Inspection on 18/03/09 for Oakfoss House

This inspection was carried out on 18th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakfoss House 22/03/07

Oakfoss House 23/08/06

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oakfoss House 6 Weavers Road Walkergate Pontefract WF8 1QR     The quality rating for this care home is:   two star good 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: Jayne White     Date: 1 8 0 3 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: Oakfoss House 6 Weavers Road Walkergate Pontefract WF8 1QR 01977704068 01977704068 oakfosshouse@etnmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Denestar Limited care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: One specific service user under the age of 65 in the category (DE), named on variation dated 24th January 2007, may reside at the home. Date of last inspection Brief description of the care home Oakfoss House provides residential care for 22 older people including those who may have mental health problems. The home is situated in a residential area close to the centre of Pontefract and all local amenities and facilities. There is a car parking area to the front and lawn areas to the front and back of the building. Garden furniture is provided for people in the summer months. The entrance leads to a small office on the 0 0 0 Over 65 22 22 22 Care Homes for Older People Page 4 of 31 Brief description of the care home right and then to a large television lounge. A smoking lounge is next door to this. There is a separate dining room. Bedrooms are situated on the first and ground floor and all floors are accessible by lift. All bedrooms are for single occupancy. The fees charged in March 2009 for the service range from 396.00 to 403.00 pounds per week. Hairdresser and chiropody are not included. People are informed of the cost at the time that an enquiry is made, when given a copy of the service users guide and the Commissions inspection reports. 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: two star good 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 conducted by Jayne White, inspector. We visited without giving the service any notice. Gaynor Saunders, managing director and Adele Tallon, the acting manager was present during the visit. The managing director completed an Annual Quality Assurance Assessment before the site visit. This gives the service the opportunity to tell the CSCI how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 22 March 2007 and any plans for improving the service in the next 12 months. Various aspects of the service were then checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. Care Homes for Older People Page 6 of 31 The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received and their views on aspects of living at the home. The care provided for four people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the acting manager about their knowledge, skills and experiences of working at the home. We checked all the key standards. All this information and peoples, representatives and staffs opinions and comments were considered for inclusion in this report. The managing director and acting manager were provided with initial feedback from the inspection during and at the end of the visit. 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. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: As detailed a care plan as possible should be in place for everyone. An immediate requirement was issued for the service to address this on the day of the inspection for one person. The service did do this. The risk assessment for falls included in care plans should assess the actual risk from falls and document the interventions to be made, to minimise any risks to the person and protect them from harm. In addition, seek health care intervention more quickly when people lose weight, so that appropriate action can be taken to promote and maintain peoples health. So that people are protected by the homes policies and procedures for dealing with medicines the amount and date of all medication that is received into the home must be recorded, handwritten entries on medication administration records should be countersigned and a lock provided for the refrigerator that stores medication. Care Homes for Older People Page 8 of 31 The care home could support people better in following personal interests and activities, by having a social care plan to provide meaningful information about how to engage that person in activities that are appropriate for them. Keep documented evidence of training staff have undertaken and/or make sure staff are up to date with training appropriate to the work they perform to make sure they are up to date with the skills and knowledge to meet peoples needs. Keep better financial records, so that is easy to see that peoples financial interests are safeguarded. 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. On the whole, people could be confident the care home could support them. This was because there had been an assessment of their needs, which told the home about them and the support they needed. Evidence: When we looked at information in the AQAA it told us after referral all people are issued with a service user guide, a thorough pre-admission assessment is conducted with full participation of the person and their representative and improvements in the last 12 months have been a new comprehensive welcome pack brochure. When we spoke to people and their representatives it told us people had received enough information about home before they moved in so they could decide if the place was right for them, although none recalled being given any information. We looked at two peoples files to check that pre admission assessments had been Care Homes for Older People Page 11 of 31 Evidence: undertaken. We concluded the registered manager carried out a needs assessment with prospective people prior to their admission. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were receiving the personal care they needed because on the whole, most people had a detailed plan of care that told staff what this was. On the whole, medication practices supported people in a safe way. On the whole, staff attitude and approach to care was based on respect for people, which promoted peoples rights and dignity. Evidence: The AQAA told us very comprehensive care plans were in place and person centred care was paramount. It stated empowerment was very much at the forefront of the care package. We looked at four care plans to check this. For one of the people, although an assessment/initial care plan had been completed, a full care plan had not been formulated. An immediate requirement was issued for one to be put in place, so that there was detailed information for staff of the care to be provided and monitored and reviewed. The information from the assessent/initial care plan was transferred during the visit, but further information about an identified need that had been highlighted during the visit was asked to be added. Care Homes for Older People Page 13 of 31 Evidence: The other care plans included relevant information about people. However, despite the care plans being reviewed, it had not always resulted in action to address issues that had been highlighted. For example, two people had lost weight. The information on one of the care plans told us this had not been actioned until 3 months later when the person continued to lose weight. When intervention had been sought the action taken to address this had not been added to the care plan, although staff were aware of what this was. Another care plan identified weight loss, again over 3 months and no intervention had been sought. The day after the inspection, the managing director emailed to say this had been followed up with the GP. Taking action when people lost weight had been highlighted at the last inspection and a recommendation made. Clearly, this was continuing to happen and is a concern that peoples weight and therefore their health needs are not being monitored satisfactorily and therefore a requirement has been made. When we spoke to staff they identified when advice should be sought about a person losing weight, despite not following this. A meeting with the provider told us this had not been done, because they use the MUST assessment tool and the person did not meet htis criteria. Risk assessments were in place, but the falls risk assessment and monitoring of accidents for one person did not serve any purpose as there was no documented information of the actual risk from the falls or of the action taken to minimise risks, although when we spoke to staff they knew what this was. The care plans identified that health care professionals did visit people to assist in maintaining their health care needs. This was confirmed when we spoke with people. When we spoke with staff they showed a good knowledge of peoples diagnosis and could verbally describe the health and personal care needs of the people they cared for. When we observed staff working there was clear and respectful communication between people and staff and staff treated people in a kind manner. Staff spoke clearly and at a steady pace with people. On the whole, we saw that people were wearing clean clothes and attention had been paid to their hair and nail care. This indicated respect and dignity by staff when caring for them. An adult safeguarding referral had been made in January 2009, which had highlighted poor medication practices. The service had addressed the agreed actions from the investigation and taken action to improve practice where necessary. A sample of three peoples medications in stock and medication records were checked. Care Homes for Older People Page 14 of 31 Evidence: It was noted that handwritten entries were not countersigned as good practice, to confirm the information was correct. This could result in errors being made in the administration of medication. A meeting with the provider provided evidence that this had been done on the reverse side of the medication administration record. In addition, the amount of medication received for medication to be given as required was not recorded, neither was the date it was received. On the whole, medication storage arrangements were satisfactory, however, there was no lock for refrigerated medication, but it was kept in the locked room used to store medication. Whe we spoke to staff about training in medication, they said they had received training, but there was no certificated evidence of this on the staff file we checked. Care Homes for Older People Page 15 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. People were treated as individuals. They were as independent as they could be, lead their chosen lifestyle and were given the opportunity to make the most of their abilities. The care home could support some people better in following personal interests and activities. People were able to keep in touch with family, friends and representatives. People had meals that were good quality and on the whole met peoples expectations. Evidence: The AQAA told us after consulting with the person a social calendar is developed to meet their specific needs and preferences, there is an in-house shop and there is a flexible visiting policy in place and families welcomed. It also said the local vicar visits monthly and other denominations are notified of clients within the home and are welcomed. The persons social calendar was not described in the four peoples files we looked at or recalled when we spoke to people. The activity log had not been completed since January. We spent some time sitting with people in the lounges and their own rooms where we Care Homes for Older People Page 16 of 31 Evidence: were able to speak with them about the lifestyle they experienced at the home and whether their