Inspection on 06/01/09 for Oaken Terrace

This inspection was carried out on 6th 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

Oaken Terrace 23/02/09

Oaken Terrace 24/08/07

Oaken Terrace 10/01/07

Oaken Terrace 17/02/06

Oaken Terrace 13/10/05

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: Oaken Terrace Hollybush Lane Oaken Codsall Wolverhampton West Midlands WV8 2AT     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: Mandy Beck     Date: 0 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Oaken Terrace Oaken Hollybush Lane Codsall Wolverhampton West Midlands WV8 2AT 01902847575 01902846974 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) : Interhaze Limited care home 92 Number of places (if applicable): Under 65 Over 65 17 20 dementia physical disability Additional conditions: 17 20 17 Dementia (DE) - Minimum age 60 years on admission 20 Physical Disability (PD) - Minimum age 60 years on admission Date of last inspection Brief description of the care home Oaken Terrace is located between the villages of Codsall and Oaken approximately four miles from Wolverhampton and stands in its own spacious grounds with spectacular views overlooking the countryside. The home has four units and provides care for people with need both personal and nursing care, this also includes people with dementia. The home is set in a rural location with good road links and nearby rail and bus services and is comprised of mainly single rooms but there are eleven double rooms available. All areas of the home have access via stairs and a passenger lift. There are Care Homes for Older People Page 4 of 32 Brief description of the care home adequate parking facilities with easy access to each unit. Each of the units are run separately, with an overall management and support services presence. The home has not included the range of fees in the service user guide or the statement of purpose. People are asked to contact the home directly for this information. Care Homes for Older People Page 5 of 32 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 an unannounced key inspection to the home. We looked at all of the information that we have received, or asked for, since the last inspection of this home in January 2008. This included the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We looked at the information we had about how the service has managed any complaints. We looked at what the service has told us about things that have happened in the service, these are called notifications and are legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Care Homes for Older People Page 6 of 32 We have taken into consideration relevant information from other organisations. We also spent time talking to the people who use the service and to the staff who support them. We looked at the care six people who use this service in depth. This is part of our case tracking process and helps us make judgements about the homes ability to meet peoples needs. 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. Care Homes for Older People Page 8 of 32 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can feel confident their needs will be assessed in full before they agree to move in. Evidence: When we visited the home in July 2008 we found that there were shortfalls in the homes admission processes. This meant that peoples needs had not been assessed in full in some cases. We also found that staff did not know peoples needs upon their admission to the home. We said that each person must have a clear assessment and care plan that detailed their individual needs. The home has been supported in making improvements in this area by the local authority and the Primary Care Trust (PCT). This has meant that everyone currently living in the home has had a thorough reassessment of their needs. The home has improved the documentation it uses and has made it more accessible and user friendly for the staff. Care Homes for Older People Page 11 of 32 Evidence: We looked at the care of four people during this inspection. We found that each person had an individual assessment, all care needs had been recorded and care plans had been written. We were also able to speak to staff who could tell us what peoples needs were and this also reflected the information in the care plans. This means that peoples needs are known and understood by the staff providing the care. Care Homes for Older People Page 12 of 32 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 home must sustain the improvements it has made in order to meet peoples health and personal care needs. Evidence: When we visited the home in July 2008 we expressed our concerns about their ability to meet peoples needs. We found that care records were not being completed by staff. They told us there is so much it takes along time to complete and we dont read them. This meant that peoples needs were not met in some cases. We shared our concerns with the Local Authority and the Primary Care Trust (PCT). As a result of safeguarding concerns a large scale investigation was completed. This meant that each person living in the home was reassessed to make sure the home was meeting their needs. The investigation highlighted a significant number of shortfalls the home needed to address in order for peoples needs to be met. We found poor care for people with pressure sores or pressure damage. Pressure relieving equipment was not always in working order and in need of replacement. We were unable to find out conclusively if one person actually had a pressure sore because of poor record keeping Care Homes for Older People Page 13 of 32 Evidence: and insufficient staff knowledge of that persons condition. The home has now taken steps to have all the pressure relieving equipment serviced and those