Inspection on 12/08/09 for Old Gates Nursing & Residential Home

This inspection was carried out on 12th 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Old Gates Nursing & Residential... 04/02/10

Old Gates Nursing & Residential... 27/05/08

Old Gates Nursing & Residential... 30/05/07

Old Gates Nursing & Residential... 06/06/06

Old Gates Nursing & Residential... 01/11/05

Old Gates Nursing & Residential... 03/06/05

Old Gates Nursing & Residential... 09/11/04

Old Gates Nursing & Residential... 18/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Old Gates Nursing & Residential Home Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU     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: Christopher Bond     Date: 1 2 0 8 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 29 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 29 Information about the care home Name of care home: Address: Old Gates Nursing & Residential Home Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU 01254209924 01254200948 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) : BUPA Care Homes (CFHCare) Ltd care home 90 Number of places (if applicable): Under 65 Over 65 0 90 0 dementia old age, not falling within any other category physical disability Additional conditions: 90 0 90 The registered person may provide the following category of service only: Care home with Nursing - code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Physical disability - Code PD, Dementia Code DE. The maximum number of service users who can be accommodated is: 90. Date of last inspection Brief description of the care home Old Gates Nursing and Residential Home is owned by BUPA Care Homes Limited. The home provides long stay and respite care for up to 90 adults who require help with personal care or who have nursing care needs. The home is a purpose built, single storey building. It comprises one reception area and three separate houses. Holly House accommodates people with nursing and personal care needs. Rowan House accommodates people who have a diagnosis of dementia and Cherry House accommodates people who require assistance with personal care. Each house has its Care Homes for Older People Page 4 of 29 Brief description of the care home own lounge/dining area and small kitchen. There are 30 single bedrooms in each. The bedrooms do not have en-suite facilities but there are sufficient bathrooms and toilets close to bedrooms and communal areas. Old Gates is situated in a residential area, close to local amenities, including a Post Office, churches, public houses and shops. It stands in landscaped grounds with several garden and patio areas. There are adequate car parking spaces. An information pack about Old Gates is sent out to anyone making enquiries about the home. The latest Commission for Social Care Inspection report is on display in the foyer and copies are available from the manager on request. The weekly fees as of 27th May 2007 ranged between #341.00 and #479.00 Additional charges were made for hairdressing, newspapers and toiletries. Care Homes for Older People Page 5 of 29 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: As part of this key inspection process we undertook a visit to the home on the 12th August 2009. This lasted for seven hours and we looked at the information that the service held regarding the care of the people who lived there. We also looked at the other records that the home had, such as information about the care staff, what training they had received and how this enabled them to do provide a better standard of care. We also looked at what arrangements were in place to help the people who use the service to voice their concerns and views, and how well they were safeguarded from harm. Safety certificates and insurance documents were also seen. We spoke to seven residents about their experiences and care at Old Gates Nursing Care Homes for Older People Page 6 of 29 Home. We also spoke to the area manager of the service, a manager from another of the homes in the Bupa group, seven of the care staff and the administrative assistant. There were several visitors to the home whilst we were there. We spoke to two visitors as part of this inspection. Every year we ask the manager of the service to send us an Annual Quality Assurance Assessment that tells us about her views on how well the service is progressing. This also tells us about what changes have been made and what future changes will be needed. This document is used by us to focus out inspection activity and provides us with essential information. What the care home does well: What has improved since the last inspection? What they could do better: There is a need to ensure that staffing within this service is consistent and that there Care Homes for Older People Page 8 of 29 are enough care staff employed in each unit to ensure that the needs of the residents are met as fully as possible. We found that there were staffing issues in the Dementia unit (Rowan) and the morale was quite low among the care staff. Cleanliness issues were also identified in this unit. We saw dried food on some of the chairs in the dining area and some areas had an unpleasant odour. It is important that the people who use the service live in pleasant and hygienic surroundings. Continence issues were also identified and the manager must ensure that there are enough staff to assist people to the toilet regularly and change people frequently. This will help ensure that the people who use the service maintain their dignity and quality of life. The caring organisation also need to ensure that a manger is registered for this service as soon as possible. 