Inspection on 16/06/09 for Revelstoke Lodge

This inspection was carried out on 16th June 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Revelstoke Lodge 24/06/08

Revelstoke Lodge 22/06/07

Revelstoke Lodge 17/05/06

Revelstoke Lodge 17/02/06

Revelstoke Lodge 02/12/05

Revelstoke Lodge 05/07/05

Revelstoke Lodge 01/12/04

Revelstoke Lodge 16/06/04

Revelstoke Lodge 24/02/04

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Poldhu

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Trevaylor Manor

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Revelstoke Lodge Boringdon Road Plympton Plymouth Devon PL7 4DZ     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: Caroline Rowland-Lapwood     Date: 1 6 0 6 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: Revelstoke Lodge Boringdon Road Plympton Plymouth Devon PL7 4DZ 01752343001 01752345575 revelstoke@schealthcare.co.uk 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) : Ashbourne Homes Ltd care home 65 Number of places (if applicable): Under 65 Over 65 55 12 old age, not falling within any other category physical disability Additional conditions: 0 20 The maximum number of service users who can be accommodated is 65. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Revelstoke Lodge is registered to accommodate a maximum of 65 service users. The home provides care for up to 55 service users of either gender over the age of 65 years requiring nursing or personal care with physical illness, disability or frailness and a maximum of 20 service users aged 18-65 years with physical disability. Accommodation is provided on two floors, there is level access both internally and externally via ramps and a passenger lift. Bedrooms are mainly single though several doubles are available. Some bedrooms offer the added benefit of en-suite facilities. The communal rooms offer space for dining and recreation. A lounge room is provided Care Homes for Older People Page 4 of 31 Brief description of the care home for people living in the home who wish to smoke. The home is owned by Southern Cross Healthcare which operates a large number of care homes nationally. The current fees range from #300 to #900 dependent upon support needs. All people living in the home are issued with a contract breaking down the fees so people can see who is paying what. The service user guide and last inspection report is on display in the entrance foyer. 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. This key unannounced inspection consisted of a visit to the home on Monday 6th July 2009. Two inspectors, one of which is the lead pharmacy inspector, and an expert by experience performed this inspection. The Care Quality Commission consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. Care Homes for Older People Page 6 of 31 During this time we spoke to the manager who is the person with day to day responsibility for the service, the deputy manager, the chef and three care staff. We spoke to many of the people who live in the home. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. We looked at three staff recruitment records, induction and training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Revelstoke Lodge. What the care home does well: What has improved since the last inspection? What they could do better: There is concern about the detail of information in plans of care. Assessments are not always being updated where changes have taken place and the detail in care plans and risk assessments do not describe how and by whom decisions are made. Without good quality information that is reviewed and changed to take into account peoples changing needs, the quality and consistency of care could be compromised. Equipment must meet the needs of the individual, this refers to handling belts being the right size and spares being readily available. There needs to be a safe system in place to ensure that medicines are available to be administered as prescribed. There needs to be a clear record made of the actual dose administered for those medicines prescribed with a variable dose. There needs to be clear protocols in place for the administration of medicine prescribed to be adminitered when required. Safe methods of obtaining blood samples for blood sugars monitoring need to be employed. Improvements are needed to ensure that peopless social and leisure needs are met and recorded, especially those with limited capacity or specialist needs. Care Homes for Older People Page 8 of 31 There must be sufficient assisted baths within the home so that people are able to bath if they so wish. The grounds must be cleared and tidied so that the people living in the home can use them and have reasonable views from the bedrooms. The home must demonstrate that robust recruitment is in place in order to fully protect people. Staff personnel records must contain the required information and evidence of safety checks. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good information available about the home and this is shared whenever possible with people considering a stay at Revelstoke Lodge. Initial assessments are good and contain sufficient information to enable staff to fully plan care. Evidence: The Service User Guide contain detailed information about the home and the service it offers. A copy of this document is kept in all bedrooms. The complaints procedure is incorporated within this document. CQC surveys showed that half of those people responding had received enough information about the home before moving in. The local PCT or social services departments refer some admissions to the home. Care Homes for Older People Page 11 of 31 Evidence: Where possible the manager or deputy visit people before they move into the home to talk about their needs and the services offered. One person was visiting the home with her family and a carer from the hospital, they had lunch and met with some of the staff and had a good look around the home. Assessments were seen of three people. Referring professionals complete a comprehensive assessment of individual needs, which is shared with the home, in order to ensure needs can be met. Assessments looked at contained good information covering aspects of personal and health care needs. Social & spiritual needs were less well addressed (Refer to standard 12). The nursing staff at the home complete their own assessment of need once someone has been admitted. Staff surveyed said they had not been asked to care for people outside of their area of expertise, suggesting the home admits people appropriately. 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. There are systems in place for informing staff about peoples care needs, although a lack of detail in some care plans may lead to inconsistencies in care and a risk that some people may not receive all the care they need in their preferred way. The home takes appropriate action to ensure that the health care needs of people are met. Poor systems for the management of medicines mean that people cannot be assured that they will receive their medicines consistently and as prescribed. On the whole, peoples privacy and dignity is maintained. Evidence: Three people responding with CQC surveys told us they always receive the care and support they need; two felt that support was usually available when needed and two said they sometimes receive the care and support they need. People spoken with during the visit were generally happy with the level of care and support provided, comments included, they are pretty good and the staff are very nice on the whole. Care Homes for Older People Page 13 of 31 Evidence: The home supplies the CQC with am Annual Quality Assurance Assessment prior to the inspection. This document allows the home to tell us of improvements they have made. The AQAA stated that care plans are more releant, person centred amnd reviewed monthly, we did not this to be so. Three of the care plans we looked at, did not contain specific information about peoples social interests or hobbies, or spiritual needs. This lack of information may mean that staff do not have the knowledge needed to offer personalised care to individuals. None of the care plans we looked at had been reviewed since March 2009; this means that the care that people receive may not be relevant or appropriate. However overall, in spite of a lack of accurate recording and details in some areas of care plans, it appeared that peoples health and personal care needs were generally met. Care plans included risk assessments for most areas of care where there may be a risk. These include moving and handling assessments, nutritional needs, skin care and continence assessments and the use of bed rails. However there was no rational in place to show how decisions were made and by whom when bed rails are used. One moving & handling assessment showed that the person needed a hoist to move; however when we looked at this hoist the handling belt was too small for the person to use. Other moving & handling equipment did not seem to have spare slings although the manager informed us that there were some disposable ones somewhere and she said she would get them out so they may be used. Three staff told us that care plans generally contained the information they needed to care for people appropriately and that the daily report was a good opportunity for discussing changes. Four of the seven people responding with CQC surveys felt that they always received the medical support they needed. Two people told us they usually have the medical support required and one person felt they sometimes received the medical support they needed. We found that for people prescribed medicines with a variable dose that although a record was made of an administration occurring there were no records made of the actual dose administered. We also found that there were no clear protocols in place to indicate how the decision to administer a particular dose were in place. This means that people cannot be confident that they will receive the medicines they need to manage their condition either safely or appropriately. We also found that for some people prescribed medicines to be taken when required that there was no guidance on how the decision to administer or not was to be made. we also found that there was confusion about how some of the medicines prescribed in this way worked although current reference sources were available. This means that people may not receive these medicines in the most appropriate way for them to meet their needs. We Care Homes for Older People Page 14 of 31 Evidence: found that a few people had not had their medicines administered as prescribed because it was recorded that stock was not available to administer the medicines. For one of these people we found a supply in the medicines stock cupboard and for another we found that was not available at the end of one administration cycle but it was recorded as administered at the start of the following cycle. This means that the system for monitoring the availability of medicines places people at risk of not having their medicines as prescribed as there is no safe system in place for the management of stock. We found that although there was a poster on display