mattresses that were shabby have been thrown away. The PCT has also been offering the home support with record keeping and education of nursing staff in this area. We looked at the care of two people during this inspection who had varying degrees of pressure damage, we found care plans were up to date and staff were able to give us accurate information about peoples conditions. Peoples weights were not always recorded regularly, this meant the home was unable to take action with peoples unplanned weight loss. The home has been supported by the dietician and the speech and language therapist and is now making sure that nutritional screening tool is used for each person. Those people who are considered to be at risk are given dietary supplements. The weighing scales have also been calibrated so they provide an accurate reading this will help the home monitor peoples weight more effectively. The home has also purchased more equipment for peoples use and comfort. They have told us we have had new hoists and slings, new suction machines and bed rails. Staff said it is much better and makes moving people; a lot easier. Each person living in the home has a moving and handling risk assessment. The information in the risk assessment tells staff how each person should be moved, they could improve upon this by including the type of lifting equipment and the size of sling to be used. This would give staff further information to reduce the risk to the person being moved. In July 2008 we spent our time on Cavell unit looking at peoples care. We found the home was not offering the care and support people needed in relation to their dementia and some challenging behaviour. This gave us concerns about the homes ability to meet peoples needs on this unit. We were pleased to see during this inspection that improvements have been made. Each of the staff has taken part in further training. The home has also been supported by the Community Mental Health Team with education of staff about challenging behaviour and person centred care. We looked at care records for two people on this unit and saw an improvement. Staff also told us the training and support we have had are brilliant, its really good here, I am more confident now, I feel I know what I am doing. We spoke to people during this inspection who told us the doctor is always called whenever I need them, the staff are wonderful they try really hard to help us all. We also spent time talking to staff during this inspection about peoples needs. We found that staff were able to give us clear, up to date information and did know the needs of the people they were looking after. This is an improvement since our last visit in July 2008 when we were unable to determine what care needs people had because staff were unable to tell us. Staff said we are being included in hand overs now so we get to know what is going on its been really helpful. We looked at medication systems the home has in place. We found that improvements are needed throughout the home. The storage facilities for controlled drugs does not Care Homes for Older People Page 14 of 32 Evidence: meet current legislative guidance and the home must take steps to address this. The home must also make sure that when staff handwrite entries on to the Medication Administration Record (MAR) sheet, two staff check and sign the entry. Where people have been prescribed a variable dose of medication, for example 10mg or 20mg, or one tor two tablets, the home must records the actual dose given. This will help the home keep track of peoples medication and maintain a clear audit trail. The home is recording the temperature of the medication fridges however each of the records we saw were outside of the recommended 2oC to 8oC range. This means the home cannot be sure those medications requiring cold storage are being stored as recommended. We have also asked the home to keep records of the temperature of the medication storage rooms to make sure medicines are being stored as per manufacturers recommendations. We looked at care plans in relation to medication. We have said that those people who require medication on an as required or PRN basis should have the details of this clearly recorded into their care plan. This will make sure that staff who are responsible for administering medication are very clear about the circumstances under which as required and PRN medication can be administered. The home should also record the effectiveness of the medication after it has been given. People told us the staff are very good and always treat us well. We noticed that staff were talking to people in their preferred term of address and did knock doors before entering toilets and peoples bedrooms. Recent changes in care planning, staff training and the purchasing of new equipment all mean that peoples right to dignity and privacy is now being recognised and promoted by the home. Care Homes for Older People Page 15 of 32 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. The home is now supporting people to lead active lives and people are encouraged to take part in activities in the home. Meals are generally of good quality and people are satisfied with them. Evidence: Since our last inspection the home has taken steps to improve the quality of activity that is provided for people to take part in. The home has increased the number of staff who have been especially appointed to do this. Each of the units has their own activity coordinator. It is their responsibility to plan and provide quality entertainment for the people living in the home. There are Welcome Boards on each of the units, these boards are a new addition and show people what activities are on offer, or being planned for that week. There is also other information about the home on these boards in