Inspection on 14/04/09 for Ridgwell House

This inspection was carried out on 14th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ridgwell House 07/05/08

Ridgwell House 26/04/07

Ridgwell House 27/09/06

Ridgwell House 17/02/06

Ridgwell House 30/10/05

Ridgwell House 04/02/05

Ridgwell House 08/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ridgwell House 95 Dulwich Road Holland on Sea Essex CO15 5LZ     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: Diane Roberts     Date: 1 4 0 4 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 29 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 29 Information about the care home Name of care home: Address: Ridgwell House 95 Dulwich Road Holland on Sea Essex CO15 5LZ 01255815633 F/P01255815633 dunaibrahim@aol.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) : Prestige International (EC) Ltd care home 16 Number of places (if applicable): Under 65 Over 65 0 16 dementia old age, not falling within any other category Additional conditions: 16 0 The total number of service users accommodated in the home must not exceed 16 persons Date of last inspection Brief description of the care home Ridgwell House is an established care home for older people in the village of Holland on Sea, near the town of Clacton on Sea. The home has been open since 1985, and was registered to the present owners Prestige International (EC) Ltd in July 2004. The accommodation offers care for 16 residents on the ground and first floor. At the time of the inspection a double bedroom was used to accommodate a single person and therefore all accommodation is in single rooms for 15 residents. There is a stair lift to the first floor. The majority of the accommodation is on the ground floor, with 4 residents on the first floor. There are 3 bathrooms and 1 shower room, all with toilets. In addition, there are 3 separate toilets around the home. Catering and laundering facilities are found in the centre of the home. Communal areas consist of a front and rear lounge and a large dining room. The rear Care Homes for Older People Page 4 of 29 Brief description of the care home lounge overlooks the rear garden, which is laid to lawn with flowers, shrubs, fruit trees and vegetable beds. In the garden there is a summerhouse, a green house and shed. Seating is provided during the summer in the garden. The front garden has a semi-circular driveway offering some off-road parking. Flowerbeds, plant pots, flowering shrubs and trees bring colour and interest to this area. The range of fees charged by the service are between £480.00 and £540.00 per week. Respite rates are up to £495.00 per week. There are additional charges for hairdressing, chiropody and staff escort fees. Care Homes for Older People Page 5 of 29 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: We visited the home for a whole day and met with the acting manager and her team. Prior to this we reviewed all the information that we already had on the home and this included the current registered managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. The completion of this document was poor overall and gave us a limited picture of the home as the manager saw it. This could relate to the limited time that the registered manager spends at the home. On the day of the inspection we spoke to residents, relatives and staff at the home and Care Homes for Older People Page 6 of 29 prior to that we sent out surveys, asking for feedback on the home. The response was quite good from relatives and these comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their needs would be properly assessed to ensure that the home would be suitable and that they would have sufficient information about the home on which to base a decision. Evidence: The manager has a statement of purpose and service user guide as a combined document. The administrator confirmed that she gives these out along with copies of the complaints procedure to new residents and/or their families. Whilst there is some pictorial content, the service user guide is not user friendly as the font is particularly small and there is a lot of written information. Consideration should be given to reviewing this document to ensure it is suitable for the resident group in the home and that it meets Standard 1 of the National Minimum Standards. The acting manager agreed that the format was not suitable. Care Homes for Older People Page 10 of 29 Evidence: The acting manager said that she undertakes all the pre-admission assessments and often takes a senior member of staff with her to assist. She also confirmed that she likes to undertake two visits, especially for residents who are potentially long term placements. The manager has a pre-admission assessments document in place and two were reviewed. Overall the assessment gives a reasonable picture of the prospective resident and their needs. More information/detail could be provided, especially on dementia, where appropriate, and how this affects the person and the needs they may have. Assessments must be dated and signed to show that they were completed at an appropriate time and by a suitable person. The acting manager also had information from referring authorities, where appropriate. However, key information on these documents was not always used in the subsequent care planning process, especially in relation to information provided on mental health and hobbies/interests. The home regularly provides care for people on respite placements and keeps one room especially for that purpose. One resident spoken to said that they chose the home themselves as they thought that the carers looked as if they cared and since being at