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Inspection on 04/03/09 for Penvose Residential Home

Also see our care home review for Penvose Residential Home for more information

This inspection was carried out on 4th March 2009.

CSCI 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

Penvose provides a comfortable home for older people in need of twenty-four hour care. People said they appreciated the small size of the home and that they were happy and felt safe. The home is well staffed and staff were described as kind and caring. Staff turnover is very low and the staff felt they worked well as a team. Food is plentiful, choices of menu are available and dietary needs are met. People have the opportunity to prepare their own meals or to do some baking if they so wish.

What has improved since the last inspection?

The finished building work provides ample storage space as well as a purpose built utility room and a new kitchen. The majority of the staff team have obtained a National Vocational Qualification in Care, for which they had to demonstrate their knowledge and skills in caring for older people.

What the care home could do better:

The care plans require more detail with regards to specific health care needs, such as the management of diabetes, to ensure people`s well-being is maintained. The plans must be updated regularly to ensure consistency in care. Thorough recruitment procedures must be adhered to in order to safeguard people and ensure only suitable staff are employed at the home. Staff must receive training in the protection of vulnerable adults to ensure they recognise the signs and symptoms of abuse and be confident of their responsibilities should they suspect someone is at risk. Staff must receive training in safe moving and handling practices and first aid to ensure they are able to respond to emergencies and to assist people whilst maintaining their own safety and that of the person they are supporting. Staff should receive regular supervision to provide them with support and to review their work performance and training needs. Records relating to the welfare of people and the running of the home must be kept up to date at all times. This includes records relating to people`s money held by the home for safekeeping to reduce the risk of money being unaccouted for due to poor record keeping.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Penvose Residential Home 1/2 Tothill Avenue St Judes Plymouth Devon PL4 8PH     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: Jane Gurnell     Date: 1 0 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 30 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 30 Information about the care home Name of care home: Address: Penvose Residential Home 1/2 Tothill Avenue St Judes Plymouth Devon PL4 8PH 01752663191 01752663191 penvoseresident@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Joyce Sylvia Reed care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 15 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other cattegory (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Penvose is privately owned and aims to provide long-term residential care for people over the age of 65 years. The home is registered to provide care and accommodation for up to 15 older persons who may also have dementia. The home does not intend to 15 0 Over 65 0 15 Care Homes for Older People Page 4 of 30 Brief description of the care home provide a service for people whose mental health issues cause them to display antisocial behaviour or aggression. The home does not provide an intermediate rehabilitation care service, however it occasionally admits people whom need shortterm respite care. It is not registered to provide nursing care. The home was originally two houses built on a hill so access to many rooms requires people to be able to manage short flights of stairs between the two lounge rooms. A stair lift provides access to the first floor. Penvose is not suitable for wheelchair users. On the split level ground floors are two lounges and the dining room. There are 13 single and two double bedrooms, none of which has en-suite toilet facilities. The home is situated in a residential area of Plymouth a short bus ride from the city centre. It is also opposite a large park. At the back of the house is an enclosed patio garden and at the front there are large gardens. The home has a cat, two budgies and a cockatiel. Limited off road parking is available for visitors at the rear of the home otherwise on street parking is available subject to parking restrictions. Penvose has a no smoking policy. The current fees at Penvose start at 377.93 pounds a week. Additional charges include a hairdresser, a Chiropodist, personal toiletries and newspapers. Information about about Penvose can be obtained directly from the home. Care Homes for Older People Page 5 of 30 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The previous inspection of Penvose was undertaken in November 2006 when the home was judged as providing good outcomes to the people living there. The inspection was unannounced and took place over two days, Wednesday 4th March between 11:15am and 2:30pm and Tuesday 10th March between 11:00am and 1:45pm. All but two of the people living in the home were spoken with as were the staff on duty. A tour of the premises was made and documents relating the care and support for four people were looked at as were the recruitment and training for three 3 staff and documentation relating to the running of the home. The Registered Provider, Mrs Joyce Reed was present on both days of the inspection and the homes manager was present on the second day. Care Homes for Older People Page 6 of 30 Prior to the inspection, Mrs Reed had completed an