social, cultural, religious and recreational needs were met. We were able to observe their experiences of living in the home and their interactions with each other and the staff. During the observation we found that the majority of peoples moods were positive. On the day of the visit, the TV was on in the main lounge, but people were not watching it. The TV playing should be an activity, people wish to do, otherwise should be turned off and a more meaningful activity arranged. This was reflected in our conversations with people. They said, dont do anything during day just watch telly and they put telly on, but we dont take any notice. Another person described there were no activities, only TV and they get bored with it. Other comments about their daily life included, (they) look after us lovely, (its) not bad here, I like being able to please myself and (they) look after us ok. When we asked what was good about living there they said, you can please yourself, I go to town once or twice a week on my scooter and if you want anything, you tell lasses. In the afternoon, in the main lounge people were enjoying and joining in a music video. Two staff members said they have a DVD every afternoon about two oclock. One of them also said we play bingo and snakes and ladders. They said activities were advertised on the board outside the lounges. Another staff member said, an hour a shift in an afternoon is allocated to activities. When we spoke to people and their representatives it told us their representatives were able to visit the home at any time and were made to feel welcome. When we spoke to people about the meals it told us that generally people liked the meals they were served. They commented, dinners are good. Teas - not so keen. Cant really say why. I like toast, sandwiches. Sometimes I have ravioli, meals good, get plenty and (meals) alright. They described breakfast as cereal and toast and this is what we saw people eating. We saw the lunch time meal being served. The dining room was comfortable and provided a pleasant environment for people to dine in. A choice of meals were offered. People were served good portions and extra portions were provided as required. Generally, it was a positive and pleasant event. The meal was hot, smelt nice and looked appealing for people who didnt need their food blending. For those people, it was not nicely presented, as the food was mixed together as opposed to each item being served individually. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. Care staff were sensitive to those people who found it difficult to eat their meal themselves and needed assistance. They helped the person at their pace, making them feel comfortable and unhurried. Care Homes for Older People Page 17 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. A complaints procedure was in place that enabled people and their representatives to feel confident that any concerns they had would be listened to. Policies and procedures were in place and the service took action to protect people from abuse, but care planning and staff training was needed to reinforce this with some staff. Evidence: The AQAA stated a complaints procedure was in place, clients were recommended to engage a power of attorney (someone to act on their behalf should they be unable to do so) and a police check was undertaken on recruitment. We saw that a complaints pack was available should people need to complain. However, information about the CSCI, now needs updating, which the service need to address. The AQAA told us 1 complaint had been received and was awaiting an outcome. We saw this was being investigated when we looked at the complaints record. When we spoke to people they said they had no grumbles. When we spoke to staff they told us they all knew what to do if a person or their representative had concerns about the service. This included reporting any allegations, although they said they had, had no cause to use the procedures as theres no abuse here, despite being aware of the adult safeguarding referral that had been made. They were not all clear that all nature of abuse must be reported as one staff member Care Homes for Older People Page 18 of 31 Evidence: when given examples of swearing and staff raising their voices said if it wasnt serious they would pull them up myself and in another example given, give them (the staff member) the benefit of the doubt. A meeting with the provider, stated this would be addressed with them. The AQAA told us there were policies/procedures/codes of practice in place to protect people from harm and abuse, that had been reviewed in June 2008. The service had the local adult safeguarding policy and procedure, which was readily available for guidance if an incident took place. The acting manager was aware of the procedures to be followed in the event of any allegations being made. The acting manager stated staff had done adult safeguarding training, but when we looked at the training records for two staff, there was no evidence of this on file (see staffing). An adult safeguarding referral had been made, with concerns being raised about restraining people and poor medication practices. The investigation highlighted that although a falls risk assessment was in place, there was no assessment of the risk presented from falls and the action to be taken to minise the risk of falls, in this case, restraint. The provider and acting manager stated there was no-one now being restrained at the service in that way. As a result of the referral, the provider recognised failures in respect of medication and issues of concerns that had been raised within the referral were addressed with care staff and action taken where necessary. Care Homes for Older People Page 19 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. On the whole, there was a well maintained living environment that was clean, tidy and a comfortable environment for people to live and enjoy. Evidence: The AQAA