the home their mind had not been changed. One relative spoken to said that she had seen a service users guide. A respite resident said that they have been well looked after and that the home was extremely good and a friendly place. Care Homes for Older People Page 11 of 29 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. Residents can not be assured that all their care needs would be appropriately met, giving them variable outcomes. Evidence: The management team at the home have a care planing system in place. Two care plans were reviewed in full and further care plans were used for cross referencing. Residents were seen to have good general profiles in place that were very person centered and outlined their routine for the day. These showed a good understanding of individual residents and their choices etc. and would provide staff with an insight into that person. They were not dated so it was unclear as to how current they were. Ideally these profiles should be linked to the care plans to make both a working document. Care plans were seen to be in place for the majority of needs but the detail was often limited, they were not very person centered and there was often no date, so it was Care Homes for Older People Page 12 of 29 Evidence: difficult to determine how up to date they were. On discussion with the acting manager, regarding a care plan for a resident with reoccurring urinary tract infections, we were told that the management of this issue had changed, but this was not reflected on the care plan, identified for review in 2009. More work is also needed on care plans that relate to residents mental health/well being and possible challenging behavior as staff were spoken to identify residents who may exhibit such behavior and on checking no care plans were in place. Key information from the pre-admission assessment documentation, on mental health needs was also not referred to in the care plan and this could affect the management and support of the resident in the home. Residents had a range of risk assessments in place, for example, for pressure sores, falls, manual handling etc. The review of these assessments was seen to be inconsistent, with some up to date and some which had not been reviewed since August 2008. This does not give staff an accurate picture of the risk or associated management. It was also noted that the staff completing these documents did not always sign to say who had completed them. Residents with identified risks for pressure sores and falls did not have care plans in place which detailed the management of the risk. Records show that residents have access to visiting health care professionals such as practice nurses and chiropodists etc. Records also show that the GP is contacted in a timely manner should a visit be required. It was noted that advice given by Gps was not always transfered to the care plan or a care plan put in place, for example, with regard to increasing fluid intake. Daily records are recorded which show that residents basic care needs are met and what they have eaten. They also show that residents are expressing choice and that staff are facilitating this. The daily notes do not relate to the care plans in place. Residents weight monitoring in the home needs to improve. Records shows that residents are weighed inconsistently and therefore their nutritional needs are not being sufficiently monitored and possibly addressed. Reviews with placing authorities showed that requests had been made to check the height and weight of specific residents and records show that this had not been done until 4 months later. Nutritional risk assessments and care plans were not in place for residents with identified needs in this area. Records are maintained of the meals residents have had but the amount eaten is not recorded. This was discussed with the acting manager. Residents weight charts, inconsistently completed, were seen to be displayed on the bathroom wall. This is a privacy and dignity issue and was raised with the manager. Care Homes for Older People Page 13 of 29 Evidence: Residents and relatives spoken to, and from audit results, commented positively regarding the care provided in the home and the overall approach of staff. The administration of medication was reviewed. The team are primarily using a blister pack system. Several shortfalls were noted that included, respite and permanent residents medication not being checked into the home on an administration sheet, staff using medications that did not have a current prescription on their MAR sheet, omissions codes for as needed medications not being used residents being given too much as needed medication without sufficient assessment of need as care notes gave conflicting information. Changes to prescriptions that occur during the month must be signed for by the staff member making the change. Dates of opening should be recorded on boxed and liquid medications for auditing purposes. No photos of residents were available on the MAR sheet which increases the risk of misadministration. From discussion with staff regarding the morning routine, it was also evident that the staff member dispensing the medication and signing the chart was not always the person actually giving the medication to the resident. This must be addressed. The shortfalls were discussed with the manager and it is strongly recommended that a regular audit be undertaken to ensure that standards of medication administration are improved to ensure reside ts safety. Residents records show that medication is often reviewed during Gp visits. Care Homes for Older People Page 14 of 29 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. Outcomes