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 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 10 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. Information is gathered regarding nursing and care needs before people are admitted to this home: this helps the carers to provide proper care and support. People had enough information about this home to make a decision as to whether the service was right for them. Evidence: We found that this home had information available that was given to prospective residents and their families about what services the home provides. There were two documents available; the Service User Guide and the Statement of Purpose. These contained information about the accommodation, the manager, the staff, and other important information such as the vision and values of the home, and the complaints procedure. There were also a number of leaflets available in the hallway of the home that gave general information about the services that Bupa offered, and other generic Care Homes for Older People Page 11 of 29 Evidence: information about Bupa care homes. We spoke to a number residents during this inspection. We were told that sufficient information was given to residents and their families prior to moving in. The manager also invited people to look round the home to view the facilities before they made a decision to move to this service. All of the care plans that we looked at contained pre- admission assessments that documented peoples needs before they moved in. These were used to assess whether the service could meet their needs, and also to gather information to help ensure that current health care requirements were being met consistently. Care Homes for Older People Page 12 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. Care provision was generally good, and the people who use this service are having their needs met in a planned and consistent way. Continence care on the dementia unit was in need of review due to offensive smells in some areas. Evidence: All of the people who lived at this home had a care plan that documented their daily health care and social needs. There was plenty of information in each plan regarding areas such as nutrition, skin condition, risk of falling, social and spiritual needs, and general health needs. This information was used by the care staff on a daily basis in order that peoples health could be monitored and to ensure that they received the right type of care. There was also a lifestyle profile that explained the residents personal preferences, such as what time they liked to get up and go to bed, and what their daily routines were. This helped the care staff to be more aware of peoples individual preferences. Care Homes for Older People Page 13 of 29 Evidence: Some people needed special care because of pressure sores, or skin tears. This was recorded clearly within the care plan and any care the person received was documented properly. There were special mattresses on some of the beds to help relieve pressure for residents who were more prone to tissue damage. There were also pressure pads and other equipment available to help prevent pressure sores. A recognized tool was used within the care plans to assess and review skin condition. There was evidence that residents were turned regularly whilst in bed to aid pressure relief. People told us this during our visit. One person said, the girls come round an turn me every two hours, they also help me to get in and out of bed. We also found that peoples weight was being recorded properly and regularly within the care plan. A change in someones weight could be an indicator of underlying health issues. Weight was being closely monitored. There were three separate units at this home. Each unit cared for people with differing needs. For example, one of the units (Rowan unit) catered for residents with dementia. The care plans were similar in each area and there was evidence that each plan was reviewed in detail on a regular basis. This helped to ensure that current care needs were being addressed adequately and that everyone involved in the persons care had good, consistent care. Some people who lived at this home had been prescribed medication by their doctor and there were records to show that this was being administered appropriately by the staff. Storage was secure and there were policies and procedures to guide the care staff when administering medication. Some people had been prescribed medication that was controlled because of its content or strength. This was being stored and dealt with as it should be. We did find that occasionally there were signatures missing within the daily records, so it could not be confirmed whether someones medication had been given correctly at the right time. This had been identified in the quality control checks done by the caring organisation and steps were being taken to rectify this. We observed care staff in the three units providing care and conversing with the people who used the service. It was good to see that people were being spoken to with respect and that, generally, a good standard of care was being given. Several residents were spoken to about their care. One resident said, Its nice, I cant fault the care. Another person told us Of course, Id rather be at home but this is the next best thing. We did, however, have concerns about the delivery of care in the dementia unit. There Care Homes for Older People Page 14 of 29 Evidence: were four carers on duty whilst we were there. The morale in this unit seemed to be quite low and the carers told us that they were frequently left short staffed. This meant that cleaning duties were sometimes left incomplete because personal care was a priority. Many of the residents on this unit had complex care needs and the manager of the home needs to look at what staffing levels are appropriate. The