Inspection on 13/02/09 for Priory Court Care Home

This inspection was carried out on 13th February 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

Priory Court Care Home 21/04/08

Priory Court Care Home 20/01/08

Priory Court Care Home 24/04/07

Priory Court Care Home 27/09/05

Priory Court Care Home 21/06/05

Priory Court Care Home 16/09/04

Priory Court Care Home 13/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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: Priory Court Care Home Old Schools Lane Ewell Village Surrey KT17 1TJ     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: Suzanne Magnier     Date: 1 3 0 2 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Priory Court Care Home Old Schools Lane Ewell Village Surrey KT17 1TJ 02083930137 02083941905 manager@priorycourtcare.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : St Cloud Care Plc care home 60 Number of places (if applicable): Under 65 Over 65 0 60 dementia old age, not falling within any other category Additional conditions: 60 0 The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia - DE Date of last inspection Brief description of the care home Priory Court is a large detached, purpose built property which is built around a central courtyard garden. The home is situated very close to Ewell village which has a range of shops, pubs, restaurants and a library. Epsom town centre is a short drive away and has a more extensive range of shops and facilities. The service is registered for sixty older people and provides residential care on the ground floor and nursing care on the first floor. Up to seven of the people living at the home may have dementia. Two passenger lifts ensure that both of the two floors are accessible to those living at the home. Care Homes for Older People Page 4 of 30 2 0 1 0 2 0 0 8 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: 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: The Quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The last key inspection on this service was completed on the 21st April 2008 and a random inspection visit to confirm compliance to the requirements made at the key inspection was conducted on 20th October 2008. The inspector looked at and assessed how well the service was meeting all the National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. Care Homes for Older People Page 6 of 30 Ms S Magnier Regulation Inspector carried out the inspection, which lasted for eight hours commencing at 09.00hours and concluded at 17.00. The person in charge represented the service with the inclusion of the deputy manager. The CSCI Inspecting for Better Lives IBL involves an Annual Quality Assurance Assessment AQAA to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received by CSCI and is referred to throughout the report. Sixty residents currently receive care and support at the home and as part of the inspection process the pre admission assessment procedures were discussed to ensure that people admitted to the home are assured that the homes staff can meet their needs. The majority of the residents spoken with were able to express their thoughts and feelings about the care they receive and all spoke favourably about the home. The information contained in this report was gathered from observation by the inspector, speaking with a number of residents, their relatives who were visiting, care staff, including the chef and from information contained within the AQAA. Further information was gathered from records kept at the home. A full tour of the premises was undertaken and documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, residents care plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the person in charge and the deputy manager about the findings of the visit. The commission have not received or been made aware of any notifications of complaints or safeguarding vulnerable adults referrals since the last random inspection. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of clients who have diverse religious, racial or cultural needs. 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. Care Homes for Older People Page 8 of 30 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 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 10 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. Information is available to prospective individuals about the services and facilities offered by the home. The admission and assessment procedures ensure that an individuals needs are appropriately identified prior to moving into the home. The home continues to offer respite care for individuals. Evidence: At the unannounced key inspection of the care home on the 21st April 2008 the inspector found that the homes statement of purpose and service users guide was not up to date and lacked the required information. A random inspection was carried out by Ms Suzanne Magnier Regulation Inspector on 20th October 2008 to confirm that the homes management had complied with the requirement. It was found that the requirement had not been met and enforcement action would be considered. The homes Statement of Purpose and Service User Guide were sampled during this Care Homes for Older People Page 11 of 30 Evidence: key inspection and both documents had been revised and included the information that prospective residents or their representatives would need to make sure they had sufficient information about the services offered by the home. Two residents care plans who had been recently admitted to the home were sampled and evidenced that an assessment had been made by a qualified person to ensure that the needs of the resident could be met by the homes staff. The person in charge and the deputy manager confirmed with the inspector the importance of undertaking pre admission assessments in order that they are sure that the homes staff can provide the appropriate care and support for individuals admitted to the home. The home continues to offer respite care for individuals. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning, risk assessment and medication processes in the home have been improved to benefit residents. Residents rights to protection, dignity and respect are promoted at all times. Evidence: The AQAA advises that the care planning documentaion has been reviewed since the last key inspection which has improved the continual assessment of residents needs leading to more prompt health care service referrals being made. Five resident care plans were sampled and these contained clear records of the care and support required by the individual. All care plans sampled had been signed by the resident or their representative. Hazards that had been identified in residents daily lives had been assessed,documented and recorded and where possible, minimised. The assessments sampled included risks associated with mobility, moving and handling, pressure sores, Care Homes for Older People Page 13 of 30 Evidence: nutrition and the use of bed rails. Residents confirmed that they felt well looked after and that if anything was wrong they felt sure staff would seek the right mediacl help. Records of residents healthcare needs and appointments were well documented and evidenced that a variety of healthcare professionals are involved in the support of residents, including general practitioners, district community nurses, chiropodists, occupational and speech and language therapists and physiotherapy. Residents, according to the completed AQAA, are supported to retain their own GP if they wish to and if the GP is willing to continue the arrangement. The home has a medication policy and procedure in place and continues to use a monitored dosage system. Medication records were well documented and all controlled medication checks were accurate. The procedures for ordering, delivery and disposal of medicines were robust. The inspector observed medication being administered during the inspection and noted that on one occassion the staff member administering medication to residents in the dining room left the medication trolley open and unattended in the corridor. This matter was brought to the staff members attention and also the managers of the home. It was observed that later occassions during the day the trolley was not left open and unattended in order to ensure the residents and other peoples safety and well being. Several staff files sampled confirmed that staff receive medication training. Throughout the day the inspector observed that residents were addressed in a polite and courteous way by all staff. 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. Peoples rights of choice about their daily routines and the range of activities offered is promoted. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet in spacious and pleasant surroudings. Evidence: The home has an activity organiser and also an assistant. The home have developed a monthly newsletter called the Priory Chronicle which details the forthcoming events that include exercise classess, Bingo, Hairdressing, quiz sessions, social gatherings with cream teas, the cinema club, group discussions and board games. Contacts with the local schools have been maintained where children visit the home for special occasions and entertain the residents. There was evidence that a mobile library visits the home and that residents spiritual needs are addressed by the opportunity to take part in a communion service held at the home. The managers advised that other demoninational services would be sought if a resident requested this. It was noted that within residents care plans a section has been developed which includes recording residents social activities which staff monitor to ensure that Care Homes for Older People Page 15 of 30 Evidence: individuals are included in stimulating activities if they choose to be. Written comments regarding the activities provided by the home included that individually tailored living is in place and clients are free to partake in many organised activities. Equally they are free to be non participants. There is an excellent choice of entertainment on offer for the clients. The provision of activities and entertainments provided is excellent. Activities are planned so that most people can join in most of the time. They are many and varied. Resident meetings continue to be held in order that people have the space to talk about matters concerning the home and to put forward any suggestions they nmay have about the home. Several residents family and friends visited during the inspection and it was observed that residents could enjoy their company in the lounge or in the privacy of their own rooms. It was observed that residents visitors had open and professional working relations with staff and managers in the home during the inspection. Several resisdents had telephones in their rooms some of which were large button phones which they said they liked to have so they could keep in touch with family and friends. It was observed that staff were at hand to talk with residents and that the interaction with residents was genuine to reflect good personal and professional relationships. Some residents were seen to move freely around the home and the atmosphere in the home was was quiet and relaxed. Several residents were observed in the morning to be walking to the various dining areas to have their breakfast and later their midday meal. The dining areas throughout the home were viewed and each room contained small tables which had been had been set with appropriate condiments,crockery, tablecloths and napkins. The residents told the inspector that the food provided at the home was very good and they had choices and knew about the menu. The meals served looked tastefully presented and there were three choices of the main meal available to residents. Staff were at hand to support residents if they required support. Some written comments received by residents about the food stated teh meals can become monotonous. An ongoing complaint about cold tea, cold plates and cold food. Chips are always cold but the meat is usually good. The charge nurse of the nursing unit advised that for residents requiring specialist care with their meals that staff are trained to support the residents following specfic training. A dining area is also available within the home for residents who need to have Care Homes for Older People Page 16 of 30 Evidence: one to one support with their meals and this facility offers then privacy and dignity at meal times. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are protected by the homes complaints and safeguarding adults procedures. Evidence: At the unannounced key inspection of the care home on the 21st April 2008 the inspector found that the home did not keep an accurate record of all complaints received by the home and a requirement was made that details be kept of all complaints received by the home in order that they are fully ivestigated and acted upon in accordance with the homes complaints procedures. A random inspection was carried out by Ms Suzanne Magnier Regulation Inspector on 20th October 2008 to confirm that the homes management had complied with the requirement. It was found that the requirement had been met. The home has an established complaints procedure which has been recently updated. It was confirmed whilst speaking with the person in charge that three complaints have been received since the last key inspection and the managers have made improvements to the homes complaints procedures yet are aware that they need to be strenghenned to incorporate a more professional approach in repsonse to complaints received by the home. Residents told the inspector that they would talk to staff or their family members if they had any concerns or were unhappy about the home. The security of the home was discussed with the person in charge as the inspector was in the foyer of the home Care Homes for Older People Page 18 of 30 Evidence: and was seen by staff members yet staff did not enquire who the inspector might be in order to ascertain peoples right of access into the home to ensure residents safety and security of vetting people visiting the home. At the unannounced key inspection of the care home on the 21st April 2008 the inspector found that not all staff had received safeguarding vulnerable adults training and a requirement was made that all staff must receive regular training in safeguarding adult procedures. A random inspection was carried out by Ms Suzanne Magnier Regulation Inspector on 20th October 2008 to confirm that the homes management had complied with the requirement. It was found that the requirement had not been met and enforcement action would be considered. The current training matrix evidenced that all staff had attended safeguarding vulnerable adults training. The home has a whistle blowing procedure in order that staff are aware of their duty of care to report any safeguarding incidents. Three Staff files sampled evidenced that Criminal Record Bureaux checks and Protection of Vulnerable Adult checks are carried out on all new staff. The home has a copy of the Surrey County Council Multi-agency Procedures for Safeguarding Vulnerable Adults. The AQAA advises that one safeguarding referral has been made since the last key inspection and the commission have been informed of the outcome. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout of the home meets the current residents needs. The control of the spread of infection and cleanliness of the home throughout is not robust and needs strengthenning. Evidence: The home has been purpose built and is arranged over two floors, with two passenger lifts providing access to both floors. The ground floor is the residential unit and the upper floor houses the nursing unit. The location and layout of the home remains suitable for its stated purpose and the home continues to provide pleasant surroundings for the residents with suitable furniture and soft furnishings throughout the home for residents to use. The home was not clean throughout and an area of concern was the hairdressing suite where it was noted the standard of cleanliness and hygiene was poor. The person in charge was unsure who had the responsibility of ensuring that the room was kept clean and stated that she would clean the room following the inspection. The laundry area of the home was well equipped yet was below standard with regard to the arrangements of control of infection in the home. The shortfalls were discussed with the laundry member of staff and the person in charge and included lack of handwashing facilities, lack of suitable arrangements for the disposal of general and Care Homes for Older People Page 20 of 30 Evidence: clinical waste, lack of provision of protective clothing. It has been required that arrangements must be strengthenned to ensure that satisfactory standards of hygiene are maintained for example control of infection and the disposal of waste in the home to ensure the welbeing and welfare of residents and people associated with the home. It is recommended that the number of housekeeping staff is increased to ensure the maitainence of a good standard of hygiene throughout the home. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are in sufficient numbers to support the people who use the service. Safe recruitment and vetting of staff protect the welfare and safety of residents and staff receive training to ensure residents needs are appropriatly met. Evidence: The homes management have maintained recording and assessing the dependency level assessments for all residents in order to ensure that the home is adequatley staffed at all times and the staffing rotas are completed according to the assessment. The staff rotas were seen during the inspection and the staffing ratios discussed at the time of the inspection. Written comments regarding the staffing of the home stated I have found some staff are unaware of some changes and need the information passed to them by other carers. Therefore they know and dont put these changes into action or information is not given properly to all carers. I feel that shifts are covered by some staff more than others. I feel I can give more care when there is at least one extra person on the floor. I feel that staff numbers on shifts should be looked into. Staff could be as much as five and as little as three. This affects not just the pressure on staff but also the service users, especially in times of sickness when the service user needs more care. In my opinion there should be more staff basic training in personal care for the service user. Care Homes for Older People Page 22 of 30 Evidence: Staff retention and increased staffing levels always assists in ensuring clients and staff have meaningfull contact time. For the most part there is good team spirit and carers help each other where necessary. The most important is that we have a good management team. Have more hours allocated to the maintenance and domestic staff to ensure standards are maintained. My freind is full of praise for all the staff and knows each one by name and interacts easily and readily with everyone. The staff are friendly and respectful and seem to have a genuine empathy with my friend and other residents. Provide better handovers at the beginning of the shifts would be more helpful. The number of staff is dictated by the number of residents in the home rather tahn how much care each resident needs e.g. whether the resident is self careing or needs full nursing care. The AQAA advises that 83 percent of staff have achieved their National Vocational Qualifications in level 2 or above. At the unannounced key inspection of the care home on the 21st April 2008 the inspector found that the recruitment practices of the home did not protect residents. A requirement was made that satisfactory checks regarding recruitment of staff be carried out and staff