Inspection on 22/04/09 for Rosemont

This inspection was carried out on 22nd April 2009.

CQC found this care home to be providing an Poor 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosemont 06/12/08

Rosemont 22/04/08

Rosemont 06/06/07

Rosemont 20/07/06

Rosemont 07/03/06

Rosemont 03/08/05

Rosemont 23/02/05

Rosemont 28/09/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Rosemont Yealm Road Newton Ferrers Plymouth Devon PL8 1BX     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Graham Thomas     Date: 2 3 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Rosemont Yealm Road Newton Ferrers Plymouth Devon PL8 1BX 01752872445 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr D M Beckhurst care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Rosemont is registered to provide care for 19 people in the category of old age only. At the time of our visit, 12 people were living in the home. It is owned and managed by Mr Beckhurst, who is assisted by another staff member who is known as the Care Manager. The home is registered to accommodate up to 19 people. Two rooms have en-suite facilities. The premises comprise a large, older property that stands in its own grounds overlooking the picturesque creek of Newton Ferrers. There are a dining room, two lounges and a conservatory. The home has two stair lifts to the upper floor and ramps to provide access in and out of the building. Adjoining the property are two privately owned flats that are not connected to the care home. The proprietor and his family live in one flat and the second is used as staff accommodation. Mr Beckhust told us that current weekly fees range between 350 and 450 pounds per week. This does not include chiropody, hairdressing or magazines and newspapers Care Homes for Older People Page 4 of 30 Over 65 19 0 0 6 1 2 2 0 0 8 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: zero star poor 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: Before our visit to the home, Mr Beckhurst returned a completed an Annual Quality Assurance Assessment (AQAA). We reviewed our records about the home and the results of a Random Inspection carried out in December 2008 and our last Key inspection in April 2008. We visited the home and spent one and a half days there. Three people living in the home were case tracked. This means that we looked in detail at their records, met and spoke with them where possible. We also discussed their needs with staff. After our visit we spoke with a member of the Community Nursing Team about one person. Some time was spent observing a midday meal time. We looked in detail at the homes system for administering medicines as part of our case tracking. While touring the premises we spoke with other people living in the home and looked at some of their records. While we were at the home we also spoke with four visitors. Care Homes for Older People Page 5 of 30 Staff files were examined and four staff were interviewed. We looked at records about the running of the home and discussed this with Mr Beckhurst, the Registered Person. After our visit we requested some additional information that was not available during our visit. Care Homes for Older People Page 6 of 30 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 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 7 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 8 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into Rosemont are given enough information to make a decision. A good enough assessment of each person is made to decide whether their needs can be met at Rosemont. Evidence: In the questionnaire completed before the inspection the service told us that peoples needs were assessed before they move in so that the home can offer the care they require. A brochure is available and families are invited to visit the home. We looked at two files of people who had moved into Rosemont recently. Assessments had been obtained form the Health and Social Services and the home had made its own assessments of each persons needs. The relative of one of these people visited during our inspection visit. The relative told us that he lived locally and knew the home and its owner well. He felt that they had Care Homes for Older People Page 9 of 30 Evidence: received enough information to make a decision about moving in. We later spoke with the person living in the home who confirmed what his relative had told us. Each person had a plan of care. It was not always clear from the care plans that the needs identified in the assessment were being met. This is described in more detail in the following section of this report. Rosemont does not provide intermediate care Care Homes for Older People Page 10 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are insufficiently well organised and detailed to provide staff with the information they need to provide care and support. Persistently poor practice in the administration of medicines places people using the service at risk Evidence: Most people living in the home and visitors with whom we spoke were satisfied overall with the care they received. one person felt that the attention received was variable depending on the staff on duty. One visitor had returned to the home to thanks staff for their care of a recently deceased relative. This person felt that the care offered by the home had been first class. Records about each person comprised daily notes and risk assessments held in a file for daily reference by staff, a detailed care plan held in the office and and old daily notes also held in the office. These were not well organised. At the start of