staff told us that it was difficult to provide an adequate level of care all of the time. We noticed that the level of care that was required in this unit was very high and occasionally the people who used the service were quite challenging. There were times when we saw that the trained staff and the carers on this unit were rushed and were finding it difficult to address everyones needs appropriately. This was particularly evident over lunchtime when people needed assistance when eating. It is hard to ensure that all peoples needs are met sufficiently and further staffing on this unit would have eased the pressure in what looked to be, at times, a highly charged situation. The information that we received was that this situation was happening more frequently and staffing was a long term problem. Although the standard of cleanliness throughout the home was good, there were some areas of the dementia unit that did not smell very nice. care must be taken to ensure that everyones continence needs are being met, and that peoples dignity is being preserved at all times. This means having enough carers on duty to ensure that people are changed regularly and assisted to the toilet on a frequent basis. Care Homes for Older People Page 15 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 generally frequent and planned. Meals were enjoyed by the people who use the service and a good variety was offered. Visitors were encouraged and valued relationships promoted. Evidence: Lunch was being served whilst we were at the home. The meal was nicely cooked and presented, and there was a choice of food for the residents. We spoke to five residents about the food that was served at the home and all said that the quality of the catering was very good and that they looked forward to meal times. Meals were prepared centrally in the main kitchen and delivered to the units on food trolleys. Everyone we spoke to said that the food remained hot during transit and was fine when it was being eaten. Snacks could be prepared on the units. The dining areas were pleasant and the tables were set nicely. One of the people who used this service commented; The food isnt bad, I can usually get something that I like, and its usually decently cooked. Each table had a card with the menu for the day on it. We looked at the menus for the home and it was clear that a balanced, nutritional meal was always planned. Care Homes for Older People Page 16 of 29 Evidence: The care plans held important information about peoples likes and dislikes regarding their diet. It was clear that special diets were provided for those who had diabetes. Peoples social history was also recorded in the form of a Map of Life. This held information about what employment people had experienced, information about their family, what holidays they have enjoyed, and what schools they have attended. This information helps the care staff to create conversation and helps people to feel at home. This service had an activities co-ordinator to oversee how daily activities were provided. There was a planned programme of activity that the residents could view and make a decision as to whether they would like to join in. We were told by the area manager that activities were regular and that games, live entertainers, sing-a-longs, arts and crafts, reminiscence therapy, music, and board games were regular feature of life within the home. Five residents confirmed that activities took place and that there was usually something to do. Each unit had a record of recent activities that had taken place. We noticed in the records that only two recent activities had taken place in the dementia unit. Stimulating activities should be a regular feature and activities should be available that people with dementia can be involved in. It was good to see that there were wall displays throughout the three units that stimulated memories. These included local historical photographs, local artwork, domestic equipment from the early 20th century and musical instruments. It was clear that the service was trying hard to ensure that people were entertained and stimulated. Five of the residents told us that they found the activities to be regular and stimulating. One person commented, Theres a good atmosphere and something to do every day. There were visitors arriving at the home whilst we were there. We spoke to two visitors who told us that they were always made welcome and encouraged to visit. One gentleman told us: Its a nice place, and Im confident that a good standard of care is given, the staff are always very friendly. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints about the service are handled properly and taken seriously. The processes when voicing concerns about this home are clear and easy to follow, meaning that people feel listened to. People are safer because safeguarding issues are promoted and taken seriously. Evidence: We looked at the information that was available in the home that helped to safeguard people from harm. There were policies and procedures to guide the manager and staff in safeguarding issues. The area manager was aware of what action to take should a safeguarding issue arise within the service. The care staff had also been trained in protecting vulnerable adults and the staff that we spoke to were aware of safeguarding issues and how to report things that they were unsure or uncomfortable about. Most of the care staff had also received this training via a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). A safeguarding incident had taken place on one of the units before our arrival at the home and the nurse in charge had followed the correct procedure in informing the local authority about this. Relatives of the person were also being informed. There were pamphlets on each unit informing care staff of the local authorities policy on safeguarding people, with advice and contact numbers. Care Homes for Older People Page 18 of 29 Evidence: The complaints procedure was displayed in the home and was part of the Service User Guide. Timescales were given for the handling of complaints and the area manager confirmed that all complaints and concerns were handled properly and seriously. The manager ensured that people were able to access a current and full complaints procedure that held current information, should they wish to voice a concern. There had been a recent concern expressed regarding cleanliness at this home. The manager had dealt with this properly and investigated the circumstances under the homes complaints procedure. We were able to track what action had been taken during our visit. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents of this service live in a generally clean and pleasant home with nice things around them. There were, however, unpleasant smells on one of the units and the cleaning and continence care was an issue. Evidence: The nurses in charge of each unit accompanied us on a tour of the bedrooms and communal facilities. The bedrooms were of a good size and there were plenty of personal possessions around that people had brought with them to make their rooms more homely and pleasant. Four of the residents that we spoke to during our visit told us that they were pleased with their bedrooms and felt comfortable there. One resident commented, I cant fault it, I have a lovely TV and a grand view of the garden, its lovely. The home was generally decorated well. The area manager told us that there were plans to refurbish and redecorate the units in the near future. There were nice garden areas around the home and access to these was good. A gardener was employed to keep these areas looking nice. There were areas for people to sit out in good weather. Care Homes for Older People Page 20 of 29 Evidence: There were adequate bathroom facilities throughout the building. Bathrooms were decorated well and bathing facilities were good. There was a choice of showers or baths. The home was clean and fresh smelling in most areas. Domestics were cleaning the rooms whilst we were there and some of the residents told us that the service was generally clean and pleasant. We did, however, find that there were rooms and certain areas of the dementia unit (Rowan) that did not smell very nice. The nurse in charge, and the area manager were aware of this. The manager had spoken to the staff and domestics who worked on Rowan unit regarding the importance of cleanliness and hygiene. The nurse who was on duty in this unit told us that access to appropriate cleaning products was sometimes difficult, as these were locked away. The building should be fresh and clean at all times for the well-being and comfort of the residents. Although the furniture generally was of good quality, there were also cleanliness issues on Rowan unit due to food on some of the chairs in the dining area. We also noticed that in some of the bedrooms the mattresses were too large for the beds and there was a significant overhang. This could be a safety issue for those who may sit on the end of the bed as they would be unsupported and could fall. The area manager told us that this problem had been identified, and the wrong mattresses had been ordered. Measures were being taken to help ensure that people were safe. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing problems were an issue in one part of this service and this affected the ability of the care staff to address assessed need. Recruitment procedures were good, meaning that the residents were protected from unsuitable staff. Evidence: There were generally enough care staff on duty to help ensure that the assessed needs of the people who used this service were properly met. The staffing rotas were looked at and staffing levels were generally consistent. We spoke to three residents who told us that their needs were being met and that the carers always had time to listen and act upon issues. There was an appropriate mix of care staff to help ensure that all of the residents care needs were addressed. We did find, however, that there were staffing issues on the dementia unit (Rowan). The care staff that we spoke to were concerned that the assessed needs of the people who used this area of the service were sometimes not being met. One of the care staff had not turned in and a replacement carer had been asked to take another resident to hospital whilst we were there. This meant that the staffing levels were down. We did not see evidence of peoples needs not being met but the morale of the care staff was quite low. This needs to be addressed by the manager of the service to help ensure that the residents receive a positive level of care. Care Homes for Older People Page 22 of 29 Evidence: Recruitment was good within this service. Each of the care staff had a file where their information was kept, along with a current photograph. This is important because good information helps to ensure that the people who use the service remain safe, and protected from unsuitable care staff. The recruitment process was generic to Bupa homes and proper checks had been made on each carer prior to employment. The service had a training programme and care staff confirmed that they had recent instruction in care related matters and safety issues, such as ensuring that people with poor mobility are moved around the home safely and professionally. Most of the care staff had a nationally recognised qualification in care (National Vocational Qualification level 2 or 3), or were working towards this. A good training programme helps to ensure that the care staff have their skills and abilities updated and refreshed at regular intervals. There was a good induction process to help ensure that new care staff were competent before commencing their role. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good management of the home helps to ensure that quality issues are dealt with properly. Management and staffing issues in one of the units need to be addressed in order that the residents needs are met appropriately. Evidence: This service does not yet have a manager who is registered with the care Quality Commission. The current manager has made an application to be registered and is currently awaiting an outcome to this. We could not speak to the manager on the day of the inspection as she was unavailable. A manager from another Bupa home was available to help us with our inspection and the area manager of the service arrived shortly after. We were able to get sufficient information about the service, and the provision of care in all three of the units. We also spoke to the trained staff in each unit, and those responsible for ensuring that each unit ran properly. There was a good management structure within the service and three of the residents Care Homes for Older People Page 24 of 29 Evidence: who we spoke to said that they thought the home was managed well. Most of the care staff were positive about their role and the quality of care that was offered. There were morale issues on one of the units, as previously mentioned, and this needs to be addressed appropriately by the manager. Some of the residents had small amounts of money that were being held by the service. There were records to show that this was being managed properly and checked regularly. The service had an administration assistant who completed most of the paperwork for the service. This allowed the manager to concentrate on running the home, ensuring that the people who used the service were cared for properly. It was pleasing to see that the residents care was being planned properly and that recordings were clear and accurate. There was clear evidence of review in the plans that we looked. The manager was ensuring that people were being cared for professionally and properly. There were certificates to tell us that safety checks on major appliances were being carried out appropriately. Safety training was being carried out for the care staff in mandatory areas, and the home was adequately insured. This helped to show that people lived in a safer home and that their well- being was being protected. There were risk assessments available on peoples care plans to help ensure that areas of potential hazard were being addressed and acted upon. The manager was ensuring that moving and handling was a key issue, and that people who had mobility issues were being helped to move around the home safely and professionally by the care staff. The caring organisation had arranged for external quality checks to be undertaken in key areas and reports were available for these. This showed that the service was taking quality issues seriously and area of need were being addressed. A good example of this was a recent audit of the administration of medication. Issues were identified and were addressed appropriately. Reports done by a representative of the company under Regulation 26 of the Care Home Regulations were available for us to view, including responses to recent complaints. Regular maintenance checks were taking place and there were records available to show the results of these. Care Homes for Older People Page 25 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(1)(a) In order to ensure that 31/07/2008 people using the service have the amount of support they need, when they need it, the manager must review the staffing levels on each house and review how the staff are deployed at various times of the day. Care Homes for Older People Page 26 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 8 12 The care of those with continence issues must be reviewed, and support must be available to deal with continence needs. This is to ensure that peoples comfort and dignity is paramount. 25/09/2009 2 26 12 The bedrooms and communal areas must smell fresh in all areas of the home. Action must be taken to eliminate unpleasant odours. This is to help ensure that those who use this service live in a clean and fresh smelling home to ensure that their welfare, comfort and dignity is addressed at all times. 25/09/2009 3 26 12 Standards of cleanliness must be consistent throughout the home. This is to help ensure that 25/09/2009 Care Homes for Older People Page 27 of 29 all of the people who use this service live in a clean and hygeinic home. Tis is to protect their health and dignity. 4 31 9 A competent and experienced manager must be registered by the Care Quality Commission. This is to help ensure that the service is run appropriately and in the best interest of those who use it. 30/09/2009 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 9 Medication records should continue to be monitored and errors addressed accordingly. The administration of medication should be recorded at all times. Activities for those people who have dementia should be frequent and appropriate. Special activities should be developed that are suitable for all to participate in. The manager should ensure that mattresses in some of the bedrooms are correctly fitting and do not present a safety issue. Management issues in Rowan unit should be addressed appropriately to improve care and cleanliness issues. Morale amongst the staff in this unit also needs to be addressed. 2 12 3 24 4 31 Care Homes for Older People Page 28 of 29 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. 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