an attempt to keep people informed. The home has an open visiting policy, throughout the inspection a steady stream of visitors was seen. One person told us I am very happy with the care here, the home is looking much brighter too. The home has told us some external activities have been planned and we are trying to make improvements in this area. In order to keep a record of the activity on offer and of peoples participation the home has introduced Care Homes for Older People Page 16 of 32 Evidence: an activity folder for each unit. Staff will record peoples activity throughout the month on a daily log. We had the opportunity to see peoples bedrooms during this inspection. People have taken the time to bring in personal items from home to make their rooms feel more cosy and welcoming for them. Other people were unable to do this and some of their rooms were bare and felt unwelcoming. An observation was made by one of the visiting nurses during the large scale investigation that peoples rooms felt sparsely decorated and were in need of further decoration to make them feel more homely for people. The home has begun to do this on those peoples behalf. Meals are prepared freshly on site. Each person is offered a choice of meals and the home does provide a varied menu. Those people who need speicalised diets are catered for. We had the opportunity to see meal times during this inspection and found them to be relaxing times and people were not being rushed whilst eating thier meals. We saw people being assisted during meal times to eat their meals, staff generally did this sensitivley and unhurried. Care Homes for Older People Page 17 of 32 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 home will listen to peoples concerns and complaints and take action to resolve them. The homes ability to protect vulnerable people has improved and will now ensure that people are protected from harm. Evidence: The home has its own complaints policy and procedure. It is clearly written and is available upon request in different formats such as, large print. Each person living in the home has a copy of the complaints procedure pinned to the back of their bedroom doors for their information. The home has received three complaints since the last inspection, all of which were investigated appropriately and records kept of the outcome of the complaint. We, the commission have been aware of two complaints about the care of people living in the home. These complaints were referred to the local Safeguarding vulnerable adults team to investigate. The result of that investigation was to conduct a large scale investigation of care practises within the home. There were concerns about the homes ability to meet peoples needs particularly in relation to pressure area care, nutrition and poor record keeping. The home has participated fully in the investigation which was conducted with the Primary Care Trust (PCT) and the Local Authority. Each person living in the home has been reassessed. The home has taken action to address concerns and work on improvements as a result of these reassessments. The home continues to be Care Homes for Older People Page 18 of 32 Evidence: supported by staff from the PCT in the form of advice and training for staff. Staff have received more training in Safeguarding Vulnerable adults and those staff spoken to during this inspection were aware of who to report any allegations of abuse to. We also spoke to the manager during this inspection who demonstrated a good understanding of her role in protecting the people who live in the home from harm. She told us I wont put up with poor practise and I work hard to make sure people are protected from abuse or harm, it is my duty to defend them. We looked at the homes policies for managing challenging behaviour and the use of restraint. The policy needs to be updated and reviewed so that staff will be very sure of the circumstances when restraint should be used. The home makes sure when recruiting new staff that the required safety checks are completed. This includes the Protection of Vulnerable Adults (PoVA) list and Criminal Records Bureau (CRB) disclosures. The checks will help reduce the possibility of unsuitable people working with vulnerable people. Care Homes for Older People Page 19 of 32 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. The home environment is improving. Further redecoration and refurbishment will make the home a more comfortable place for people to live. Evidence: We were concerned about the appearance of Cavell unit. Despite some recent redecoration the unit felt drab and shabby. We were also concerned about the equipment that was available for peoples use. Pressure mattresses were not inflated as they should be and bed rails were not fitted correctly. There were other issues raised from the large scale investigation. There was insufficient lifting equipment, a lack of suction machines on the nursing units and some of the pressure relieving equipment needed to be replaced or repaired. It was pleasing to see the home has now purchased all of this equipment for peoples comfort and safety. There has also been considerable redecoration throughout the home not just Cavell unit. Peoples bedrooms have been redecorated and there are plans to provide new furniture in the near future. Other people were unable to do this and some of their rooms were bare and felt unwelcoming. An observation was made by one of the visiting nurses during the large scale investigation that peoples rooms felt sparsely decorated and were in need of further decoration to make them feel more homely for people. The home has begun to do this on those peoples behalf. Each of the units has a welcome board that informs people of the activities that are planned for the week and of other