the inspection there was some confusion about where the detailed care plans were stored. Mr Beckhurst (who was in charge of the home) could not easily locate them and the staff did not know where they were. It was some hours before they were discovered in Care Homes for Older People Page 11 of 30 Evidence: a locked cupboard under other items. This is a cause of concern since the daily notes available to staff ask them to refer to the detailed care plans held in the office. We looked in detail at three care plans and daily records and looked at specific information in two others. The plans we examined showed evidence of recent review by the Care Manager. They contained risk assessments concerning such risks a flooring, furniture and use of the bathroom. Moving and handling assessments were also seen in the care plans. However, in one plan we could not find a records or assessments regarding the use of a hoist. A hoist was present in this persons room and the person confirmed that staff used it to assist them. One plan was particularly disorganised and hard to follow. Pages were not in sequence and several pages had the same number. Some areas of the plans such as social needs lacked detail and were incomplete. For example, one entry referred to the person being a regular church goer. There was no indication of the denomination. It was not always clear how needs identified in the initial assessment were being monitored and met. One person was described as liking company but spent both days of our visit in their room and not assisted to join others. This person told us that they were bored. The notes available to staff had not been updated in accordance with the detailed care plan. For example, a risk assessment in the daily file pre-dated the risk assessment in the detailed plan. We spoke with two members of staff who both appeared to have a reasonable understanding of peoples personal care needs and associated risks. A particularly frail person person was receiving daily input from the Community Nursing Service. A Nurse attended the home to see this person during our visit. We spoke with a Community Nurse Manager about the needs of this person. She told us that the persons need for support in feeding and drinking were apparently well met. She told us that the home was usually compliant with any prescribed regime of care and usually called for assistance promptly when needed. Evidence seen in other care plans showed that the assistance of other health professionals had been called as required. Some equipment such as new hoists has been obtained to provide safer support for people. Staff have been trained in the safe use of the hoists. We looked at the way medicines were used in the home. Since our last inspection a new padlocked box has been introduced to carry medicines around the home. We saw that when it was not in use, the box was kept in the locked office. Other medicines were stored in a locked cabinet in the office. Recording of the use of medicines was not safe. When we arrived at the home we examined the medicines administration records. We found that night staff had signed for most medicines to be given in the morning though most had not yet been given. This included medicines for two people that were to be given later by another staff member. Two peoples records showed Care Homes for Older People Page 12 of 30 Evidence: that eye drops had been prescribed. Apart from two doses, these had not been signed for. Mr Beckhurst stated that the people using the drops were administering themselves. However, no risk assessments had been completed for self administration of medicines. The eye drops were kept in the peoples rooms. We visited one person with a member of staff to find the eye drops. On being asked where they were the person said that had forgotten to use them that morning. In the other persons room we found one of the eye drops in use was past its use by date. Two doses of one persons medicines were found in their box although they had been signed for as administered. We heard staff speaking supportively and kindly to people living in the home and saw them offering support when this was needed. Some staff used terms of endearment such as darling or my love when speaking with people, rather than their preferred names. Staff generally knocked on doors before entering and closed doors when providing personal support. However we saw a door left open when staff were assisting a person in the toilet at the end of the main entrance corridor. The staff member was loudly prompting the person about intimate matters. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rosemont offers a satisfactory lifestyle for people who are more independent. However, social opportunities and choices are too limited for people who are lass able. Evidence: The questionnaire returned to us before our visit said We provide a friendly and caring environment and encourage residents to be independent and make choices which reflect their capabilities and wishes It also said: We hope to provide a larger range of activities using the enthusiasm of our younger members of staff. We looked at how peoples care plans described their social needs. Some of plans we looked at contained little or nothing about the persons social needs. For example, one persons plan stated that they used to be a regular church goer. The plan did not describe which denomination or how this need was to be met. Some people living in the home said that they were able to follow their own routines and were happy with the lifestyle provided by the home. We saw that people who were able could choose whether to take their