Inspection on 30/09/09 for Rosglen

This inspection was carried out on 30th September 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosglen 01/10/08

Rosglen 03/10/07

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth 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: Rosglen 2 Highfield Range Darfield Barnsley South Yorkshire S73 9BQ     The quality rating for this care home is:   one star adequate 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: Jayne White     Date: 3 0 0 9 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 31 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 31 Information about the care home Name of care home: Address: Rosglen 2 Highfield Range Darfield Barnsley South Yorkshire S73 9BQ 01226752238 01226752238 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Just Global Limited care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 11 The registered person may provide the following category of service only: Care Home only - Code PC To Service users of the following gender - Either Whose primary care on admission to the srevice are withing the following cateogires: Old age not falling within any other category - Code OP, maximum number of places, 11 Date of last inspection Brief description of the care home Rosglen is a care home providing personal care and accommodation for 11 older people. Just Global Limited own the home. The home is situated in Darfield, Barnsley. It is close to a bus route and there are shops, including grocers, hairdressers, chemist, post office and newsagents in the village. Care Homes for Older People Page 4 of 31 Over 65 9 0 1 6 1 0 2 0 0 8 Brief description of the care home The home is single storey. It has 7 single and 2 double rooms. Communal areas include two lounge areas and a dining room. There is a central kitchen and laundry. There are various bathing facilities. Information about the home, including the service user guide is available in the entrance hall. This includes the most current CQC report about the service. On 20 October 2009 the manager said the fee was £356.00. The service user guide states additional charges are limited to personal extras including toiletries, hairdressing, private medical treatment, chiropody, dentistry, optical services etc, dry cleaning, telephone calls and non-urgent escort services. 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: This was a key inspection. We visited without giving the service any notice from 10:30 until 16:30. Ms Kerry Jones, acting manager was present during the visit. She is not yet registered with the Commission. We did not receive the Annual Quality Assurance Assessment (AQAA) before the site visit, but the owner assures us it was sent. She provided it on the day of the site visit. The AQAA gives the service the opportunity to tell the Care Quality Commission (CQC) how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 16 October 2008 and any plans for further developments in the next 12 months. Various aspects of the service were checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. Care Homes for Older People Page 6 of 31 We sent nine surveys to people living at the home, asking them about their experiences of living there, nine to the representatives of people living at the home (this included family and friends), asking them about the experiences of their contact with the home, three to health professionals, asking them about their experiences of working with the home and five to staff, of their experience of working at the home. Three surveys were returned by people that lived there, four from their representatives, one from a health professional and one from staff. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received, as were some of their representatives. The care provided for two people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home. We checked all the key standards and previous requirements. The manager was provided with initial feedback from the inspection during and at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Improve records in peoples care plans to confirm that people were receiving the health and personal care they needed. Weigh people on their admission and then on a periodic basis, so that peoples health is monitored and action can be taken where necessary. Improve medication records, so that the quantities of medication received into the Care Homes for Older People Page 8 of 31 home and returned to the pharmacy are recorded, controlled drugs have a witness signature and there is a record authorising changes to peoples prescribed medication. Refurbish and repair some aspects of the environment, so that the home is a tidy and well maintained environment for people to live. Have ancillary staff for duties such as cleaning and cooking. This would give care staff more time to spend with people, engaging them in their chosen activities, improving their quality of life, because people and their representatives in their surveys made the following comments about what the service could do better - make the home better outside so residents could sit outside if weather good, leisure activities are at a minimum, maybe a little more stimulation e.g. activities and more entertainment seasonal activities. Quality assurance systems needed establishing, so that the quality of the service can be monitored and the health, safety and welfare of people and staff are not placed at risk. This includes staff receiving mandatory training relevant to their role. 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 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. People could be confident the care home could support them. This was because there had been an assessment of their needs, which told the home about them and the health and personal care they needed. Evidence: In the AQAA the owner stated a full assessment was carried out on all clients prior to their admission, gathering information from various sources. We looked at the files for two people to check what the owner had told us in the AQAA. They contained an assessment from the placing care manager. On one of the files the pre-admission completed by the service had been completed after their admission. On the other, the homes assessment had only been partly completed. A plan of care had been put together from the information. The health professional survey that was returned told us the services assessment Care Homes for Older People Page 11 of 31 Evidence: arrangements usually ensured that accurate information was gathered and the right service was planned for people. All peoples surveys that were returned stated theyd received enough information to help them decide if the home was the right place for them. Two of them stated they didnt know if they had a contract, one said hadnt. When we spoke to one person and their representative about why the process of how they were admitted and why they chose Rosglen they said, recommended by nurse from doctors. 