for residents are good in relation to meals and exercising choice but shortfalls in the social activities programme means that their needs may not be met in full. Evidence: Residents were seen during the day, busy in the garden and helping in the kitchen etc. It was positive to seeing residents making choices about how to spend their time, where able. Residents spoken to said that they had a choice about when they got up and went to bed, one said I can watch TV all night if I wish. The managers AQAA said that we encourage residents to lead a more active life by getting involved with day to day tasks From discussion with staff, it is evident that there is generally a person centered approach to the daily routine. From discussion, staff need to ensure that toileting routines are individual to the person and needs led and that a task led approach is not taken. The team at the home have opened a small shop for residents so that they can purchase toiletries and sweets etc. Residents spoken to said that staff are always helpful when you need to get shopping or post mail etc. Residents were seen to be very relaxed with the staff team and interaction was good and some were seen to be going out with their families. Care Homes for Older People Page 15 of 29 Evidence: Residents personal profiles identified what they often liked to do with regard to social activities, such as helping in the kitchen etc. but the actual social care plans in place contained limited generalised information that did not identify specific needs and the promotion of independence and self worth. Social and family profiles may also be of value so that staff are aware of residents lives before they came into Ridgewell House. Activities are held downstairs and therefore residents who have to or choose to stay in their rooms have little or no social stimulation and they also confirmed that they never see the activities programme. One resident said I miss my gardening and would appreciate some-one to talk to. This residents social care plan did not reflect her current needs. Staff spoken to say that activities are provided at 10 - 10.30 a,m and that the person in charge decides what is going to happen. A more person centered, needs led approach needs to be taken and the team also need to ensure that both group and individual needs are met as far as possible. Staff report that activities consist of manicures, chatting, playing catch with a ball and sometimes taking residents down to the seafront for a walk. Records shows that the following has been provided recently, exercise to music, singing nursery rhymes, music playing, ball and skittles, looking at scrap books and church services. A programme of events is displayed which is not user friendly for the residents group and records shows that it is not followed. The manager informed us that an activities lady does pop in twice a week to see the residents but no records are maintained. Activities, in the managers own audit, scored poorly overall, with some residents and relatives saying that activities are never provided and comments included more activities and games would be a good idea. This was also reiterated in the feedback surveys that we received from relatives. Lunch was observed to be a relaxed time, residents ate their meals where they wanted and the dining room was pleasant, with the tables nicely laid and condiments available. Residents were observed to be eating different meals showing that their choice and preferences had been taken into account. Where required, residents were help in a sensitive manner by staff and staff were heard to ask them if their meal was alright and whether they had had enough. Residents who commented said that the food is good and they are always willing to make things for you, they are always encouraging me to eat and they make me homemade soup. The acting manager said that she planned to introduce a visual menu to help residents in the home choose their own meals. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents know how to raise concerns, they cannot always be fully assured that the matter would be dealt with as per the homes procedure. Evidence: Residents spoken to said that they would raise any concerns with either the acting manager or the administrator and confirmed that both were very helpful. Relatives said on our feedback surveys that they knew how to make a complaint and that they did not have any. The manager logs any complaints in a small notebook which, on review, contains very little detail. A formal logging system is recommended so that the home can evidence that they have followed their own complaints procedure. Only two complaints have been logged since the last inspection and this related to the cleaning in the home and the other related to staff behavior. The records did not always show that these matters had been dealt with in the correct manner and outcomes were not recorded. This needs to improve and was discussed with the acting manager. The registered manager in her AQAA said that we follow up complaints and research them and we have improved by having detailed complaint investigation and swifter resolutions. The evidence at the home would not concur with this. Staff spoken to identified an understanding of adult protection matters but could not locate the most up to date guidance on this subject, within the home. The manager later located this and made it available to staff. Staff training records showed that Care Homes for Older People Page 17 of 29 Evidence: there was a good compliance rate with staff training on this subject. Care Homes for Older People Page 18 of 29 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. Residents