Inspection on 26/01/09 for Pear Tree Lodge

This inspection was carried out on 26th January 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pear Tree Lodge 01/02/07

Pear Tree Lodge 12/01/06

Pear Tree Lodge 30/09/05

Pear Tree Lodge 28/02/05

Pear Tree Lodge 23/11/04

Similar services:

Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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: Pear Tree Lodge Shaw healthcare (Homes) Limited Pear Tree Lodge 340 Preston Road Kenton Middlesex HA3 0QH     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: Ram Sooriah     Date: 2 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Pear Tree Lodge Pear Tree Lodge 340 Preston Road Shaw healthcare (Homes) Limited Kenton Middlesex HA3 0QH 02083851640 02083851642 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw healthcare (Homes) Limited Name of registered manager (if applicable) Mr Manny Tagulinao Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD (E) Date of last inspection Brief description of the care home Pear Tree Lodge belongs to Shaw Homes, a national provider of care services. The home is found on Preston Road and is about two minutes walk from local shops and facilities. It is easily accessible by public transport. There is a good bus service along the Preston Road and the Underground station is about five minutes walk away. There is limited parking in the grounds of the home, but additional parking can be found on the nearby roads. The home benefits from a maintained garden at the back Care Homes for Older People Page 4 of 32 care home 9 Over 65 9 0 Brief description of the care home and some lawn areas in the front and on the side of the building. The home is a converted big house. Residents are accommodated in single bedrooms on two floors. There are four bedrooms on the ground floor and five bedrooms on the first floor. The main kitchen, dining/lounge area and the laundry are on the ground floor. The first floor also has a dining/lounge area and a kitchenette. The home provides personal care to nine elderly residents of mixed gender with learning disabilities. It was previously registered for ten service users, but one of the bedrooms has been converted into an office area. The home charges 948 pounds weekly. At the time of the inspection there were nine residents in the home. 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: 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 report contains the findings of a key inspection that was carried out on Monday 26th January 2009 from 11:00-14:30 and on Thursday 29th January 2009 from 10:3014:30. The last key inspection of the service took place on the 1st February 2007, when the service was rated good. According to our approach to regulating care services, we then carried out an annual service review on the 3rd March 2008. We have however been monitoring the home, as we do for all regulated services, from notifications that are sent to us, as required by law, and from feedback from stakeholders and social and healthcare professionals. Care Homes for Older People Page 6 of 32 For this key inspection we collected evidence by looking at the plans of care for two residents and a sample of records that the home keeps, touring the premises, and conversing with four residents and five members of staff. We also received seven completed questionnaires from residents , eleven from members of staff and one from healthcare professionals. We also used the Annual Quality Assurance Assessment (AQAA) that was completed by the manager to inform this report. We would like to thank all people who kindly provided feedback to us about the service and the manager and all his staff for a kind welcome to the home and for their assistance during the course of the inspection. What the care home does well: What has improved since the last inspection? There are now care plans in place when residents develop short term needs such as when they have a chest infection. All areas of the home were clean at the time of this inspection including the Kitchenette area. This was not so clean during the inspection in February 2007. Recruitment procedures have improved. The personnel files of two new applicants had all the necessary checks and records as required by legislation. The home now makes sure that residents are appropriately consulted when things are purchased for them. In the past documentary evidence was not always kept about how residents were consulted when things were bought for them and their rooms with their personal money, particularly from charity shops. We noted that when the residents are Care Homes for Older People Page 8 of 32 not able to make an informed decision then the relatives/representatives or advocates of the residents are consulted. 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. 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 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. Residents have the opportunity to visit the home and are provided with the relevant information for them to decide if they would like to live in the home. The staff team are familiar with the needs of the residents and are able to meet these in a holistic manner. Evidence: We noted that the home has kept the service users guide and the statement of purpose updated. We were informed that these are provided to all prospective residents for them to learn about the service that the home offers and for them to decide if they would like to move into the home. The manager said that the relatives/representatives of prospective residents are encouraged to visit the home and to meet staff and other residents who live in the home. In the case of a newly admitted resident we were informed