events Care Homes for Older People Page 20 of 32 Evidence: happening around the home. There is also a photo gallery of all the staff on each unit. People are encouraged to decorate their rooms to their own taste and we saw that most peoples rooms have deen decorated with their own furniture and other possessions. The home makes sure that infection control is managed safely. Staff have access to gloves, aprons and liquid soap and paper towels. These measures will help reduce the risk of cross infection to people libing in the home. Staff are enrolled on training in infection control and they were able to discuss current best practices when questioned. Care Homes for Older People Page 21 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service will be supported by staff who have been recruited safely and have been appropriately trained to meet their needs. Evidence: The home is adequately staffed. There were sufficient numbers of staff on duty during this inspection to meet peoples needs. Staff told us we are supported by the manager, things have improved a lot recently and I think we all feel better about our work. The home has also recently employed activity coordinators for each of the units to help encourage people to take part in activities and build upon social contacts. A registered mental nurse will also be joining the staff team to help support and provide training for other staff in the home in mental health issues. Staff told us they were supported by the home in completing their National Vocational Qualifications (NVQ) in health and social care. At present over 89 per cent of care staff have completed their NVQ training. This training should give staff the knowledge and skills they need to complete their duties. We looked at the staff files of six new employees. We did this to assess whether the home is continuing to recruit people safely and in a way that protects the vulnerable people living in the home. Five of the staff files were found to be complete with the required checks in place, such as two written references, a check against the Protection of Vulnerable Adults List (PoVA) and a Criminal Record Bureau (CRB) Care Homes for Older People Page 22 of 32 Evidence: disclosure. These safety checks help prevent unsuitable people from working with vulnerable adults. We found one persons file had not been updated as it should have been. The manager explained this was because the worker had previously worked for the company. The home must make sure that each new person that begins working at the home is subject to the recruitment process regardless of whether they used to work there. We also looked at the induction process for new staff and found it be satisfactory. This means that new staff are supported by experienced staff when they start working in the home. The induction training meets the skills for care induction standards and offers workers a basic introduction to social care. Care Homes for Older People Page 23 of 32 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. People living in this home are supported by a management team that is working hard to make improvements to the service they provide. Evidence: The management of the home has not changed since our last inspection. Mrs Gumede has told us that she feels very positive about the recent changes in the home. When we visited the home in July 2008 we said the home had a lot of work to do in improving the record keeping systems so that people were not being placed at risk. The large scale investigation has also highlighted areas for improvement the home will need to do in order for it to move forward. Both the PCT and the Local Authority have been working with the home and the manager to bring about these improvements in the home since July 2008. The home has worked hard to address the shortfalls in the service provision and this has been evident throughout this inspection. Both the home and the manager need to sustain these improvements and continue working to move the service forward. Care Homes for Older People Page 24 of 32 Evidence: The home has its own quality assurance system, this involves the manager and responsible individual completing audits about the quality of the service the home is providing. Whilst it is positive the home does this, it is also concerning that none of the shortfalls highlighted by the large scale investigation were picked up as a result of these audits. The home should review the effectiveness of their quality assurance systems and take action to improve it. The home has also completed their Annual Quality Assurance Assessment (AQAA), all sections of this were completed and the information gives a reasonable picture of the current situation within the service. The AQAA gives us limited detail about the areas where they still need to improve. The home has since provided us with an updated improvement plan following the large scale investigation and we will be monitoring this through further inspections of the service. We looked at way in which people are supported in managing their money. Generally the money people hand into the home for safekeeping is securely held and there is a system in place for monitoring what people are spending. There are improvements that could be made to offer further safeguards to people. For instance the home does not keep peoples receipts separatly, all receipts are numbered and grouped together. This made an audit of individual peoples money difficult and the receipts were hard to find. All of the money that is handed into the home for safekeeping on peoples behalf is kept together. This means that people would have to rely on the balance sheet to tell them how much money they have at any one time. The difficulty arises when receipts for all transactions cannot be found. This