meals in the dining room or in their own room. Those who were able, spent time in the homes two lounges or in the conservatory while others chose to remain private. However, during our visit we met Care Homes for Older People Page 14 of 30 Evidence: two people who were unable to walk independently. In their plans one was described as very social and the other as liking company. Both were in upstairs rooms and neither was supported to join groups downstairs during the two days of our visit. One person was described by a staff member as room bound after an accident. Mr. Beckhurst said that negotiations were taking place to move this person to a downstairs room. Three people with whom we spoke said that there were few activities and that they would like to go out on more trips. Staff said that there were occasional activities. However, there was no plan of activities or records of when activities had taken place. We saw one person being helped with a jigsaw by a member of staff. We observed a lunch time meal which was mostly taken in silence while staff served. There was some interaction when one staff member who was not involved in serving passed through the room and chatted with one person. Staff told us that people were offered choices such as salad or omelette if they did not wish to take the meal on offer. However, most people we spoke with were unaware that there was a choice. Two people believed that there was not a choice of meal. It was not clear how people were made aware of the days meals in advance, whether there was a choice or whether they would like an alternative. The meal offered when we observed was roast lamb with fresh vegetables followed by individual trifles. We saw people being offered an alternative sweet when they declined the one on offer. Menus showed that a varied traditional menu was provided. We spoke with family members visiting the home. They told us that they could visit at any time and were always made welcome. This was confirmed in our conversations with people living in the home. Care Homes for Older People Page 15 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. People living at Rosemont are able to complain and sufficiently well protected from abuse Evidence: Most people we spoke with said that they would feel able to raise concerns with staff. A copy of the complaints procedure was displayed in the hallway of the home. Since our last key inspection we received anonymous concerns about the home. We carried out a random unannounced inspection visit in December 2008 and found that most of the concerns were substantiated. As a result we made a number of requirements. We also received an anonymous concern during the inspection which we were unable to substantiate. No complaints log was available for inspection. Mr Beckhurst said there had been none. We interviewed three members of staff, all of whom had received at least in-house training on safeguarding vulnerable adults from abuse. Each was able to identify different forms of abuse and describe who they would alert if it was witnessed or suspected. The homes policy on safeguarding adults does not conform to current guidance as it suggests that staff should conduct an investigation into suspected abuse in the first instance. Care Homes for Older People Page 16 of 30 Evidence: Care Homes for Older People Page 17 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. People living in the home have benefited from improvements made since our last visit. However, as there are more people living on the upper floor with impaired mobility, greater attention is needed to the risks posed by stairways. Evidence: People we spoke with told us that the home was usually kept clean and that they found the accommodation comfortable. During our tour we noted that cleaning was taking place and that there were no unpleasant odours in individual rooms or public areas. The questionnaire returned to us before our visit said that the homes environment had been improved by a replacement stair lift, new commodes, bedside tables and a new shower. Some soft furnishings and floor coverings had also been replaced. Several areas had also been redecorated. In our tour of the home we confirmed these improvements. In response to requirements made at our last visit, hoists and new wheelchairs have been obtained to assist with moving and handling. Staff confirmed that they had received training in the use of this equipment. When we visited in December 2008, we found shortfalls in the control of infection. We Care Homes for Older People Page 18 of 30 Evidence: found that hand washing and drying facilities were not always available for people when visiting the toilet and when providing personal care. These arrangements were found to be satisfactory during this visit. We also found that improvements had been made in the handling of soiled laundry to prevent cross infection. This included the provision of colour coded bags for transporting soiled laundry to the laundry room. We noted that fire safety had improved since our random inspection in December 2008. Fire safe hold-open devices had been fitted to several doors and Mr Beckhurst told us that further devices were to be fitted. Fire exits were not obstructed. However we saw that the automatic closing mechanisms on two doors were not working effectively, and that the doors were not fully closing. This poses a potential risk in the event of a fire. However, Mr Beckhurst subsequently advised that these had been rechecked and were working properly. In our tour of the premises we saw that the threshold strip in an archway near the kitchen was loose and lifting on