to staff about the need to ensure that only the correct lancets were used when monitoring blood sugars, that the lancets we found to be in use were labeled by the manufacturer as being suitable for a self testing person only. We were told that the person these were prescribed for did not self test and that the testing was carried out by members of staff. This means that safe systems were not in place to reduce the risk of a needle stick injury occurring along with the subsequent infection control risks. This means that people cannot be assured that safe practices are used within the home. When asked, people told us that the staff treated them kindly and with respect. People told us, Staff are very good and Most staff are polite. Staff were seen to knock on bedrooms doors and wait before entering. No evidence was seen of personal care being given with doors open. No one made any adverse comments about the staff who were seen to be very busy, respectful and caring but with little time to engage with their charges other than when undertaking care duties. A visitor said, The staff look after my wife particularly well and she is better since coming here. One person commented, there appear to be frequent changes of staff and they are quite cosmopolitan. Some call bells were out of the persons reach in some of the bedrooms and one person complained that when in bed she was not always able to reach her drink. Call bell response time was said to vary between 5 and 50 minutes depending on how busy the staff were. 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. Whilst there are some activities, and good contact with family and friends, social and leisure needs do not provide regular stimulation for people to ensure that their individual needs are met. people are given choice but staff are often task led. People do not always enjoy the food, which does not always meet their preferences. Evidence: Three people responding with surveys told us there were usually activities they could join in with. The majority of the people spoken with said they chose to remain in their rooms unless there was an activity of their liking they could engage with. It appears that the activity organiser has been absent for many weeks although entertainers have been attending. A couple of people mentioned trips to Dartmoor, bingo and quizzes in the recent past. One person said, This place is not quite my scene, I am an active person and go out with my son twice a week. A person with horticultural experience mentioned she no longer assists with the garden and plants due to the absence of the activity organiser. Another commented, I am happy the way I am going and I dont want to join in with anything. Not all people were aware of that the local Curate visits people individually by request. One person responding via a CQC survey said Activities are for the elderly residents, occasionally there is a trip out of interest. These Care Homes for Older People Page 16 of 31 Evidence: occasions are rare. There is nothing in place for the younger group at all. We saw people nursed in bed, their care plans had no record of preferences with regard social activities yet each person had either the television ( one elderly gentleman has a cookery programme on, he was asleep) or the radio on. The radio station was tuned into a modern station playing mostly pop music, leading us to believe that these were on for the benefit of the staff. During our observation time we saw some good interactions, which improved peoples state of being. Staff were friendly and good humored often having a joke with the people living there. Whilst the majority of respondents said they chose their own time of rising and retiring (even if it was a set time) others were of the opinion that due to insufficient staff they rose and retired at a time not of their choosing. One person said Unless I am in bed by PM it can be PM before I can go, the staff say there are only two of us on. Another said I get put to bed at PM and am got up anytime between AM and AM, these are not times of my choosing. Those people choosing to eat in the dining room did not require assistance whist some of those electing to eat in their bedrooms were seen to be given help in a sensitive manner on a one to one basis from a carer sat alongside them. All four of the people returning CQC surveys told us they sometimes enjoyed the food. When asked about food peoples responses varied from, Very nice, Alright, Edible, Adequate, Not too bad, Depends on your palate, Could be improved especially the main course at lunchtimes, as I have mentioned to various managers several times, Food is tasteless and overcooked, Depends which cook is on duty to Generally awful but occasionally nice. A choice is made the previous day from two main courses with an alternative (said by some to be ham and chips) being found if necessary. One person said Sundays and Wednesdays are best when we have a roast. No one could recall being asked what his or her favorite meal was. On the day of the inspection the main meal was either Lancashire hotpot with cauliflower, sweet corn and carrots or scampi, chips and mushy peas. A visitor said, I am pleased that my wife was given soft food like ice cream and soup that she could swallow and enjoy. 