makes auditing of peoples money difficult and the home cannot always be sure that its records are accurate as a result. We have recommended the home keeps peoples money individually and all receipts pertaining to their expenditure are to be kept with the persons money. The home is making sure that peoples health and safety needs are being promoted in most cases. Again there are improvements to be made. During the inspection in July 2008 we noted that peoples bed rails were not fitted as per manufacturers instructions, in some cases only one bed rail was fitted to a persons bed. We asked the home to review this urgently because of the risk posed to people. The home responded by checking all bed rails and supplying them in pairs as recommended for those people who needed them. The home has also supplied bumpers for each bed rail for peoples added safety. We saw that people who needed bed rails on their beds to keep them safe did not always have a risk assessment in place for their use. The manager did show us a new format for a risk assessment that she plans to introduce in the near future. However the home must make sure a bed rail risk assessment is completed before bed rails are fitted to a persons bed. We have also recommended improvements to the way the home records the maintenance and visual checks it completes on bed rails. The home arranges regular training for staff in fire safety, first aid, infection control and moving and handling. We noted that there have been some gaps in the training Care Homes for Older People Page 25 of 32 Evidence: programme but the manager has arranged for these to be covered. The home must make sure however that staff take part in fire drills, in recent months there has been some slippage of the planned drills. The manager has told us this will be addressed promptly. On Norton unit we noticed the windows opened with an excessive gap at the top. We have said the home must risk assess this promptly to reduce the risk from falling from windows. Where necessary the home must fit restrictors for peoples safety. Care Homes for Older People Page 26 of 32 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 27 of 32 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 (2) The home must make sure that fridge temperatures are kept between 2oC and 8oC. This will mean that medications requiring cold storage are being kept appropriately and not placing people at risk. 11/02/2009 2 9 13 (2) The home must make 11/04/2009 sure that the current storage for controlled drugs is replaced. The home must do this to make sure they are complying with new legislation and peoples medication is being securely stored. 3 9 13 (2) The home must make sure that when people are prescribed medication on a PRN or as required basis there is a clear record in the care plan about the 11/04/2009 Care Homes for Older People Page 28 of 32 circumstances of its administration. This will mean that all staff are clear about the specific circumstances of when this medication should be administered. 4 29 19 The home must make sure that every new worker goes through the recruitment process even if they have previously been employed the home. This will reduce the risk of unsuitable people working with vulnerable adults. 5 38 23 The home must make sure that fire drills are undertaken at suitable intervals. This is so staff will be sure of evacuation procedures in case of fire and the do not place people at further risk. 6 38 17 The home must make sure it 06/02/2009 keeps written records of the safety checks it carries out on peoples bed rails. This will help the home audit the use of bed rails and the continued safe use. 7 38 13 (4) (c). The home must 02/03/2009 make sure that bed rails are not used until a risk assessment for their use has been completed. 27/02/2009 09/03/2009 Care Homes for Older People Page 29 of 32 This will reduce the risk of harm being caused to people using the service. 8 38 13 The home must make sure 02/03/2009 that people are not placed at risk of falling from windows by excessive gaps. The windows must be risk assessed and the home must take appropriate action to keep people safe. This must be done to reduce the risk posed to people living in the home. 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 9 The home must make sure that where people have been prescribed a variable dose such as one or two tablets, the home records how many have been administered on the MAR sheet. When staff make handwritten entries onto the MAR sheets we recommend that two people check and sign this entry. This is to reduce the risk of errors occurring. The home should consider reviewing its policy on control and restraint so that staff have clear guidance about how to do this whenever needed. The home should consider keeping individual records for peoples money and storing peoples money The home should make sure that gaps in staff training in health and safety continue to be addressed and that all staff are up to date with mandatory training. The home should obtain a copy of the Health and Safety Executive (HSE) guidance on Falls from Windows. This will help the home assess the risk to people living in the home. The home must make sure that all staff participate in regular fire drills. This will help staff to understand their Page 30 of 32 2 9 3 18 4 5 35 38 6 38 7 38 Care Homes for Older People role and responsbility in the event of fire. 8 38 All staff involved in the fitting and safe use of bed rails should undertake training in their use. This will help make sure staff are aware of the risks associated with bed rails use and keep people safe. Further information can be obtained from the Health and Safety Executive. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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