care Homes for Older People Page 11 of 29 Evidence: management of pain. The staff were able to tell us the action they took but this was not recorded. Another example was of a person who displayed challenging behavior. This meant staff had to use a number of approaches and skills to ensure the persons wellbeing. Staff were able to tell us the strategies they used, but there was no care plan and records of incidents and action taken by staff was lacking in detail. Although staff verbally communicated peoples needs, staff knowledge of individuals and the action that needed to be taken was not always recorded in the care plan. This may not support staff particularly when staff were unfamiliar with individuals needs. A requirement made following the last inspection about care plans, has been carried forward in this report as a recommendation. People told us they were able to have appointments with their Doctor, Dentist, Optician, Chiropodist and other health care professionals. Records were kept of appointments and they detailed the outcome of any visits and the action staff needed to take. This made sure peoples health care needs were met. The manager told us the medication system was checked regularly by the primary care trust pharmacist. The home had a medication policy and staff responsible for administering medication were trained. Medication was administered by qualified nursing staff. Records were kept of medication received into the home, administered and disposed of. However there were some examples of procedures not being followed. Medication was being administered without any specific instructions on medication administration records for staff to follow. There was one example of a controlled drug not being signed for by a second trained person. The balance of medication was not being carried forward from the previous month. This made it difficult to monitor stock. An agency nurse responsible for administering medication, had removed medication from original containers and put them into pots with a piece of paper with peoples names. We observed her administer medication to people from these pots. These were poor, unsafe practices which placed people at unnecessary risk and was not in line with the Misuse of Drugs (safe custody) regulations 1973. Since the inspection we have been notified that the agency nurse no longer works at the home. Some people told us they were treated with dignity. We observed staff approaching people In a patient and sensitive way. Staff were able to tell us how on a daily basis Care Homes for Older People Page 12 of 29 Evidence: they promoted choice and independence. By offering choice, giving information and treating people as they would like their relative to be treated. This showed some examples of peoples rights being respected. Some relatives (four) spoken to on the day of the visit raised issues about peoples dignity. Relatives said there were occasions when people were not attended to in a timely manner and buzzers were not always answered quickly. Relatives and people using the service told us that the majority of the staff were caring and patient. However relatives and some of the people using the service spoke of inconsistencies in the attitude and commitment of the staff. Comments received included, the staff are marvelous OK It depends which staff are on, some staff are better than others I have no complaints they do their best. Relatives told us they had raised concerns about the standard of care provided by some staff, but were not always satisfied, as any improvements were short lived or inconsistent. This meant that some people did not always receive the care they needed. Care Homes for Older People Page 13 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities were provided, contact with family and friends was encouraged. This meant that peoples daily life and social activity needs were met. Evidence: The home employed an activities coordinator who worked full time. People told us they were able to take part in activities if they wished. The programme of activities included, art and craft, bingo quizzes, one to one pamper sessions, reminiscence and some outings including to the coast. Records were kept of the activities that took place. This made sure people had the opportunity to take part in recreational activity. Since the inspection we were were told People using the service were involved in taking digital photos and using an Alzheimers book of activity to aid memory. Additional staff to support the activities worker when larger group activities were planned, may be beneficial. People told us they were able to maintain contact with family and friends. Staff told us they encouraged people to make choices by sharing information, encouraging independence and informing people of their rights. This made sure people were able to have some control over their lives. Care Homes for Older People Page 14 of 29 Evidence: We received mixed comments about the food provided. Comments included, good very good rubbish not always cooked enough not enough choice plenty of choice It was clear that peoples experience of the food provided varied. There was evidence that food was discussed regularly with people and that action had been taken to respond to comments received. We were told that specialist diets were catered for. It had become common practice (on blue floor) for the teatime meal to be served to people in the lounge, using bed tables, while people remained seated in armchairs or wheelchairs. Four relatives told us (from their observations) this practice meant that people were not offered a choice and three of the staff told us not having enough time and sometimes insufficient staff was the reason for this. Care Homes for Older People Page 15 of 29 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. Complainant did not feel they were always listened to. Staff who had failed in their duty of care were dealt with appropriately. Evidence: The home had a complaints procedure, people using the service and relatives told us this information was given to them on admission and there were copies of the procedures in peoples bedrooms. Records of complaints were kept, they included