Annual Quality Assurance Assessment (AQAA), which is a document used to inform the Commission of the quality of the care and support provided in the home and what improvements have been made over the past 12 months. Questionnaires were sent by the Commission to eight people living in the home, eight staff, 3 health care professionals and 2 GPs and the information obtained from these is included in the report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to Penvose can feel confident that their needs will be assessed before moving into the home and that they can have the information they need to make an informed choice about where to live. Evidence: A colour leaflet with information and photographs of Penvose is available for prospective residents and their families. From talking to people and looking at the care files for four people it was evident that each person had a contract with terms and conditions of residency. This included the room they were to occupy and the weekly fee for residing in the care home. People said they had visited the home prior to making a decision to move in and Mrs Reed confirmed in the AQAA that people were invited to spend the day in the home to meet other people and to have a meal. Many of the people living in the home had Care Homes for Older People Page 10 of 30 Evidence: previously lived in the local area and were aware of the home before moving in. Pre-admission assessments of care needs were seen in each of the files looked at indicating that peoples needs had been known prior to their admission. Care plans describing each persons care needs had been developed from these as well as the assessments and information received from social services if they had been involved with the person before their admission. The manager confirmed that if time allowed people had been written to prior to their admission confirming the homes ability to meet their needs. Care Homes for Older People Page 11 of 30 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. People can feel confident that the staff team is respectful and reliable. Changing needs are not promptly recorded in the care plans which places people at risk of not having their needs met in a safe or consistent manner. Evidence: Nine out of the 11 people living in the home were spoken with and all expressed their satisfaction with the care and support they receive. People said this is my home and its lovely here. Three out of the six people who returned a questionnaire said they always received the care and support they need, and two people said they usually do. Five out of the six people said yes to the question do the staff listen and act on what you say, one person said no. As some of these questionnaires were completed anonymously, the manager was made aware of this negative response to enable her to consult with each person living in the home to ascertain their views. Four care plans were looked at. All were clearly written giving a description of what the person could do for themselves and what assistance staff should provide. There was some evidence that the plans had been reviewed and updated when needs had Care Homes for Older People Page 12 of 30 Evidence: change, but not monthly as advised in the National Minimum Standards. For one person, the care plan had not been updated following a recent admission to hospital and significant changes in the persons care needs, although these were well known by the staff team who were receiving daily support from the District Nursing Service. More detail was needed in the care plans when referring to specific health care issues to provide staff with information about their responsibilities to ensure care and support is provided in a safe and consistent manner. For example, for someone having insulin injections and regular blood sugar testing to manage their diabetes there was no information for staff as to what was a safe range for the blood sugar reading and what to do should the reading go above or below this. Also this care plan did not refer to the any dietary precautions, such as a sugar controlled diet or the actions staff should take if the person doesnt eat their meal, particularly after receiving the insulin injection. Two questionnaires were recived from local GPs and two from District Nurses who attend the home regularly. All four confirmed their confidence in the staffs ability to meet peoles needs. The Nurses confirmed that staff ask for assitance and advise promptly, and one suggested that staff would benefit from further training in health care issues such as diabetes. One Nurse said they try very hard to make residents as comfortable as possible. The medication was seen kept in a lockable, fixed cupboard and there was a separate fixed, lockable cupboard for controlled medication. A lockable fridge was available should any medication need to be kept cool. The medication records were all seen and were up to date and signed accordingly. Staff were advised to record the reason for giving as needed medicines such as paracetamol on the record on the reverse of the medication record sheet, to ease the monitoring of the persons discomfort or changing needs. A photograph identifying each person was attached to their medication record to reduce the risk of medicines being given to the wrong person. At the time of this visit, no one required any controlled medication, and no one was responsible for their own medication. Staff members responsible for medication administration had attended training in safe medication practices and additionally the manager and deputy manager had completed a course on General Medicines Management. It was evident from talking to people and observation of interactions between people, staff and the owner that people felt well looked