one side, presenting a trip hazard. We also saw several hazards at the top of the main stairway. The area was poorly lit and a short step to the top landing was not highlighted. The floor boards at the top of the stairs were uneven. A passage nearby was ramped and had an unsecured rug on the ramped area. All of these things presented the possibility of a slip, trip or fall down the main stairway. As more people with impaired mobility now occupy the upper floor, this risk is increased. We also found that floorboards in the main lounge / dining room and some individual rooms, were uneven. A three-quarter glazed exit door in the passage leading from the dining room did not appear to be fitted with safety glass. Care Homes for Older People Page 19 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Poor recording and administration of staffing records made it difficult to establish a clear picture of staffing arrangements in the home. Evidence: The questionnaire completed before our visit told us that the home had been recruiting new staff and that a training programme had been introduced. The staff rotas were not clear as to the actual number of staff working in the home. Mr Beckhurst stated that the actual number on duty was usually greater than indicated and staffing resources were used flexibly to meet any additional demands. At the time of our visit Mr Beckhurst was standing in for the cook. A part time cleaner was working in the home. Most people with whom we spoke said that the staff were respectful and supportive. This was confirmed by our observations during the inspection visit. However, we also saw that staff spent most of their time engaged in necessary tasks such as personal care, serving meals, laundry and administering medicines. Little time was spent engaged in social interaction with people living in the home, even when there were opportunities to do so, such as at lunch time. We noted that, since our last key inspection more people living in the home required Care Homes for Older People Page 20 of 30 Evidence: help with mobility and other tasks. It was not clear how this increased level of need was being addressed. We spoke with four staff and examined the staffing records. The staff with whom we spoke said that they did not commence duties before their criminal records checks had been completed. Records relating to a recently recruited member of staff confirmed that this was the case. They also confirmed that they had attended various short training courses such as moving and handling and the administration of medicines. However, staffing records were not well organised. Most were held together in a single file which was not sub-divided. One record of a recently recruited staff member was in a separate file and did not contain all the details required by regulation. There were copies of training certificates in the main file but this did not represent a complete record of the training for each staff member. Mr Beckhurst was unable to produce a training plan. Additional information was requested after our visit which has been provided. In our discussions with staff, they described a basic induction programme. The records indicated, however, that one recently recruited staff member was on waking duty at night alone the day after commencing duties in the home. Care Homes for Older People Page 21 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements for the home are not sufficient to provide a safe, consistent service to people living there Evidence: Mr Beckhurst is Registered with the Commission as both provider and manager of the service. He is assisted in the management of the home by a member of staff known as the Care Manager. Both are experienced in management and the Care Manager holds the Registered Managers Award. Mr Beckhurst does not hold this qualification. During this visit, the Care Manager was on holiday. Mr Beckhurst was cooking and cleaning on both days. This left little time for oversight and supervision of staff. We found a file which showed evidence of some recent audits of the quality of care provided. However, this was a work in progress and required further development. For example, evidence in relation to the continued shortfalls in medication practice suggest that a more robust auditing system is required. Care Homes for Older People Page 22 of 30 Evidence: Mr Beckhurst stated that the home is not involved in any way in the finances of people living there other than to hold small amounts of cash for safe keeping. Individual finances are managed either by the person concerned, their relatives or other representatives. This was confirmed in conversation with people living in the home. It is of concern that Mr Beckhurst was unable to locate key records in relation to the running of the home. The inability of Mr Beckhurst or the staff to locate detailed care plans is of particular concern as these are referred to in the daily notes held for staff reference. The records we saw were poorly organised and it was difficult in some instances to locate key information. One person told us about a serious accident which had resulted in an admission to hospital. This was recorded in the homes accident records and daily notes. We looked at health and safety issues in the home. We saw a sample of recently updated risk assessments about risks in the homes environment. For example, these included the restriction of windows on the upper floor and the risk of scalding from hot water. Since our last inspection, hoists have been obtained for moving and handling and staff confirmed that they had received training in their use. Other improvements