details of the complaint, the investigation and outcome. We received mixed comments from relatives about the way complaints were handled. one was satisfied, whilst four were not. Some relatives told us, improvements in practice following complaints, were in their experience short lived and inconsistent. This meant some people did not feel their complaints were listened to and taken seriously. Since the last inspection there had been three safeguarding referrals. One was dealt with under Sheffield Social Services serious incident procedures. This case was not yet concluded at the time of this visit and there were ongoing investigations. Two referrals were investigated under Sheffield city council safeguarding procedures Care Homes for Older People Page 16 of 29 Evidence: and were not upheld. Investigations had been carried out by the the provider, which concluded that 3 staff had failed in their duty of care to people using the service. Appropriate action was taken as required by the provider. Sheffield Social Services suspended placements at the home in April 2009 for a four week period. This suspension had been lifted at the time of this inspection. The records showed that not all staff had received refresher training in safeguarding adults. Since the inspection we have been told that the home has established abuse and whistle blowing procedures. Care Homes for Older People Page 17 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and well maintained. This made sure that people lived in comfortable environment. Evidence: All areas of the home were reasonably maintained. People told us they were happy with their bedrooms. The furniture and furnishings were mainly domestic in appearance and there was no offensive odour. We noticed that there were 10 bed tables, (the type of which is usually used for people who are in bed). Scattered around the lounge on the red corridor. The manager told us that these were used for people to eat their teatime meal. These tables cluttered the room, were in the way of the television and created a health and safety hazard. At the time of the inspection the home was clean. The domestic staff told us they had the equipment they needed and when things broke down they were repaired quickly. Domestic staff told us there was enough of them to keep on top of surface cleaning but found it difficult to carry out deep cleaning jobs. Care Homes for Older People Page 18 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were not always enough staff to meet peoples needs. There were gaps in staff training and the homes recruitment procedures. This meant that people did not always receive consistency of care. Evidence: People told us they had seen a lot of change of staff over the last few months. They told us that this had made them feel unsettled sometimes and wanted, wherever possible to have the same people taking care of them. The staff rota showed there had been many shifts where agency staff had been used. There had been efforts made to offer some consistency and to obtain where possible the same agency staff, however this was often not possible. The manager, staff and people using the service told us there had been some serious staff shortages. This had occrued due to people ringing in sick and cover not being available at short notice. One person using the service told us it felt to them that staffing levels were hardly ever sufficient. Two relatives and three people using the service told us they felt, some of the staff, particularly agency, staff did not have the knowledge they needed to support them. There was a previous requirement made following the last inspection regarding Care Homes for Older People Page 19 of 29 Evidence: staffing levels. This requirement is carried forward with a very short timescale. We received mixed comments about the attitude of the staff. Some of these comments included, very good nice patient just doing their job for some I can tell its just a job Some of them cannot do enough and will always make time for me the standard of care depends on whos on. Staff told us there was low morale, there was need for more teamwork, improved communication and more commitment to better standards. We checked three staff recruitment files. These contained criminal records checks, Identification, nurses pin numbers and dates of expiry, work history, heath checks and photograph. For one staff member there was only one reference which was from her previous employer. Since the inspection the manager confirmed that the 2nd reference had been obtained and the manager had previously worked with this person. Training records were checked. The training provided included, moving and handling, food safety, safeguarding adults, dementia awareness and person centered care Staff told us they received mandatory training. For some staff the training records showed that refresher training was out of date. The manager told us that some staff were reluctant to attend training. These people had recently been sent letters reminding them that it was essential to attend training and the implications of not attending. Care Homes for Older People Page 20 of 29 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. There were shortfalls in the management of the home and procedures for maintaining health and safety. This meant that the home was not always run in the best interest of the people using the service. Evidence: There has been a new manager registered since the last key inspection. Four relatives commented that she was not always approachable and they did not feel she took their comments seriously. The manager continues to inform the commission of things that have happened in the home and there were some examples of issues being managed well. People told us they were able to comment on the quality of the service. Staff told us that meetings were held and they were able to talk about how they felt and how they thought the service could be improved. Care Homes for Older People Page 21 of 29 Evidence: We saw minutes of these meetings and they reflected some positive comments and others which supported the view that people were not always satisfied. Staff meetings minutes supported the concerns about