live in a home that generally meets their needs but outcomes could be improved further. Evidence: A tour of the home was undertaken with the acting manager. All the communal areas and bathrooms were seen along with the majority of the bedrooms. Overall the standard of decoration and furniture is satisfactory but there are still some areas and items that need attention. The bathrooms in the home do need some work to bring them up to an acceptable standard and ensure that they are fit for purpose. The home has a pleasant front lounge and dining area. The acting manager says that lockable bedside cabinets are on order for the bedrooms . It is unfortunate that one bedroom opens directly onto the main lounge area, limiting privacy and peace and quiet. Since our last inspection and following shortfalls highlighted by other placing agencies, new radiators covers have been put in place, along with window restrictors and thermostatic valves. A urine odour was noted in the downstairs back corridor and on entering the home. This was highlighted to the manager and indicates that either more input is needed with the management of continence or cleaning in the home. A cleaner works in the home in the mornings five days a week. The team do not have a carpet shampooer. Care Homes for Older People Page 19 of 29 Evidence: Overall the atmosphere is homely and residents spoken to liked the premises. The home has very pleasant gardens to the front and the rear and some residents take an active part in gardening. Relatives who commented in our surveys felt that the home was clean. The manager in her AQAA said that we provide a pleasant and uninstitutional feel and we continue to make improvements - upgrading furniture and accessibility. Signage around the home is poor and on discussion the acting manager agreed with this assessment. The home is primarily for residents with dementia and the lack of signage does not promote their independence and therefore wellbeing. The home has a gardener that also completes some maintenance work and the acting manager confirmed that they also had two other external contractors that they could use for minor works and paperwork seen evidenced this. Records of staff highlighting maintenance work that is needed show that in some cases items are attended to promptly whilst others are not depending on availability. Fire safety records were reviewed and found to be in reasonable order with staff attending fire drills, systems being checked and maintenance certificates in place. More regular checking of the emergency lighting is needed and a maintenance certificate should be in place. The manager also has a fire a safety risk assessment in place for the home. Care Homes for Older People Page 20 of 29 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. Residents benefit from a stable workforce but shortfalls in recruitment mean that they may not always be protected. Evidence: The current staffing levels for the home are one senior or the manager and 3 care staff for 16 residents during the day and 2 awake care staff and one asleep at night. In addition to this is a cook working 9 - 2 p.m and a tea lady working 4 - 6 p.m. Residents spoken to said that the staff are all very nice and friendly, sometimes there are only 2 staff on which means you have to wait but they also come to see you and reassure you that they will be along. Minutes of staff meetings do show that staffing levels are adjusted to suit the needs of the residents, especially when respite residents are admitted. Overall, relatives and residents were happy with the staffing levels. The manager in her AQAA said we maintain a stable, loyal and trained workforce. Staff files in the home were reviewed in order to assess recruitment practices in the home. These need work to ensure that residents in the home are protected as far as possible. For example, staff did not have appropriate CRBs in place and often commenced work without having a POVA first check, one file only had one reference Care Homes for Older People Page 21 of 29 Evidence: and very old paperwork was used for staff members who kept leaving the employ of the home and returning. Staff spoken to confirmed that they were waiting to start further NVQ qualifications. Out of 22 staff 8 have an NVQ qualification including the manager. The acting manager has recently completed a training needs analysis for the staff team in the home. Records show that the team have a generally good level of compliance with both statutory and additional training on subjects relating to old age. There are some gaps where staff have not attended fire training or manual handling training and this needs to be addressed. Staff have been attending training on activities for people with dementia and equality and diversity, so this learning should be put into practice. Staff files showed that they had attended basic in house inductions and after six weeks had only completed part of this. This needs more attention to ensure that staff are supported and residents are cared for properly. The manager confirmed that in the past Skills for Care inductions have taken place and any new staff will undertaking this. The manager in her AQAA said that we need to improve by upgrading our induction process. Care Homes for Older People Page 22 of 29 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. Inconsistent management of the home has limited its progress and there in some areas where outcomes for residents could be better. Evidence: The current registered manager is not running the home on a day to day basis, spending extended periods of time abroad. In August 2008 in her submitted improvement