told us in the last 12 months a 2 year refurbishment programme had been completed, including the dining room, residents participate in the choice of decor and soft furnishings and all clients before admission are encouraged to personalise their accommodation. It stated the home complies with infection control issues and personal equipment is available to all clients, following individual assessment which is maintained and serviced where required to meet current legislation. When we spoke to people they thought the home was fresh and clean. People were happy with their rooms, that most of them had personalised with pieces of their own furniture and possessions. It was good to see couples that lived there using one of their bedrooms as a day room. When we looked round the home, the environment was suitable for the needs of people that lived there. Generally, the home was clean and well decorated and maintained. Areas that needed addressing were the lock on a toilet door jamb upstairs, opposite the gate that had broken off and some carpets were soiled. There were notices in bathrooms reminding staff of their duties. Removing these would lend Care Homes for Older People Page 20 of 31 Evidence: itself better to providing a more homely environment for people to live. Also, we saw that staff did not always clean carpets, when someone had been incontinent and placed a chair over it. This does not control the spread and prevention of infection, nor enhance a clean and pleasant environment. It must be noted, there was no unpleasant smell on the day. Also, the cords to the emergency call systems in the lounge were wound round the actual call system and not accessible for people. This should be addressed, as it was highlighted at the last inspection. There were sufficient bathrooms and toilets for people that were appropriately located and easily accessible. The toilets had been adapted to assist people with their independence when going to the toilet. The communal lounges and dining area were generally well decorated and were a comfortable environment for people to live. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received support as there were enough staff on duty. On the whole, they could have confidence in the staff, because sufficient checks had been done to make sure they were suitable to care for them. An audit of staff files was needed to make sure certificates of qualifications and training were in place to confirm the training staff had undertaken. Evidence: When we spoke to people it told us that they had confidence in the staff that cared for them and that staff listened and acted on what they said and staff were available when needed. When we spoke to staff they said, generally there was enough staff to meet the individual needs of all people using service, but today they were one member of staff short. The acting manager was working on shift to help out. The AQAA stated staffing levels reflected the staffing forum (a guide to determine the minimum staffing levels). We looked at the staffing forum and checked this against the rota. The hours recommended were provided. The AQAA stated no staff had left in the last 12 months, which meant a consistent staff team was in place, which is important when caring for people. Care Homes for Older People Page 22 of 31 Evidence: When we observed staff on duty, they worked hard, were patient and showed empathy to people. There was mutual respect between people and staff and their conversations were relaxed and friendly. The owner in the AQAA told us a dementia care mapping course was to be given to staff to enhance the quality of life for people, the service endeavoured to always meet 50 ratios of staff holding NVQ Level 2, with 3/4 of the staff holding NVQ Level 2 in Care or equivalent and all staff receiving a recognised induction programme. The owner stated they had obtained the Investors in People Award December 2008. We looked at three staff files for their training records to confirm information in the AQAA and what staff had told us when we spoke with them. There was some evidence that training took place in three of the files, including, induction. The AQAA stated there was a recruitment policy in place and that everyone who had commenced employment in the last twelve months had satisfactory pre employment checks. Two personnel records were examined to check this. These showed that recruitment was conducted in a way that in the main protected people and included satisfactory references, a protection of vulnerable adults check (enabling a check to be made against whether the person is suitable to work with vulnerable people) and a criminal records bureau check, prior to completion of recruitment. In one instance a full employment history had not been maintained. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The acting manager had the qualifications required of the person in charge in day to day control of the delivery of care, but there were some aspects of the Care Home Regulations that hadnt been met. People controlled their own money where they were able and chose how to spend it, but records where the service held monies on behalf of people, needed to be kept in better order. The environment was safe for people and staff, because appropriate health and safety practices were carried out. Evidence: The acting manager was experienced in the care of older people and her direction and leadership promoted a relaxed and friendly atmosphere. The AQAA stated the temporary manager is awaiting registration confirmation. She holds the registered managers award qualification and is supported by the managing director. At the inspection the managing director stated a manager application had been submitted and they were advertising the deputy post. However, as can be seen throughout the report, there were some aspects of the Care Home Regulations that the acting manager hadnt met. When the manager was not on duty, responsibilities for the dayCare Homes for Older People Page 24 of 31 Evidence: to-day operation were carried out by the senior care on duty. The adult safeguarding referral had identified a notification of an injury that hadnt been reported immediately it had happened, because the acting manager had been on leave and the person left in charge was unaware they needed reporting. When we spoke to staff they said the manager was approachable and they felt confident in her. One said, Adeles brilliant. She can be stern, but deals with things professionally. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. It gave a a comprehensive picture of the current situation within the service, what they had improved in the last 12 months and what they could do better, to identify a plan for improving the quality of life for people. There was a comprehensive quality assurance programme in place as a method of auditing the service. It covered different topics each month. The AQAA stated regular staff meetings and comprehensive staff supervision, development and appraisal system is offered and they hold resident meetings to give them the opportunity of how the budget is spent with regard to recreational interests inside and outside the home. When we spoke to people and their representatives they expressed satisfaction with the service they received. The AQAA stated clients were advised to maintain financial independence, but some peoples monies was held by the home. It seemed that peoples finances were safeguarded, but the records were of poor quality, lacking clarity about where monies came in and went out to, the balance, what monies had been spent on and providing two signatures to verify transactions. The owner in the AQAA told us staff are fully trained in all mandatory areas, with all staff having training in prevention and control of infection and half of the catering staff and 20 of care staff had received training in safe food handling. We looked at three staff files for their training records to confirm the information in the AQAA and what staff had told us when we spoke with them. There was some evidence that training took place in three of the files, including, fire safety, moving and handling and food hygiene. The AQAA stated maintenance of equipment was in place for portable electrical equipment, lifts, hoists, fire detection and alarms, fire fighting equipment, emergency lighting, emergency call equipment, premises electrical circuits, heating and gas Care Homes for Older People Page 25 of 31 Evidence: appliances. Fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. Care Homes for Older People Page 26 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 27 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 1 7 15 Regulation 15 (1) A care plan must be put in place for the person identified. So that staff are clear about the care to be provided. 05/06/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Regulation 12 (1) (a) 04/09/2009 This also links to standard 8, health care and standard 31 day to day operations. When people lose weight, this must be brought to the attention of relevant health professionals. So that appropriate intervention is provided to promote and maintain peoples health. 2 7 13 Regulation 13 (4) (b) This also links to standard 8 health care, standard 18 protection and standard 31 day to day operations. The falls risk assessment must document the risk presented from falls and the 04/09/2009 Care Homes for Older People Page 28 of 31 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 action to be taken to minimise the risk of falls. So that there is documented information about interventions to be carried out for people identified as at risk of falling. 3 30 18 Regulation 19 Schedule 2 This also links to standard 9 medication, standard 18 protection and standard 31 day to day operations. Staff files must contain documentary evidence of the training staff have undertaken. To provide evidence of the training they have received appropriate to the work they perform. 4 30 18 Regulation 18 (1) (c) (i) 03/12/2009 This also links to standard 9 medication, standard 18 protection, standard 28 qualifications and standard 31 day to day operations. An audit must be done of staff training and where training is required this must be provided. So that staff receive the training appropriate to the work they perform. 04/09/2009 Care Homes for Older People Page 29 of 31 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 To verify the information about medication to be given to people, hand written entries in medication administration records should be double signed. To store all medication in line with good practice guidelines, a lock should be provided for the refrigerator that stores medication. A social care plan should be developed to meet peoples social, cultural, religious and recreational specific needs and preferences, so that they can be engaged in meaningful activities, which are appropriate for them. Where people need their food blending, each item of food should be blended separately, so that the meal is presented in a manner, which is attractive and appealing. So that people have access to equipment to maximise their independence and keep them safe, call systems with an accessible alarm facility should be available for them to use. To make sure people are protected by the homes recruitment practices, full employment histories, together with a satisfactory written explanation of any gaps in employment should be obtained. So that peoples financial interests can be seen to be safeguarded, financial transaction records must be kept in better order. So that the health, safety and welfare of people are promoted and protected all notifications of death, illness and other events should be reported to the Commission without delay. 2 9 3 12 4 15 5 19 6 29 7 35 8 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. 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