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. Records were insufficient to confirm that people were receiving the health and personal care they needed, which may place them at risk. Medication was not always managed safely, which could place people at risk of harm. People were treated with respect, dignity and privacy. Evidence: When we spoke to people and their representatives they were happy with the way that staff looked after them and respected their dignity. In their surveys they all stated they always received the care and medical support they needed. They commented, the staff care is very good, caring as if you are the only one important. Listen and I was quite ill when I came here and can say I am 100 better. Well done!! When we observed staff working there was a clear and respectful communication between people and staff and staff treated people in a kind manner. Staff included people in conversation and day-to-day life. Care Homes for Older People Page 13 of 31 Evidence: The member of staff who returned their survey stated: They were always given up to date information about the needs of the people they cared for. The way information is shared about people they care for with other carers and the manager always work well. They commented, the home provides excellent care and always has a very homely feel. All the representatives in their surveys stated: They felt the service met the needs of their relative and provides the care they expect. They were kept up to date with important issues affecting their relative. In respect of what the service did well they commented, the basic care of clients and the promotion of their self esteem and dignity, the standard of care my mother receives is person centred and excellent, lots of care and love and a feeling of being someone special, Rosglen in my opinion looks after my mother excellent. She is well cared for and all her needs are met. She is very happy to be here and so am I, provide individual care depending on circumstances of patient and Rosglen is an excellent care home. I was always very pleased and am pleased with the care. The health professional survey that was returned stated: Peoples social and health care needs are always properly monitored, reviewed and met by the care service. The service always seeks advice and acts on it to meet peoples social and health care needs and improve their wellbeing. The service always supports people to manage their own medication or manages it correctly where this isnt possible. The service usually respects peoples privacy and dignity. They commented, very friendly. Staff are dedicated and familiar with residents. They are knowledgable of their residents medical background. The owner in the AQAA told us there were very informative care plans in place, which are updated monthly with the changing needs of the clients, including any risks and equipment used for the promotion of tissue viability. We looked at two care plans to confirm what people and the owner had told us. There wasnt always sufficient detail on the plan for staff to be clear about the care to be provided. For example, moving and handling risk assessments werent fully completed to confirm to staff how people must be moved. Risk assessments with regard to falls, nutrition and pressure areas were blank. One person had not been weighed for ten months, the other for five months. This is poor record keeping and doesnt confirm that how staff are caring for people is sufficient to meet their needs. The manager had also begun an audit of peoples files and highlighted similar aspects that needed action. Care Homes for Older People Page 14 of 31 Evidence: We looked at how the service looked after peoples medication. There was medication that wasnt stored in accordance with current safe custody regulations. This was brought to the attention of the manager. She was aware further storage was needed. The manager had already identified actions to be taken to ensure medicines were dealt with in accordance with good practice guidelines. We checked a sample of the medication given to five people, including controlled drugs. These were all now being recorded in the controlled drugs register. Records needed to improve, because for one medication the date it was received was not recorded. There was one day when a second signature had not been obtained to confirm the medication given to two people. In another, a handwritten entry had been made that changed the persons prescription. There was no record of who had authorised the change and from when. There were four gaps in the medication administration record. This not confirm people had received the medication they were prescribed. The medication administration record identified some medication had been returned to the pharmacy, but this wasnt recorded in the controlled drugs register and therefore there was a discrepancy with this. A returns book had been implemented to record medication returned to the pharmacy. This should be amended to include the date. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were treated as individuals, being encouraged to be independent, leading their chosen lifestyle and given opportunities to make the most of their abilities. They were not always supported to follow their own personal interests and activities. On the whole, people had meals they liked at times and places that suited them. Evidence: When we entered the home there was a pleasant ambience. People were sat in the lounges. The TV was on in one lounge, playing a Daniel ODonnel video that some people were enjoying. The TV was on in another lounge, but the person in the lounge wasnt watching it, but was people watching. When we looked at the care plans for people there was no plan for social and leisure interests. Reviews told us these were discussed, as peoples preferences were recorded on them. We saw the people partaking in some of those activities, but their records didnt support this. Everyone living at the service who returned their surveys stated the service only sometimes arranged activities they could take part in. They commented about what the service could do better - make the home better outside so residents could sit Care Homes for Older People Page 16 of 31 Evidence: outside if weather good and more entertainment - seasonal activities. When we spoke to people and their representatives they commented, really happy, staff love her and treat her well, she does jigsaws and likes reading and gets confused, but has settled, loves music. The representatives surveys stated: The service helped their relative to keep in touch with them. Three stated the service always supported people to live the life they choose, one usually About what the service could do better they commented, leisure activities are at a minimum and maybe a little more stimulation e.g. activities. The service need to act on the information received by people and their representatives about what the service could do better, so that people experience the activities they wish to take part in. The health professional survey stated the service usually supports people to live the life they choose. The staff survey made a comment, all residents and their families or visitors are all like a big family. Rosglen always has time for its residents and their families. When we spoke to people they were positive about their lifestyle within the home. The surveys returned by people told us two always liked the meals that were served, one usually. When we spoke to people and their representatives one said, meals fantastic Sunday joint, they make their own yorkshire pudding, cooking/baking lovely. We saw lunch being served. The meal was well presented and the meal time was a leisurely and relaxed time for people. Staff were patient and helpful and allowed people time to finish their meal comfortably. 