after and respected. There was a very homely atmosphere. When asked, more than one person said that they would ask for something if they needed it and would let staff know if they didnt like something. All the people spoken with during this visit spoke highly of the care they receive. They Care Homes for Older People Page 13 of 30 Evidence: considered it to be personalised to suit them. If the information was available, the care plans had details of specific wishes regarding preferences for funeral arrangements. A local funeral director had produced a booklet containing useful contacts and other general and helpful information about what to do after someone dies. Mrs Reed explained during this visit that giving these booklets to relatives had proved to be successful as it gave them a step-by-step guide on how to arrange a funeral. The manager was in the process of arranging Funeral training for staff to give them an insight into the role of the undertaker. Mrs Reed stated that there was always a representative staff group at every residents funeral and this was especially important for those residents without families or friends. Care Homes for Older People Page 14 of 30 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. Generally people are satisfied with their lifestyle at Penvose, although some would like more planned activities. Meals are varied, nutritious and enjoyed. Evidence: All nine people spoken with said they enjoyed living at Penvose. Of the six people responding to the questionnaires, one person said there was always activities arranged by the home that they can take part in; three people said sometimes and two people said never. This information was passed to the manager to enable her to consult with each person with regards to their preferences and what activities they would like to participate in. In the AQAA Mrs Reed said the residents are encouraged to continue with their outside interests and even adopt new ones. We have a knitting club that knit squares to be sewn into blankets for the cats and dogs home. A variety of activities are facilitated by the staff, such as bingo and sing-a-longs, and once a fortnight people have the opportunity to join in with an Armchair exercise group. The manager has obtained a training pack for the staff with regard to proving activities suitable for older people who may be infirm. Penvose is not specifically a faith-based home however it has links with a local Church of England church. A service of worship is available at the Care Homes for Older People Page 15 of 30 Evidence: home to those people who wish to attend once a month. Activities are planned to celebrate seasonal events such as St Georges Day, the Queens Birthday, Easter and Christmas and bonfire night: people are encouraged to make suggestions for these events. A local mobile book club comes to the home regularly to offer a library service. Relatives and friends are welcomed and can visit at any time of the day. The home has a cat and people said they very much enjoyed her company. The cook confirmed that people had all been consulted about food and a four weekly menu had been compiled to try and meet all the preferences. Choices for the lunch time and tea time meals were available and people are offered drinks and snacks throughout the day. All the people spoken with said they enjoyed their food and that there was always food available if they were hungry between meals or if they had been out at the homes meal times. Four people returning a questionnaire said they usually liked the meals and one person said always (one person did not answer this question). Suggestions were made to increase the amount and variety of vegetables provided such as stewed onions. This information was passed to the manager to allow her to ask people about their preferences. On the first day of the inspection, people were offered a roast chicken meal with roast potatoes, cabbage, carrots, swede and gravy. In the AQAA, Mrs Reed said the new kitchen also enables it to be used with staff supervision for client activities as some of ours liked and still do like to cook. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their families and friends can feel confident that any issues of concern or complaints raised by them will be dealt with appropriately. Training in the protection of vulnerable adults would benefit both staff and people living in the home and raise the profile of safeguarding. Evidence: Since that last inspection neither the home not the Commission has received any complaints about Penvose. The homes complaints procedure was seen displayed in the main hall near the front door. Mrs Reed confirmed that should someone living in the home or a relative raise anything with herself or a staff member, she would endeavour to sort out the matter to everyones satisfaction. None of the nine people spoken with had any concerns and said if they did they would speak to the staff, manager or Mrs Reed as they were all very approachable. Of the six people returning a questionnaire, five said they knew how to make a complaint, one person said they did not know and this information was passed to the manager. There is a suggestion box in the main hallway to allow people living in the home and visitors to make comments or suggestions for changes or improvements. The manager confirmed that none of the staff had received training in the protection of vulnerable adults but she was aware of her responsibilities should she suspect someone is at risk of abuse. The manager was advised to seek formal training to Care Homes for Older People Page 17 of 30 Evidence: ensure staff are familiar with the signs and symptoms of abuse and the local authoritys procedures for managing any suspicions. Care Homes for Older People Page 18 of 