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Inspection on 18/08/09 for Portland Nursing Home

Also see our care home review for Portland Nursing Home for more information

This inspection was carried out on 18th August 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 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

People told us their needs, or those of their relative, were met at the home. They said "he`s much better since he came here. He always looks well cared for", and the staff "respond quickly to residents` needs, make new residents feel at home". People told us they received the care and support they needed, including medical care. They said the home was good at "general nursing care". They said that staff usually listened to them and acted on what they said. They said that staff "make people feel comfortable", and were "very kind, patient, dedicated, interested in the residents". People told us they enjoyed the meals provided - "especially the cooked breakfasts!". They said they could have a choice if they didn`t like what was offered on the menu. Out of 22 care staff, 15 had already achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard of 50% of care staff with a relevant NVQ.

What has improved since the last inspection?

A part-time activities coordinator had been appointed to provide a more structured approach to organising activities for people in the home. Informal complaints were recorded with details of the action taken and the outcome. This helped to ensure that all complaints were listened to and taken seriously. We found that the programme of refurbishment in the home had continued including new carpets in nearly all the bedrooms, new curtains in the lounges, and redecoration of the main lounge. There had been an infection control audit by the local Primary Care Trust. The manager had developed an action plan to address issues raised and most of this plan had been completed. There had been recent changes in shift patterns to allow more overlap between day and night shifts. This was to ensure more staff were available at busy times. Staff told us this was working well.

What the care home could do better:

Ensure that each person in the home has a care plan that includes all of their assessed needs and is person centred. Also, ensure that people, and/or their representatives are involved and consulted in planning their care. This will help to ensure consistent and effective delivery of person centred care. Ensure the needs of people with dementia are better met through staff training and further development of the activities programme. Ensure that there are sufficient, suitably qualified staff to meet people`s assessed needs. Ensure that staff are fully aware of and competent in the safe use of wheelchairs so that the risk of harm to people is reduced. Ensure that any accidents or other events are reported as necessary to comply with the Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations (RIDDOR). This will help to ensure robust systems that protect people in the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Portland Nursing Home 8 Park Road Buxton Derbyshire SK17 6SG     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: Rose Moffatt     Date: 1 8 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Portland Nursing Home 8 Park Road Buxton Derbyshire SK17 6SG 0129823040 0129823040 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Joginder Singh Rai care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: No one falling within category OP to be admitted into Portland Nursing Home when there are 40 persons of category OP already accommodated within the home The maximum number of persons to be accommodated within Portland Nursing Home is 40 Date of last inspection Brief description of the care home Portland Nursing Home is situated near to the centre of Buxton where there is a wide range of amenities. The Victorian building has been extended to provide accommodation on three floors, accessed using a passenger lift or staircases. The home is registered to provide personal care with nursing for up to 40 older people. There are a large number of shared bedrooms. None of the bedrooms have en-suite facilities. Three lounges, including dining facilities, are provided on the ground floor. There is a patio area to the rear of the building. Care Homes for Older People Page 4 of 31 Over 65 40 0 1 7 0 9 2 0 0 8 Brief description of the care home Information about the service, including CSCI/CQC reports, is available in the main entrance area of the home and on request from the manager or provider. The fees charged range from £478 - £725 per week, depending on the care required and the room occupied. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of our inspections is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. The last key inspection of this service was on 17th September 2008. We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment Care Homes for Older People Page 6 of 31 that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits that we have made to the service in the last 12 months; relevant information from other organisations; what other people have told us about the service. We carried out an unannounced inspection visit that took place over 7 hours on 18th August 2009. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 29 people accommodated in the home on the day of the inspection visit, all except 1 assessed as needing nursing care. People who live in the home, visitors and staff were spoken with during the visit. The manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 3 people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. What the care home does well: What has improved since the last inspection? What they could do better: Ensure that each person in the home has a care plan that includes all of their assessed needs and is person centred. Also, ensure that people, and/or their representatives are involved and consulted in planning their care. This will help to ensure consistent and effective delivery of person centred care. Ensure the needs of people with dementia are better met through staff training and further development of the activities programme. Ensure that there are sufficient, suitably qualified staff to meet peoples assessed needs. Ensure that staff are fully aware of and competent in the safe use of wheelchairs so Care Homes for Older People Page 8 of 31 that the risk of harm to people is reduced. Ensure that any accidents or other events are reported as necessary to comply with the Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations (RIDDOR). This will help to ensure robust systems that protect people in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process was sufficient to ensure that peoples needs could be met at the home. Evidence: At our last inspection in September 2008 we found that there was a satisfactory assessment process and people said their needs were met at the home. At this inspection we looked at the records of 3 people in the home. Each had a preadmission assessment carried out by the manager or deputy manager of the home. The information in this assessment was basic and brief. 1 of these assessments was not signed or dated. Each person also had a more comprehensive assessment by social services and/or hospital staff. The admission procedures did not include recording if the person had made an advance decision on receiving medical treatment, had a Lasting Power of Attorney Care Homes for Older People Page 11 of 31 Evidence: (LPA), Independent Mental Capacity Advocate (IMCA), or Relevant Persons representative (RPR). People told us their needs, or those of their relative, were met at the home. They said hes much better since he came here. He always looks well cared for, and the staff respond quickly to residents needs, make new residents feel at home. Staff told us they usually had up to date information about the needs of people in the home. They said they had training to help them to understand and meet those needs. Some staff had received training about the needs of people with dementia. The AQAA said that people who want to see the home are shown around by senior staff whenever possible so they get full and correct information. The AQAA said they would like to have more single bedrooms to offer. Standard 6 did not apply as there were no people in the home receiving intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The varied approach, lack of detail, and gaps in care plans did not ensure consistent and effective delivery of person centred care. Evidence: At our last inspection in September 2008 we found that the approach to care planning was not consistent or person centred. Care plans lacked information and did not have sufficient detail of peoples personal preferences. At this inspection, we looked at the care records of 3 people in the home. 2 people had a set of documentation recently introduced. The documentation was from the local Primary Care Trust for use in hospitals and had not been adapted for use in the care home. Consequently, there were many areas where the documentation was not appropriate and information asked for was not applicable to people in the home. The care plans were standard pro-formas with the name and some individual details of the person added. For these 2 people, the care plans in place had sufficient detail of the action required Care Homes for Older People Page 13 of 31 Evidence: by staff to meet the persons needs. The care plans had been reviewed monthly up to date and changes made as necessary. There were no care plans in place for these 2 people about their communication, night-time, social or spiritual needs. Also, there were no care plans in place about the medication each person was prescribed and what help they needed to manage this. 1 person had a care plan in place from a previous care home. This was detailed and person centred, though it was not dated or reviewed so it was not clear how up to date the information was. There was also a care plan written following the persons admission to Portland Nursing Home. This was not person centred and lacked detail of the persons preferences regarding their daily routines. There was an additional plan, in a different format, with detailed information about the persons swallowing difficulties. All 3 people had assessments of their health-care needs, including