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. People can be confident that their complaints will be listened to and staff understands the principles of adult protection, which helps to protect people from abuse. Evidence: The complaints policy is given to all people living in the home. In surveys respondents say they know who to speak to if they are not happy and know how to make a complaint. We were told that all complaints made are recorded and investigated. Four complaints have been received by the CQC since the last inspection. These were in relation to environmental issues in the home including the heating system, medication issues and moving & handling training. These issues have now been resolved. All staff was aware of procedures to protect people from harm although they said they were waiting for up to date training on safeguarding; They were able to give appropriate examples of unacceptable practice (such as shouting), and knew they must report this to senior staff. All people living at the home asked said they felt safe at the home. Care Homes for Older People Page 18 of 31 Evidence: 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment within the home is satisfactory providing people with reasonably homely surroundings, which are maintained to a good standard. Improvements are needed to the gardens in order for the people living at the home to use and enjoy them. The cleanliness of the home in general is good although improvements could be made to ensure every room is free from offensive odours. Evidence: The premises inside appeared homely, and generally well maintained. There is a programme of routine maintenance and re-decoration in place, two people are employed to undertake this work. The outside of the home looks overgrown and unkempt. Flower containers were either empty or contained dead flowers, paths had weeds growing over them and the grass and planter areas were overgrown meaning that people in the ground floor rooms had no view and their rooms were dark as a result. Individual bedrooms seen were personalised with sentimental items, photographs and small pieces of furniture, including a fridge. People told us they were happy with their accommodation. Care Homes for Older People Page 20 of 31 Evidence: Currently there is no working assisted bath within the home. There is no bath that can be used on the first floor and the bath on the ground floor does not work. This has recently been fitted but needs further work; the home said they were waiting on the manufacturer to get back to them to resolve this problem. All radiators are covered to reduce the risk of burns to people and water temperatures are controlled by thermostatic valves to reduce the risks of scalding. The home has a dedicated team of cleaners and the housekeeper takes pride in ensuring that the home is clean and free of offensive odours. The home was clean. Four rooms were found to have unpleasant odours. People responding with CQC surveys said that the home was Always or Usually fresh and clean. Staff spoken with had a good understanding of infection control; All staff were seen to wear gloves and aprons when providing personal care. Alcohol gel is freely available to promote infection control measures. The laundry facilities are old but generally well organised. Staff demonstrated a good knowledge of their responsibilities. There is a system in place for dealing with soiled laundry, which reduces the risk of infection. 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. People living at the home benefit from having skilled, experienced and friendly staff in sufficient numbers who have a good understanding of their care needs. Aspects of record keeping in relation to recruitment need improvement to demonstrate that prospective staff are suitable to work at the home. Evidence: People living at the home praised staff at the home almost universally. One person told us, Staff are so pleasant, always happy to help, another said, Nothing is too much trouble for them although sometimes it is hard to understand the ones that dont speak clear English. Surveys received from people living at the home showed that staff were always or usually available when needed. However when we asked people living at the home on the day they told us that call bell response time varied between 5 and 50 minutes depending on how busy the staff were. During our visit staff responded to call bells and on the whole peoples care needs appeared to met in a timely way. Staff told us that they were busy at times and that it would be beneficial to have more time to spend doing one to one activities with people. Staff said that the majority of the time they were rushed but had enough time to provide the care required. Care Homes for Older People Page 22 of 31 Evidence: The recruitment files of three members of staff were inspected to ensure that procedures were robust and protected people living at the home. Recruitment processes were undertaken by the administrator who has now left and the home told us it was having difficulty locating all the paperwork needed. Personnel files looked at contained most of the necessary checks,however, one did not contain a Criminal Record Bureau (CRB) check, the other only contained one reference. All staff responding with surveys and those spoken with said they had received induction training when they first started working at the home, to help them understand how the home works and how to work safely and respectfully with people. Training records provided evidence that some training is provided although some areas were need of updating for example Protection Of Vulnerable Adults which had been planned for the following week. All staff spoken with said they really enjoyed working at the home. The general atmosphere is good and staff appeared happy and cheerful. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed resulting in practices that generally promote and safeguard the health and well being of the people living there. Evidence: Although there is currently no registered manager at the home, Janet Smith is the manager and she is applying to register with the Care Quality Commission in the very near future. Staff spoken with on the day said they felt settled and there was a clear line of management; they felt confident that they were able to raise concerns and issues. There is an adequate quality assurance system in place. This includes people living at the home, friends, relatives and health professionals satisfaction surveys. A satisfaction survey is undertaken by head office, the last one was done last year. We were told another is due imminently. Staff and residents meetings are undertaken although we were told that no one living at the home participates so the manager likes Care Homes for Older People Page 24 of 31 Evidence: to deal with issues on a day to day basis instead. However people we spoke with on the day were aware of who the management of the home were but said they never see them, one said I hardly ever see the manager although I suppose I could if I needed to. We looked at the personal allowances of the people who live at the home; we were unable to check individual monies as the home has a system whereby people monies are pooled; although this is not best practice we were assured that audited records were available if required. Receipts and clear records are kept and on the day of the inspection a financial audit was being undertaken by a member of staff from the head office of the company. Maintenance and associated records provided evidence that the registered provider has a sensible approach towards maintaining the safety of the environment; the fire precautions logbook indicates that the fire alarm is tested weekly and emergency lights monthly. All radiators we saw throughout the home had been covered to prevent people from being burnt. Care Homes for Older People Page 25 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 26 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 13 You must ensure that unnecessary risks to the health and safety of people are identified and so far as possible eliminated. Risk assessments must identify behavioral, situational and environmental risks, describe the measures in place to reduce harm and who was involved in this process. This means people will be safe and decisions made on their behalf if they lack the capacity to do so are fair and necessary. 31/08/2009 2 7 15 The care plan must be up to 31/08/2009 date and reviewed when required. The plan must provide staff with up to date, detailed information on peoples needs and wishes. The plan must provide clear instructions to staff on what they need to do to care for Care Homes for Older People Page 27 of 31 people safely and consistently. This means people will get the care they require at all times. 3 8 12 You must ensure people are 31/08/2009 provided with the equipment they require to meet their health and welfare needs. This means people will be cared for in a safe way. 4 9 13 (2) Arrangements must be made to ensure that only suitable lancets are used for obtaining blood samples for blood sugar monitoring. This is to ensure that the reisk of needle stick injury and possible cross infection are managed safely and eliminated where possible. 5 9 13 (2) Arrangemetns must be 07/09/2009 made to ensure that there is a safe system in place to monitor available stock of prescribed medicines and obtain replacement supplies before they run out. This is to ensure that people can have their medicines administered to them as prescribed. 6 9 13 (2) Arrangements must be 07/09/2009 made to ensure that there are clear protocols in place on how medicines prescribed to be administered when required are to be used. 07/09/2009 Care Homes for Older People Page 28 of 31 This is to ensure that people receive therir medicines in a consistent way to manage the symptoms they have at the time, 7 9 13 (2) Arrangements must be made to ensure that the actual dose administered is recorded when medicines are prescribed with a variable dose. This is to ensure that it is possible to monitor the effect of a particular dose for the person and then to report these effects to the presscriber 8 12 16 You must consult with 31/08/2009 people about their social interests and make arrangements to enable them to engage in a range of activities inside and outside of the home. Particular consideration must be given to people less able and those spending considerable time in their bedrooms. This will enable people to have a fulfilling lifestyle. 9 19 23 External grounds, which are 31/08/2009 suitable for, and safe for use by, are appropriately maintained. This means people will be able to enjoy the garden and have a reasonable view from some of the bedrooms. 07/09/2009 Care Homes for Older People Page 29 of 31 10 21 23 There must be a sufficient number of baths and showers working within the home for people to use. This means people will be able to stay clean and have the choice of how to do so. 31/08/2009 11 29 19 You must demonstrate that 31/08/2009 you operate a robust recruitment procedure in order to protect people. Staff personnel records must contain the required information and safety checks. This will mean people are cared for by suitable staff. 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 7 Call bells should always be provided. Where people are unable to use a call bell a risk assessment should be completed and a plan drawn up to manage this. 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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