30 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. Penvose has a homely, safe and well-maintained environment that is clean, pleasant and hygienic. Evidence: Since the last inspection the building work to replace the garage and utility room has been completed and provides ample storage space above the garage and a purposebuilt utility room. The new utility room houses a domestic washing machine that the staff explained was for delicate items of clothing: this is additional to the industrial machines in the laundry room. The kitchen had also been remodeled and completely refurbished. All the occupied bedrooms seen were personalised. Some people were spoken to in their rooms and they said that they had chosen how the furniture was arranged and confirmed that they had been able to bring in pieces of their own furniture. Some bedrooms had personal telephone lines and the manager confirmed that these could be fitted in other rooms if requested. None of the bedrooms had locks however Mrs Reed confirmed locks would be fitted should one be requested. The home was found to be very clean and hygienic throughout and people said this was always the case. It was also found to be in good order and upkeep. The patio area at the rear of the home provided a pleasant are for people to sit out in warmer weather, and the front garden was lawned and prepared for bedding plants: the home has won Plymouth in Bloom for several years. Care Homes for Older People Page 19 of 30 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. The staff group is motivated and caring, but some staff would benefit from more support from the manager or owner. Updates in training are necessary to ensure staff remain confident and skilled in their role to protect their safety and that of the people they are caring for. Evidence: At the time of this visit the home had a staff group that worked well together. A minimal turnover helped to maintain good morale and promote peoples confidence. In response to the Care Workers Survey questionnaire, one staff member wrote, we have a good team working together here. The files of 3 staff members were looked at. All contained the necessary Criminal Record Bureau check but two contained only one written reference, rather than two as required, to ensure the suitability of the staff member and in turn protect the people living in the home. The files contained information about the training staff had previously undertaken. All staff had either obtained a National Vocational Qualification (NVQ) in care or were in training. Many staff were undertaking a higher level NVQ qualification indicating their commitment to continuing with their own personal development. The manager confirmed that the home was late in providing up-dated training in first aid and safe Care Homes for Older People Page 20 of 30 Evidence: manual handling. It is important that staff are provided with ongoing training to ensure their work practices are current and safe. Four of the six staff returning a questionnaire said they received the training they felt they needed: two said they did not. With regard to staff support from the manager or owner, one staff member said they regularly met, two staff said they often met, one person said they sometimes met and one staff said they had never met with the manager to discuss their support needs and how they are working. One member of staff said there was always enough staff on duty: five staff said usually and one said sometimes. This information was passed to the manager for her to discuss with each staff member. Observation of staff during this visit saw them being polite and respectful to people. There was a lot of light-hearted chatter as well as gentle encouragement when it was needed. Three people living in the home returning a questionnaire said staff were always available when needed, two said usually and one person did not answer the question. One person said staff are very busy but always available when needed. At the time of the inspection, there were 11 people living in the home and three staff were on duty supported by a cook and housekeeper. Mrs Reed is in the home most days and is not included in these numbers. In the evening there are two staff members on duty and, at night, one member of staff awake and one member of staff sleeping-in and available in an emergency. Care Homes for Older People Page 21 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health, safety and welfare is promoted and protected by a conscientious owner who is keen to achieve positive outcomes for people living in the home and the staff. Poor records of the handling of peoples money places them at risk of money being unaccounted for. Evidence: Mrs Reed, the owner and Registered Provider, is actively involved in the day-to-day running of the home. There were clear lines of accountability and the management of the home was transparent and honest. Observation during this visit saw that the staff group respected her. People spoke highly of Mrs Reed and the manager appointed to assist Mrs Reed. The manager had achieved the Registered Managers Award and was undertaking Level 4 NVQ in Health And Social Care at Plymouth Business College: both qualifications require the manager to demonstrate her knowledge and skills in caring for older people and managing a care home. She had also gained a Mentors Award to Care Homes for Older People Page 22 of 30 Evidence: enable her to support the staff team more effectively, and she and Mrs Reed have taken a six-month course in Environmental Management, a course about making the home environmentally friendly and environmentally aware. The manager formally consults with relatives once a year to ask them their views on the running of the home and the care and support