staff morale and the need to improve standards of care and continuity of care. News letters about the home, activities and planned events were provided for people using the service and were also available in the reception to the home. People had access to the last inspection report which was displayed. Regular monthly monitoring visits were carried out and a report was completed. People using the service and the staff told us they were approached and spoken to by the person doing the monitoring visits. They told us they were given the opportunity to comment on the quality of the service. However the shortfalls in the service were not reflected in this report. People told us they were happy with the financial arrangements in place and they had access to their money when they wanted it. The manager told us there were procedures in place to make sure peoples financial interest were safeguarded. We observed some good moving and handling practice. People using the service told us in the main they felt confident in the staff ability in this regard. We found substances insecurely stored in the bathroom cabinet. These included. prescribed bath oil, two tubs of prescribed barrier creams and a bottle of nail polish remover. The records showed that staff who only worked the night shift did not take part in a fire drill. This meant the night staff did not have the opportunity to test their knowledge of what to do in the event of a fire. Care Homes for Older People Page 22 of 29 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 27 18 There must be sufficient 10/05/2008 numbers of competent and experienced staff on duty at all times. Previous time scale 01/07/07 not met Care Homes for Older People Page 23 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be administered from the original container. To make sure that people using the service are protected by the homes policies and procedures for dealing with medicines. 04/12/2009 2 9 13 The administration of controlled drugs must be witnessed and records signed by a second trained person. To make sure that people using the service are protected by the homes policies and procedures for dealing with medicines. 04/12/2009 3 9 13 Medication must have clear 04/12/2009 administration instructions and be administered according to this instruction. Care Homes for Older People Page 24 of 29 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 make sure that people using the service are protected by the homes policies and procedures for dealing with medicines. 4 16 22 All complaints must be taken 04/12/2009 seriously and acted upon. Improvements made as a result of a complaint must be maintained. To make sure peoples complaints are taken seriously and acted upon. 5 18 13 Staff must receive training in safeguarding adults. To make sure people using the service are protected from harm or abuse. 6 27 18 The use of agency staff must 04/12/2009 not prevent people using the service from receiving continuityof care. To make sure peoples needs are met. 7 27 18 There must be sufficient numbers of competent and experienced staff on duty at all times. To make sure peoples needs are met. 04/12/2009 04/12/2009 Care Homes for Older People Page 25 of 29 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 8 30 18 Staff must receive refresher training appropriate to the work they are to perform. To make sure people are cared for and supported by staff trained and competent to do their job. 04/12/2009 9 38 18 All staff including night staff must receive fire instruction and take part in a fire drill. To make sure they know the action to take in the event of a fire. and to reduce the risk of harm to people. 04/12/2009 10 38 18 All substances hazardous to health including prescribed creams must be stored appropriately and securely. To make sure people are not placed at unnecessary risk to their health. 04/12/2009 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 Care Plans should include details of peoples needs, the action required by staff and detailed records of care given. Reviews must take place and record any changes in peoples needs. To make sure staff have the information they need to support and care for people appropriately. Care Homes for Older People Page 26 of 29 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 2 9 Records should be made of medication carried forward from the previous month. This will make sure stocks can be audited and the system more easily monitored and there is an audit trail. When necessary staff should be delegated wherever possible to offer assistance to the activities worker. To make sure all people who wish to have an equal opportunity to take part in activities. 3 12 4 15 Further discussion and action, should be taken in response to the comments received about food provided. To make sure people have a diet that is balanced and enjoyable for them. 5 15 The practice of serving the teatime meal, in the lounge, should be reviewed in consultation with people using the service. To make sure people have a choice about where to sit at mealtimes. 6 26 There should be enough domestic staff who are deployed in a way which allows deep cleaning of the home to take place when necessary. The comments received about staff morale, communication and team work should be addressed. To make sure good working relationships are developed and maintained and to enhance the experience of people using the service. 7 27 8 33 Action already implemented by the management should continue, regarding ensuring a consistently good standard of care. This should be provided by staff who all work in a way that promotes the rights of people. This should be monitored though the quality assurance system. To make sure That all people using the service are treated with respect and dignity at all times. 9 38 The manager should address the comments made by some of the relatives about communication. Care Homes for Older People Page 27 of 29 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 To make sure they feel their comments are taken seriously. Care Homes for Older People Page 28 of 29 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). 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