plan, it was stated that she planned to put forward another manager to be registered. To date this has not occurred. The lack of consistent management is reflected in several areas of the home and the current registered managers submitted AQAA, which was weak in content, gave a limited reflection of the home. The acting manager who was in charge on the day of the inspection said that she had completed her Registered Managers Award and planned to put in an application to be registered soon. This would be her first managerial post, but has been working in the home for nearly 6 years. She reported that since Feb/March 2009 she has been supernumerary to enable her to manage the home. Records show that the acting manager is keeping Care Homes for Older People Page 23 of 29 Evidence: herself up to date with the required training and additional courses. The acting manager has held staff meetings and the minutes show that she covers a range of topics that affect the residents and the staff. The provider has a quality assurance system in place that consists of a survey for residents, relatives and other interested parties.. This has been completed recently and comments included a more friendly home I have not seen, staff intermingle with residents and always appear happy and satisfied with their conditions and staff are always polite and helpful. Whilst there is evidence that the manager has followed up some issues that were raised in this feedback, an analysis of the results should be undertaken and the report and any action plan made available to interested parties. No resident or relatives meetings are held for ongoing consultation and thought should be given to this. Overall,the new manager for the home needs to get some management systems in place, including general audits, to maintain and improve upon standards in the home. Staff files showed that staff had supervision agreements in place and had received an appraisal but were not due for further supervision for another 6 months. Some observational supervisions had been completed that were seen to be valuable. Some files showed that staff were having regular supervision. It is clear that a system has been put in place but this is yet to be consistently applied. Staff need to be more aware of COSHH items in the laundry and the kitchen, where residents have easy access. These items should be locked away to reduce the risk of accidents. Accident records were reviewed and found to be completed fully and showed few accidents. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 16 22(8) People who use the service must be confident that their complaints, their investigation and their outcomes are recorded. 30/06/2008 2 36 18 Staff supervision must be 31/08/2008 consistently carried out. This will support staffs? development and practice in meeting residents? needs. This is a repeat requirement. Care Homes for Older People Page 25 of 29 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 Residents must have up to date care plans in place that ideally are person centred and contain sufficent detail to guide staff. So that residents recieve the care they need in a way that they would wish. 30/06/2009 2 8 12 Residents must have up to date risk assessments in place, as required, that contain sufficient detail to guide staff. So that any risks to residents are appropriately managed and kept under review. 30/06/2009 3 8 12 Residents weight monitoring 14/06/2009 and subsequent assessment and managemnet must be consistant and effective. So that residents recieve the care that they need in reltion to thier weight. Care Homes for Older People Page 26 of 29 4 9 13 Medication management at the home must improve and staff must follow procedures. To ensure that residents receive the correct medication and that they are safe from risks. 14/06/2009 5 12 16 The social activities programme must be developed so that it is resident led and meets their group and individual needs. So that all residents have sufficient social stimulation that meets their differing needs. 30/06/2009 6 16 22 The complaint procedure that is in place must be followed and adequate records maintained to evidence this. So that residents can be assured that their concerns would be dealt with properly. 14/06/2009 7 19 16 The home must be kept free from offensive odours. So that the quality of life for residents is acceptable. 30/06/2009 8 31 8 The current management situation at the home must be confirmed. So that standards in the home improve and are consistently applied. 30/06/2009 Care Homes for Older People Page 27 of 29 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 2 3 1 10 12 A review of the service users guide is recommended to ensure that it is user friendly for the resident group. Private information regarding residents should not be displayed in public areas of the home. Review the routines of the day in relation to supporting residents with their continence management during the day and the night so the care is resident/needs led. Ensure that staff are aware of the most up to date guidance on adult safeguarding. The overall refurbishment of the home, especially in relation to furniture and the bathrooms should continue. The quality assurance process should continue to be developed through the use of residents and family meetings. The staff supervision system should continue to be developed in a consistent manner in order to support staff. Staff need to be more aware of the risks associated with the Control of Substances Hazardous to Health by locking items away. 4 5 6 18 19 33 7 8 36 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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