that the manager visited Care Homes for Older People Page 11 of 32 Evidence: the person to assess her needs and to complete a preadmission assessment. The care records contained this document and also a copy of the local authority assessment of the needs of the person. We found that as a result, the manager and his staff had enough information to decide whether they would be able to meet the needs of the prospective client. We found that all residents were given a contract/statement of terms and conditions when they were offered a place in the home. These were signed where possible by the resident or next of kin. The residents that are admitted to the home meet the category of registration of the home. The manager and his staff have experience in caring for this group of residents and are fully aware of their needs, including the cultural and spiritual needs of the residents. These needs are assessed and recorded as part of the assessment of needs and are addressed in the care plans. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans of residents are personalised and addressed the needs of residents using a person centered approach. These are reviewed and kept up to date. The home on the whole ensures that residents health is appropriately promoted and maintained and that they have access to the relevant healthcare services according to their assessed needs. Medicines management in the home is of a good standard to ensure the safety of residents. Residents end of life care needs are appropriately addressed in their care plans to make sure that these will be met when the time comes. Evidence: We looked at the care plans of two residents, then talked to them and looked at their rooms and asked staff about their care, to find out if the care plans reflect the care and support that the residents receive. The care plans follow a Person Centered Format and the needs of residents are Care Homes for Older People Page 13 of 32 Evidence: addressed from the residents perspectives. Many areas of the care plans are written in an easy to read format, with pictures and signs, and in large font. The plan of care starts with information about the person, the circle of people around the resident including the photographs of these people where available. This is followed with information about the needs of the resident and the areas where they would require care and support as well as the type and care and support that they would require. We think that the needs of residents are appropriately assessed and recorded. This allows for appropriate care plans to be put in place that detail the action that the individual resident would like to be taken to meet their needs. The care plans and the risk assessments are on the whole reviewed monthly. We noted that risk assessments for falls, manual handling risk assessments, pressure sore risk assessments and nutritional risk assessments were in place to address the safety of residents. We think that the nutritional risk assessment might not be sensitive enough to detect changes in the nutritional status of residents. On one occasion the nutritional risk assessment for a resident did not change to show that the resident might be at an increased risk of malnutrition, when they lost about 10 of their body weight. Staff agreed with the above and we noted on the second day of the inspection that staff were thinking of introducing a new nutritional screening tool. We also discussed the action that staff were taking to manage the loss in weight. It seemed that staff were monitoring the weight of the resident closely, but no weight was recorded for the month of December. There was a note to say that the resident refused to be weighed on a particular day and there was no indication that staff had re-visited the resident to re-weigh them. A range of other risk assessments are carried out to make sure that residents are able to engage in a number of activities that promotes their independence and inclusion in the local community, while ensuring their safety. Care plans and risk assessments are generally agreed with residents or their representatives where possible. In a few cases the residents do not have people close to them and in these cases there is no other person to agree the care plans with, except with representatives from the funding authority such as the social worker. All residents presented as clean, appropriately dressed and groomed. Male residents were appropriately shaved. The personal care records of residents were appropriately Care Homes for Older People Page 14 of 32 Evidence: completed to show that residents personal hygiene was maintained according to their individual care plan. Residents feedback suggests that staff attend to the personal care needs of the residents in a manner that promotes their dignity and privacy. We noted the use of incontinence sheets in the home. These are placed on the chairs of residents in the communal areas and are visible to visitors. They therefore raise issues about dignity and privacy as these make it easy to identify the residents who are incontinent. The use of incontinence sheets should be used as a last resort and based on an individual continence assessment and recorded in the care plan of the resident to manage incontinence. One resident who had a continence sheet did not have a continence assessment and care plan that identified the need for the continence sheet. Incontinence sheets were however not in use on the second day of the inspection. At the time of the inspection, there were no residents with pressure ulcers in the home, but a resident had previously developed two small pressure ulcers that have now healed. Whilst we found that the home had