recruitment more robustly managed. A random inspection was carried out by Ms Suzanne Magnier Regulation Inspector on 20th October 2008 to confirm that the homes management had complied with the requirement. It was found that the requirement had not been met and enforcement action would be considered. The home has a recruitment and selection policy, which incorporates equal opportunities. The inspector sampled three staff files which included care and ancillary staff. The staff records were well recorded and evidenced the vetting practices concerning the recruitment of staff had improved in order to ensure the safety and protection of residents in the home. The files contained application forms, with two references, evidence that face to face interviews had taken place and the job description in order that the staff member was clear about their roles and responsibilities. There was documented evidence that a CRB clearance had been obtained. The managers affirmed that the home is committed to the ongoing training and development of staff and the three staff files detailed that the staff had attended induction and statutory training with further evidence that courses had been booked for the staff to attend. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home has been strengthenned and the home continues to be run in the best interests of the residents. Residents views and opinions and those of others associated with the home are sought. Individuals welfare is generally promoted through monitoring of health and safety in the home yet some areas identified within the report need to be strengthenned. Evidence: The management of the home has been reviewed and the inspection was undertaken with the person in charge and the deputy manager. The review has included that the person in charge oversees the whole registered establishment as opposed to the homes nursing and residential units being managed separatley. Staff confirmed they felt this was a better way of working and have enjoyed gaining experience and getting to know all the residents throughout the whole of the home. Care Homes for Older People Page 24 of 30 Evidence: The person in charge has advised that they wil be submitting their application to register with the commission as the registered manager. Written comments regarding the home stated the general care is very good. One to one communication between clients and staff is good. The general communication skills between staff could be improved. A well run home with a good reputation. What could improve is to spend more time with clients, sit and chat, read the newspaper. This is not possible as staff are too busy especially on the nursing shift. I would like to say that the home is a great support to the family, we beleive every member of staff is fully supportive of our mother bearing in mind her individual needs and demands, thanks to them we have no concerns about mums day to day requirements. The home scores well in many areas cleanliness, staff friendliness, expertise and reponsiveness, activities available and services offered. Well done Priory Court. Priory Court is a well run and managed centre and should be commended. It was evident during the inspection that the homes staff have open and professional relationships with visitors to the home and that their views about the care and support their friends and relatives receive is listenned to and acted upon by the homes senior managers. Concern was raised regarding the storage of chemicals in the home and this was brought to the attention of the person in charge as on two occassions the inspector found hazardous substances were not stored in compliance with the control of substances hazardous to health COSHH legislation in order to ensure the safety and welfare of residents. Senior staff were prompt to remove the chemicals and store them appropriatly during the inspection. A requirement has been made that this shortfall is rectified. The homes chef confirmed that the fridge, freezer and pantry were well stocked. Fresh fruit and vegetables were available for residents. Records of food temperatures, storage of food in the fridge and pantry was in compliance with food hygiene standards to ensure residents health and safety. The homes fire procedures sampled confirmed that records were kept of weekly fire tests and equipment checks. It was noted that a fire exit door handle needed to be repaired and the homes management had documented a risk assessment and had been proactive in trying to obtain a new handle for the door. Signage was available within the home to show people other nearby fire exits. Regulation 26 records of an unannounced visits by the organisations area manager Care Homes for Older People Page 25 of 30 Evidence: were sampled and it was noted that the record was thorough in assessing the quality of the service and any issues identified would be noted by the owners in order that appropriate action would be taken to rectify the shortfalls. Three residents finance records were sampled. Two were accurate and one record was inaccurate. The person in charge was reminded that all records must be accurately recorded and the the use of correctional fluid ceased in order that residents finances are safeguarded. A certificate of Insurance was sampled and was confirmed as a current document. The recording of accident and incidents has been maintained with the commission continuing to be informed promptly of events which affect the well being and welfare of residents. Care Homes for Older People Page 26 of 30 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 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 26 16 Arrangements must be strengthenned to ensure that satisfactory standards of hygiene are maintained for example control of infection and the disposal of waste in the home. To ensure the welbeing and welfare of residents and people associated with the home. 20/03/2009 2 38 13 Arrangements must be made that all hazardous substances must be stored in compliance with the control of substances hazardous to health COSHH legislation. in order to ensure the safety and welfare of residents. In order to ensure the safety and welfare of residents other persons in the home. 20/03/2009 Recommendations Care Homes for Older People Page 28 of 30 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 26 It is recommended that the number of housekeeping staff is increased to ensure the maitainence of a good standard of hygiene throughout the home. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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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