assessments of their risk of developing pressures sores, their continence, their nutritional needs, and their manual handling needs. These assessments had been reviewed monthly up to date. Some of these documents were not signed or dated. There was little evidence that people, or their representatives, were actively involved in planning their care. 2 people had signed assessments of their need for bed rails to be in place. Medication was securely stored and there were satisfactory systems in place to ensure safe-handling and administration. There were a few gaps in the administration records. The manager was aware of this as the records were regularly checked and was taking action to address the problem. People told us they received the care and support they needed, including medical care. They said the home was good at general nursing care. They said that staff usually listened to them and acted on what they said. They said that staff make people feel comfortable, and were very kind, patient, dedicated, interested in the residents. We observed that most staff had an appropriate and respectful approach to people. Not all staff had received training about the care of people with dementia and this was apparent in the way some staff spoke to people. The AQAA said the home had improved by training staff to be able to deliver manual handling training, introducing new risk assessments, and by senior staff having Care Homes for Older People Page 14 of 31 Evidence: training about the Deprivation of Liberty Safeguards. They planned to improve further by more training for qualified nurses at the home. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were gaps in care plans and a lack of information about personal preferences so that the service provided was not always geared to individual needs and wishes. Evidence: At our last inspection in September 2008, we found that activities offered and routines in the home generally met the expectations of people living there. We found that there were few activities provided specifically for people with dementia. We made a recommendation that an activities coordinator should be employed and the programme of activities should be further developed to meet the needs of all people living in the home. At this inspection we found that there was a part-time activities coordinator who also worked as a care assistant. Forthcoming events were advertised on the notice board in the main hallway. Activities included entertainers visiting the home, walks into the town centre, and manicures. Most people told us there were activities they could take part in. One person said they would like to go out more often and the manager said that more trips out were being planned. There appeared to be few activities to meet the needs of people with dementia. Care Homes for Older People Page 16 of 31 Evidence: 1 of the 3 care records we looked at had a life history with details of the persons family, previous work and leisure interests. 1 had similar information from the last care home the person lived in, and this also had good details of the persons preferred routines. 2 people did not have a care plan to meet their social needs. None of the 3 we looked at had a care plan to meet their spiritual needs. People told us they could usually follow their preferred routines, such as getting up and going to bed when they wanted to. For people less able to communicate their preferences, there were general reminders to staff about ensuring people were not assisted to bed too early. The care plans seen had few details of each persons preferences regarding routines. People were able to bring their own possessions into the home and their bedrooms were well personalised. Visitors told us they were always made welcome. They said they were kept informed about any concerns about the person. The manager had advertised meetings for people in the home and/or their relatives, but said there had been no response. People told us they enjoyed the meals provided - especially the cooked breakfasts!. They said they could have a choice if they didnt like what was offered on the menu. We saw that fresh fruit was available in the lounges. People ate breakfast in their rooms and other meals in the lounges. Most people did not use the dining tables and sat in the lounge chairs for meals. There appeared to be enough staff available to help at mealtimes. The AQAA said that changes to activities and meals provided had been made as a result of consulting with people in the home. The AQAA said they planned to improve by engaging more people in outdoor activities and in using local luncheon clubs. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory systems in place and good staff awareness so that people were protected and their concerns effectively dealt with. Evidence: At our last inspection in September 2008 we found that there were satisfactory policies in place and good staff awareness so that people were protected and their concerns were taken seriously. We made 1 recommendation that the outcome of complaints should always be recorded. At this inspection we found that records were kept of informal complaints with details of the action taken and the outcome. The manager said they had not received any formal complaints. The complaints policy was displayed in the main hallway. People told us they knew how to make a complaint and were confident that appropriate action would be taken. There was a suitable policy in place about safeguarding vulnerable adults. Most staff had received relevant training and were aware of the correct procedures to follow if abuse was suspected. We had not received any complaints about the home or any safeguarding adults referrals. Care Homes for Older People Page 18 of 31 Evidence: The AQAA said that complaints were dealt with as soon as possible. The AQAA said they could improve by having leaflets available about how to make a complaint. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, suitably equipped and well maintained so that people lived in a pleasant and comfortable environment appropriate to their needs Evidence: At our last inspection in September 2008 we found that the home was clean, well maintained and suitably equipped. Improvements had been made, including refurbishment of bathrooms and bedrooms. At this inspection we found that the programme of refurbishment had continued including new carpets in nearly all the bedrooms, new curtains in the lounges, and redecoration of the main lounge. The lounges were comfortably furnished, bright and clean. Two lounges had new televisions. The manager said new furniture for the lounges was planned as part of the refurbishment. People told us they were satisfied with their bedrooms. The bedrooms we saw were personalised with peoples own possessions. We saw a shared bedroom that did not have a privacy curtain. People told us the home was clean and tidy and homely. They said The lift is Care Homes for Older People Page 20 of 31 Evidence: small and quite difficult for wheelchair users to manage, and,Perhaps the paved patio area could be made more attractive to those residents who like to sit outside. An infection control audit had recently been completed by the local Primary Care trust (PCT). The manager had devised an action plan to address the issues raised and most of the actions had been completed. The registered nurses at the home had recently received training about infection control. Other staff had all had in-house training about infection control as part of their induction and the manager said that further training was planned. Staff were aware of good practice in infection control and the correct procedures to follow. The AQAA said they planned to improve by continuing with the refurbishment, and also by installing a stairlift for use in case of the passenger lift breakdown. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment, induction and training of staff were generally satisfactory to ensure people were protected and their needs understood. Staffing levels at weekends did not reflect the assessed needs of people in the home or the Statement of Purpose. Evidence: At our last inspection in September 2008 we found that there were satisfactory staffing levels, recruitment practices, staff induction and training. At this inspection we looked at the records for 3 members of staff. All 3 had Criminal Record Bureau (CRB) disclosures, 2 written references, and a suitable form of identification. 