managed the pressure ulcers relatively well for these to heal, we noted that the resident did not have any equipment in place and that there was no care plan addressing the pressure ulcers. We also did not find photographs or wound mapping to monitor the progress of the ulcers and there were no referral to the district nurses. Staff said that they used sudocream on the broken area. Whilst sudocream is good as a barrier cream, all wounds should be covered with a dressing to create the optimal conditions to promote wound healing. We also observed that some residents would benefit from seating assessments because of their posture and the current availability of specialised items of furniture. For example a resident kept sliding from his chair. The manager stated that he would arrange for seating assessments to be carried out where required. The care plans clearly address the end of life care needs of residents including the wishes and expectations of residents about the future. We were informed that the home will look after residents who have end of life care needs as far as possible and that the residents would only be transferred to another establishment if the staff are unable to meet the needs of the residents. Although the home provides personal care, few people are ever transferred to care home with nursing when they become more frail. We looked at the management of medication in the home. The front of the medicines folder contains records that show that all people who administer medicines have had a competency assessment and training in the administration of medicines. Care Homes for Older People Page 15 of 32 Evidence: The home kept good records about the management of medication and we were able to note that the amounts of all medicines were recorded when received in the home. There were signatures when staff administer medicines and no signs of omissions.The location and instructions to administer creams and lotions were clearly documented. The home did not keep any control medicines and there were no medicines that required to be kept in a fridge. There was however a fridge to use for the storage of medicines if that was required. The fridge was however, not lockable, and staff had put a lockable box in the fridge to store medicines, if that was required. We noted that the box could easily be carried away and this therefore raises questions about the safety of any medicines if these are stored in the lockable box in the fridge. It would be better if the fridge itself was lockable. The manager later told us that the home has acquired a fully lockable medicines fridge. Care Homes for Older People Page 16 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. Residents have the opportunity to engage in a range of internal and external activities that suit their needs. Meals that are provided in the home are varied and sufficiently nutritious to meet the dietary needs of residents. Evidence: The care records contain appropriate information about the social and recreational needs of residents. These are recorded in the pen picture of residents and in the assessment of needs. Care plans were then put in place to address the individual needs of residents. Each resident also had a weekly programme of activities that had been devised according to their needs, wishes and choices. We observed residents interacting among themselves and members of staff, reading newspapers, listening to music or just relaxing in their chairs. There were board games, bingo, painting and colouring for them to take part in if they wished to. Residents feedback suggests that they were satisfied with the activities that they were engaged in. Care Homes for Older People Page 17 of 32 Evidence: The home does not employ an activities coordinator and that task is delegated to one member of staff. Most activities are carried out by members of staff except for a dance and music/exercise session that is conducted by a physio assistant once a week or when outside entertainers visit the home. We were informed that residents enjoy going out in the local community, visiting local shops and restaurants. For example residents go restaurants when there is a birthday to celebrate. The home also arranges holidays for residents who wish to go on holidays. A number of residents confirmed that they have been on holidays. We observed that one of the residents regularly goes out for walks and bus trips in the local community, accompanied by a care worker. A few goes to day centers and one goes to a social club one a week. The home does not have its own transport and uses public transport or minicabs when that is necessary. Ministers from the local churches visit the home to see residents on a regular basis. we did not see any visitors in the home during our inspection but we were told that relatives and the friends of relatives are encouraged to visit the residents. The home has an open policy for visiting but encourages visitors to come during the day. We observed lunch being served on the second day of the inspection. There was sausages, mashed potatoes and sprouts. Most residents opted for the sausages and we were told that other options are provided to those who do not want the main meal of the day. The home has a four weekly menus and the menus are presented to residents in the form of pictures for them to make a decision about the meals that they would like to have. Records were kept about the meals that were taken by residents. Whilst most residents had the opportunity to make choices about their meals, we noted that one resident who was on a reducing diet was not able to make a choice and was given her meal according to the decision that has been made by a member of staff. Whilst we understand the motive for doing that, we think that the resident could have been encouraged to make some choices but with an emphasis on the need to have a reducing diet. The kitchen was clean and tidy during the inspection. All records were kept as required and food that was kept in the fridge and freezer had an expiry date on them.The home was rated a 3 star service out of 5 stars, following the latest visit by the local environmental officer. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 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. Complaints and allegations and suspicions of abuse are taken seriously and are appropriately dealt with by the organisation to ensure the safety of people who live in the home. Evidence: According to the AQAA, the home has not had any complaints. There has however been an anonymous complaint that was received by the Commission since the last key inspection, and that was referred to the safeguarding adult team of the local borough as this included some allegations of financial abuse. These were appropriately investigated by the organisation and there was no evidence to substantiate the allegations that were made. Our experience of the service has told us that the organisation and the service take complaints seriously and address these in an appropriate manner when these are received. The complaints procedure is clearly displayed in the home and available in an easy to read format for residents. A safeguarding adult procedure is in place an this been kept up to date. All staff have had training in safeguarding adult and are familiar with the action to take if there are allegations or suspicions of abuse. Care Homes for Older People Page 20 of 32 Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel that the home provides a clean, homely and personalised environment for them. Evidence: The front area and the grounds at the back of the home were maintained to a good standard, despite the time of the year. The lawn looked well maintained and there were many plants and shrubs that provided a pleasant environment. There were benches and tables for residents to sit outside when the weather is nice. The exterior of the building looked like it might benefit from some maintenance. There were some cracks in the rendering/paint and some wooden window sills seem to be in need of repair/replacing. The interior of the home was warm, airy and free from odours. We noted that the carpet in the corridor of the first floor was being replaced when we visited the home on the first day of the inspection. We also saw that a number of bedrooms have been redecorated. A redecoration and maintenance plan was available for inspection. The lounge/communal areas on both floors were appropriately furnished and decorated. The bedrooms of residents were on the whole appropriately decorated and Care Homes for Older People Page 22 of 32 Evidence: maintained. We noted that the bedrooms were personalised according to the needs, likes and wishes of the residents. None of the residents had a key to their rooms although this facility was available if required. The standard of cleaning in the home is generally good. There is one domestic on duty daily and the latter is responsible for cleaning the home. The home is a home for personal care and has a sluice but there is no sluicing disinfector. The training records showed that staff have had training in infection control and in the Control of Substances Hazardous to Health. Care Homes for Older People Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides well qualified staff and in sufficient numbers to meet the needs of the residents. Evidence: The manager is supernumerary to the staff team. During the day there is a team leader for the whole home and a carer on each floor. At night there is one team leader and one care worker. These numbers seem to be adequate for the numbers and needs of residents that are accommodated in the home. We looked at the personnel files of two members of staff. These on the whole contained all the necessary records as required by legislation. There were appropriately completed application forms, proof of identity, evidence of CRB checks, interview notes and appropriate references. The training records showed that all members of staff receive induction to the home and induction as per the common induction standards from Skills For Care, once they become a permanent member of staff. We found that bank members of staff receive an induction to the home and mandatory training, but do not complete the common induction standards. Care Homes for Older People Page 24 of 32 Evidence: The care staff team consists of 12 care workers and out of this number, 11 are NVQ qualified in care. 10 are also qualified in NVQ for dementia care. The only member of staff without an NVQ qualification is in the process of completing this qualification. Domestics and the chef also have NVQs in their relevant areas of work. The home is accredited to Investors In People (IIP) and as a result is able to demonstrate its commitment in investing in its staffs personal development. There are individual learning plans for staff and a development and training plan for the whole workforce. All members of staff that we spoke to, said that they are satisfied with the standard of training that they receive in the home. They said that they get a good standard of training that prepares them for a career in social care. Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager runs the home in an open and inclusive manner. The quality management system is effective in ensuring consistent improvement in the standard of service that the home provides. The personal money of residents is clearly recorded and managed to protect the interests of residents. Whilst health and safety policies and procedures are generally complied with, an issue was noted with the window restrainers that must be addressed to make sure that residents are safe. Evidence: The manager of the home has been in post prior to the inception of the Commission. He keeps himself updated, not only with mandatory training but also with training in new aspects of the provision of care such as, the soon to be implemented Deprivation of Liberty Safeguards. He is a trained nurse and has a qualification in management. Care Homes for Older People Page 26 of 32 Evidence: The manager benefits not only from good line management support but also support from his staff team. There is a well developed internal management structure. All senior staff in the home are delegated responsibilities and duties, with the manager overseeing that these duties/tasks are completed. As a result everybody is clear about their responsibility and role. Minutes of staff meetings were available for inspection and showed that these are held at least every three months. Residents meetings are held every two months according to a prepared programme. Minutes were available for residents meetings as well. The home uses the quality management system of Shaw Homes. There are quarterly audits that are scheduled by the head office and that are completed by the home. These were available for inspection. Action plans are drawn to address areas of non compliance. The home also carries out a six monthly customer survey. A report is generally produced to address the findings of the survey. We looked at the management of residents personal finance. We noted that each resident had clear information in their care plan detailing the management of their finance. This was clear enough to enable a person reading the information get a full understanding of the management of the residents money.The information included the types of benefits and the amount of money that each resident receive, the way that these are handled, information about bank accounts, and the way that the personal money of the resident is spent. Records confirmed that residents property, valuables and possessions are checked and recorded when admitted to the home. This is good practice. We checked the management of health and safety in the home by looking at the health and safety and maintenance records, touring the premises and talking to people. We found that items of equipment are appropriately maintained and that the appropriate checks are carried out. The home has an electric wiring test certificate, a portable appliances test certificate, and gas safety certificate. There were weekly fire detector tests, monthly emergency lights tests, and checks on the fire detection and fire fighting equipment by a contractor. Lifting equipment, including the lift, was also maintained as required. A fire risk assessment and a fire emergency plan were up to date and available for inspection. A health and safety risk assessment was also in place. Care Homes for Older People Page 27 of 32 Evidence: We noted during a tour of the premises, that at least three bedrooms windows on the first floor did not have window restrainers. As a result we found that a person could easily pass through the opened windows, if they wanted to, and fall from a height. The manager stated that he had a list of the window restrainers that needed replacing, but we were not sure if that list contained all the windows that needed window restrainers. We expressed our concerns about this issue, the need to have all the windows checked and for window restrainers to be in place as soon as possible. We also suggested that the manager has a risk assessment in the interim, as the home accommodates some very vulnerable residents. Care Homes for Older People Page 28 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 29 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 7 12 Residents who develop pressure ulcers, must be assessed for pressure relief equipment and appropriate wound care. A care plan must also be put in place to detail the management of the pressure ulcers. To provide evidence that a high standard of pressure area care is given to residents 23/04/2009 2 38 13 The manager must ensure 23/04/2009 that all windows are checked and risk assessed with regards to having a window restrainer in place. To ensure the safety of people who use the service 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 Care Homes for Older People Page 30 of 32 1 8 Residents must have seating assessments where required. This could be indicative when residents look uncomfortable in their armchairs and when they keep sliding down the chairs. That residents weights are monitored at least monthly particularly when they are loosing weight. If they cannot be weighed on a particular day, they should then be revisited another day. That incontinence sheets be used as a last resort to manage incontinence based on an individual continence assessment and recorded in the care plan. This is required to make sure that residents privacy and dignity are always maintained to the highest level. When staff choose residents meals, they must balance the likes and dislikes of the residents and the capacity/ability of residents to make choices about their meals with the health benefits of the meals. The exterior of the building should be given some attention, including the wooden window sills that look as needing maintenance or replaced. 2 8 3 8 4 15 5 19 Care Homes for Older People Page 31 of 32 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. 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