provided. The most recent survey was undertaken last summer: the manager said the results were very positive and she had changed the menus as a result. The manager confirmed that she would shortly be sending surveys to people living in the home, their relatives, staff and visiting health care professionals such as the District Nurses. The manager was advised to summarise the results of the surveys and record the actions she had taken in response. Mrs Reed explained that she tries to encourage people or their families to keep responsibility for their money however a small number of people have money in the homes safe. The financial records for these people were inspected. There were several discrepancies in the records and they had not been kept up to date. Several receipts for each person were loose in the safe and the balances had not been amended. Mrs Reed confirmed one person had been given an amount of money from the safe but this had not been recorded onto the balance sheet nor had the person been asked to sign to confirm she had received this. Mrs Reed and the manager agreed to talk to all senior staff about the importance of keeping these records up to date at all tmes. Mrs Reed was advised to have two members of staff sign every transaction, that the balance sheet be amended at the time money was received or spent, and to ensure receipts accurately identified who they were for and for what purpose. The Registered Provider confirmed that all the maintenance checks were complete and up to date. The fire logbook indicated regular testing and servicing of the system was undertaken to make sure it was maintained in good working order. Records also showed staff had received regular fire drill training but the manager confirmed the annual training by an external fire-training officer was late and would be arranged for the near future. Goggles and face masks were seen provided in the sluice room for staff protection when emptying and cleaning commodes, etc. Gloves and aprons were also seen for staff to use. The cooks have completed the Safer Food, Better Business training to implement a kitchen routine that complies with the Food Standards Agency regulations and Care Homes for Older People Page 23 of 30 Evidence: recommendations. The Accident Book was seen and accidents had been recorded correctly. The Commission had not been notified of an accident which resulted in an injury to someone living in the home: the home is obliged to keep the Commission informed of events that affect the well-being of the people living in the home. Care Homes for Older People Page 24 of 30 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 35 Sch 4 (9)17(2, 3a) The Registered Provider must 12/12/2006 ensure that all financial records of monies held on behalf of residents are accurate and up to date. Care Homes for Older People Page 25 of 30 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 15 Each person must have a written care plan that describes their current care needs and the action required by staff to meet those needs. This is to ensure all staff are aware of peoples needs, needs arent overlooked and needs are met in a safe and consistent manner. 30/04/2009 2 18 13 Arrangements must be 30/06/2009 made, by training or other measures, to prevent service users being placed at risk of abuse. Staff must be able to recognise the signs and symptoms of abuse and know what to do should they suspect someone is at risk. 3 29 19 People must not be 31/03/2009 employed at the home unless satisfactory outcomes have been obtained in Page 26 of 30 Care Homes for Older People 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 relation to all the information as detailed in Schedule 2 of the Care Homes Regulations 2001 Two written references must be obtained in relation to the applicant prior to the commencement of their employment to ensure as far as possible only suitable staff are employed. 4 30 13 The registered person must 31/07/2009 make suitable arrangements for the training of staff in first aid and to provide safe moving and handling of service users. This is to ensure staff have the necessary skills to respond to an emergency and to assist service users in manner that protects their health and safety and that of the service user. 5 33 24 The registered person must consult with service users and their representatives to review the quality of the care provided at the home. This is to ensure people are receiving a service that meets their expectatins and one that meets their needs. 30/09/2009 Care Homes for Older People Page 27 of 30 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 6 35 13 The registered person must make arrangements to ensure service users are not placed at the risk of abuse. Records relating to the service users money held for safekeeping by the home must be accurately maintained to ensure the service user is not placed at the risk of theft. 31/03/2009 7 37 17 The registered person must ensure service user records are kept up to date. This is to ensure the information written about each person describes their current needs and staff action and records relating to money held for safekeeping are accurate. 31/03/2009 8 38 37 The registered person must inform the Commission of any event that affects the well-being or safety of a service user. This is to enable the Commission to monitor significant events with each service and peoples safety. 31/03/2009 Care Homes for Older People Page 28 of 30 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 36 Staff should receive regular supervision to monitor their work performance and training and development needs. Care Homes for Older People Page 29 of 30 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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