2 had application forms with a full employment history, 1 had an application form with a partial employment history. There was an induction programme for new staff that met Skills For Care standards. Most staff had completed training in manual handling, fire safety, and safeguarding vulnerable adults. Some staff had received training about the care of people with dementia. Out of 22 care staff, 15 had already achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard of 50 of care staff with a relevant NVQ. We found that there were usually 6 care assistants on duty for the morning shift and 4 Care Homes for Older People Page 22 of 31 Evidence: during the afternoon. There were 2 registered nurses on duty during the day from Monday to Friday, though only 1 on Saturday and Sunday. Most of the people in the home were assessed as needing nursing care, (28 on the day of our inspection visit). The homes Statement of Purpose indicated that there were always 2 registered nurses on duty. There had been recent changes in shift patterns to allow more overlap between day and night shifts. This was to ensure more staff were available at busy times. Staff told us this was working well. People told us staff were always available when needed. They said the staff were friendly and efficient and always approachable, and very kind, patient, dedicated. We observed that there appeared to be sufficient staff available to meet peoples needs on the day of the inspection visit. The AQAA said that all shifts were covered using the homes own permanent or bank staff, with no reliance on agency staff. They planned to improve by accessing more training for all staff, including training about the needs of people with dementia. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although some improvements had been made, there were continuing issues that compromised the health, safety and welfare of people in the home. Evidence: At our last inspection in September 2008 we found that the home was well managed and there were satisfactory systems in place so that the health, safety and welfare of people was promoted and protected. We made a recommendation that there should be a report produced from the analysis of quality assurance measures. Since the last inspection the manager had completed the Registered Managers Award. The manager was supported by a deputy manager. The manager said that an administrative assistant working 12 hours per week was about to start at the home. People told us they had confidence in the manager and deputy manager to take appropriate action if concerns were raised. Staff told us the manager and deputy manager were both approachable and usually listened to staff ideas and opinions. Care Homes for Older People Page 24 of 31 Evidence: The AQAA was completed by the manager and gave us a reasonable picture of the current situation within the home. There was satisfactory evidence to support the comments made, although there were areas where more supporting evidence would have been useful to illustrate what they have done in the last year, and how they were planning to improve. The AQAA gave limited detail about areas where they still needed to improve and how they were planning to do this. The data section of the AQAA was fully completed. Quality assurance surveys had been used in July 2009 and the results had been analysed. The manager said the results, and any action taken, would be made available in a report to people in the home and their relatives/representatives. The manager said that meetings for people in the home and/or their representatives had been organised several times, but little interest had been shown. The provider made regular visits to the home and produced a monthly report that included the comments of people living in the home and staff. We looked at the records of personal money held for people living in the home. The records were up to date and the money was securely kept. We looked at accident records and found that 1 accident had not been reported as required by the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). At our last inspection we found that wheelchairs were being used without the footplates in place when transporting people. We made a requirement that there must be a risk assessment in place for each person using a wheelchair without footplates. At this inspection we found that there were suitable risk assessments and that most people were assessed as needing the footplates in place for their safety. However, we observed that 2 people were moved into the main lounge by wheelchairs with no footplates attached and the wheelchairs tipped back. As noted in the Health and Personal Care section of this report, there were gaps in care plans, a lack of a person-centred approach, and little evidence of the involvement of people in planning care. Similar issues were noted in our last inspection report. The AQAA showed that the maintenance and servicing of equipment and systems in the home was up to date. Also that all relevant health and safety policies and procedures were in place and had been reviewed in the last 12 months. Care Homes for Older People Page 25 of 31 Evidence: There were no protocols or procedures in place about the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The relevant codes of practice were available in the home. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 in the home must have a care plan that includes all their health and personal care needs, and is written after consultation with them, (or their representative). This will help to ensure consistent and effective delivery of person centred care. 31/10/2009 2 19 16 A suitable curtain or screen must be provided in all shared bedrooms. This will help to ensure that peoples privacy and dignity are maintained and promoted 30/09/2009 3 27 18 At all times there must be suitably qualified staff in such numbers as are appropriate for the health and welfare of people living in the home. 30/09/2009 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that peoples needs can be fully met at the home. 4 30 18 Staff must receive training 31/12/2009 appropriate to the work they are to perform. Specifically, training about the needs of people with dementia. This will help to ensure that people are supported by staff who understand and meet their needs. 5 38 13 The manager and staff must 30/09/2009 be aware of the requirements of RIDDOR and must comply with these. This will help to ensure robust systems that protect people inthe home. 6 38 13 All staff must be fully aware 30/09/2009 of and competent in the safe use of wheelchairs. This will help to protect people in the home and minimise the risk of injury. 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 3 The admission procedures should include: - recording if the person has made an advance decision on Page 29 of 31 Care Homes for Older People 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 receiving medical treatment - recording if the person has a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Person Representative - consideration of the persons capacity to make decisions about their daily lives, care and treatment. 2 7 To ensure good record keeping in care records, documents should always be dated and signed, and there should be a line through any spaces left at the end of entries in daily reports. This will help to protect people and ensure that staff have up to date information. The activities programme should be further developed to include activities appropriate for the needs of people with dementia. This will help to ensure that the needs of all people in the home are met. There should be a full employment history obtained for all staff employed at the home. This will help to ensure a robust recruitment system that protects people living in the home. Policies should be developed to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. 3 12 4 29 5 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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