include hand washing and drying facilities, and better arrangements for handling laundry. Staff training in health and safety issues was not clear. It was not clear during the inspection whether there was a trained first-aider on duty at all times. This was not indicated on the staffing rota. Neither could we establish whether all staff who handle food had received training in food hygiene. The home appeared reasonably well maintained and there was evidence of recent investment on items such as a new stair lift and shower facility. However, records of routine maintenance and safety checks could not be located. A sample of these was requested after our visit but these have not been supplied. Care Homes for Older People Page 23 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) The homes systems 20/01/2009 concerning the use of medicines must conform to the guidance of the Royal Pharmaceutical Society and be handled safely. In particular: All medicines administered msut be signed for. A clear account must be given for any medicines not administered as prescribed. All medicnes must be securely stored. All medicines must be checked into the home so that a full audit is possible. (Previous Timescale 20/1/09 not met) To prevent mistakes and mishandling of medicines, which put people at risk. Care Homes for Older People Page 24 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 1 19 12 The Registered Person must 01/05/2009 assess the risk posed by the glazed exit door in the passageway leading from the dining room and take action to minimise the identified risks This is to protect people living in the home, staff and visitors from potential injury. 2 19 12 The Registered Person must secure the threshold strip in the archway leading to the laundry so that it does not present a trip hazard This is to protect people living in the home, staff and visitors from potential injury. 01/05/2009 3 19 12 The Registered Person must assess the risk of slips, trips and falls in the area around the head of the main stairway and take action to minimise the identified risks This is to protect people living in the home, staff and visitors from potential injury. 01/05/2009 Care Homes for Older People Page 25 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Person must 05/06/2009 ensure that each person has a care plan that provides a detailed description of the persons needs and how they are to be met. This is so that staff are clear about the care required and how to provide it. 2 9 13 Medicines that are out of date must be disposed of and replaced where necessary This is to ensure that the medicines people receive are effective 19/05/2009 3 9 13 The Registered Person must ensure that a risk assessment is produced for any person living in the home who administers their own medicine. Such risk assessments must be reviewed regularly. This is to ensure that it is safe for people to administer their own medicines 19/05/2009 4 9 13 The Registered Person must 19/05/2009 ensure that all medicines are signed for at the point of administration by the person administering them. Care Homes for Older People Page 26 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that people received their medication as prescribed and provide a clear audit trail 5 10 12 The Registered Person must ensure that the privacy and dignity of people using the service is preserved at all times. In particular this refers to occasions when assistence is given to use the toilet This is to ensure that people do not suffer undue embarrassment or indignity. 6 19 12 The Registered Person must ensure that floors in all areas of the home have an even surface. This is to Minimise the risk of injury due to slips, trips and falls. 7 27 17 The Registered Person must 29/05/2009 produce and maintain a daily staffing rota that shows the actual as well as planned staffing This is to ensure there can be a clear audit of the homes staffing 8 27 18 The Registered Person must review staffing numbers in relation to the numbers of 12/06/2009 12/10/2009 19/05/2009 Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action people living in the home and their needs. A copy of this review must be provided to the Commission This is to ensure that sufficient numbers of experienced staff are on duty at all times to meet the needs of people living in the home. 9 37 17 Records required by 27/08/2009 regulation about the care of people using the service and the running of the home must be maintained and made available for the purposes of inspection This is so that people using the service can be protected by effective regulation 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 7 12 All staff should be aware of the location of detailed care plans and have access to them. Social, liesure and recreational opportunities should be made available to all people living in the home, including those with cognitive or sensory impairments or physical disability. People living in the home should be made aware of the meals on offer each day and that alternatives are available. Care plans should describe each persons social and Page 28 of 30 3 4 12 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations spiritual needs, interests and preferences and how these will be met. 5 18 The homes policy on safeguarding vulnerable adults from abuse should be updated to conform to current local and national guidance. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC 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. Re-publishing this information is in breach of the terms of use of that website. 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