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 were able to express their concerns, had access to a complaints procedure and their concerns were looked in to. There were adult safeguarding policies and procedures in place that promoted the protection of people from harm. Evidence: When we spoke with people and their representatives they said they were highly satisfied with the care they received and felt safe. They said they would speak up if there was something they werent happy about. This indicated there was an open culture that allowed people to express their views and concerns in a safe and understanding environment. They said they had no complaints or grumbles. People felt the owner listened when they did have anything to say. Everyone living at the service who returned their surveys told us there was someone they could speak to if they werent happy. They all knew how to make a formal complaint. One commented, I am happy here and have no complaints at the moment. The staff survey told us they knew what to do if someone had concerns about the home. All the representatives surveys that were returned told us they knew how to make a complaint and said the service responded appropriately if they had raised any Care Homes for Older People Page 18 of 31 Evidence: concerns. People could access the complaints procedure because it was displayed on the notice board in the entrance hall for them should they wish to make a complaint. It was clearly written, easy to understand and explained what the procedure was and how long the process would take. We looked at the complaints record and this was inadequately completed, for the complaints that had been made. This was because the information did not clearly record how the complaint was investigated to reach an outcome. There was no further action identified, to reduce the risk of the same complaint happening again. The new manager gave us sight of the complaints record she was going to implement and this would be much better. There were adult safeguarding policies and procedures in place that promoted the protection of people from harm or abuse. They were available to staff and gave clear, specific guidance to those using them. There had been no referrals to adult safeguarding. When we spoke with the manager about the procedures to be used to safeguard people, she was clear of the procedure to be followed. She told us how she was planning to do an information session with staff about the Mental Capacity Act and Deprivation of Liberty Safeguards, so that they were aware of how they impacted on the care they provided. 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. Some aspects of the environment needed attention, so that the home would be a tidier and better maintained place for people to live. Evidence: There was a selection of communal areas, which meant people had a choice of where to sit, meet with family, sit quietly or engage with other people that lived there. It provided sufficient space for the number of people that lived there. There were sufficient toilets for people that were appropriately located and easily accessible. Paper towels were provided, which would help prevent the spread of infection. Access around the home was good. When we spoke to people they said they thought their home was comfortable. They told us they had a comfortable bedroom and we saw how they had personalised the space with pieces of their own furniture and possessions. We saw that there were some maintenance issues to be attended to in peoples rooms in order that they were well maintained spaces for them to live. For example, ensuring there are no gaps in tiling around sink areas. There was a mixed response from people in their surveys about whether they thought their home was kept clean - one stated always, one usually, one sometimes. Care Homes for Older People Page 20 of 31 Evidence: When we looked round the home it was well lit and smelt fesh. There were some areas that were untidy. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received appropriate support because there were enough staff on duty. Their needs were met by staff, but staff didnt always have the relevant training and support from their managers. Evidence: When we spoke to people and their representatives they had confidence in the staff that cared for them and that staff were usually available when they needed them. The people living at the home that returned their surveys all stated staff were always available when they needed them and always listened and acted on what they said. We observed how staff worked during the visit. This told us there were good relationships between staff and people and they responded in a timely way when people needed assistance. Staff were very busy helping people with their physical care needs. In addition, care staff carried out the cleaning duties. This meant that other then when assisting people at this time or when providing assistance at meal times, they spent little time with them pursuing their leisure and social interests. Also, on the day of the inspection it was the cooks day off and a carer covered those duties, leaving only one carer on duty at that time. This was confirmed on the staff rota and when we spoke to staff. Care Homes for Older People Page 22 of 31 Evidence: The staff survey stated there was always enough staff to meet the needs of people. Generally, there were two members of care staff on duty during the day. A cook worked 10:00 - 14:00. This meant care staff also made breakfast, tea and supper meals. This was confirmed when we spoke to people that lived there and looked at the rotas. Since the last inspection, the owner had reduced staffing levels on a night, so there was one member of staff who slept on duty, but was on call and another who was awake. The manager stated this arrangement was working as she herself had covered some night shifts and had not been woken to give assistance. We had discussed with the owner at the previous inspection about having ancillary staff, because of the lack of individual social pastimes that people could take part in, that some areas of the home were untidy and that care staff were also responsible for preparing and serving some meals. The service had a recruitment procedure that included prospective employees completing an application form, the service obtaining two written references, documentation of a full employment history and a Criminal Records Bureau and Protection Of Vulnerable Adults first check. The staff survey that was returned stated: Their employer carried out checks, such as CRB and references before they started. Their induction covered everything they needed to know to do the job very well when they started. They were given training that was relevant to their role, helped them understand and meet the individual needs of people, kept them up to date with new ways of working and gave them enough knowledge about health care and medication. They were confident they always had enough support, experience and knowledge to meet the needs of people. The representatives surveys told us: Three felt the staff always had the right skills and experience to look after people properly, one usually. The health professional survey stated managers and staff usually have the right skills and experience to support peoples social and healthcare needs. They commented in what they felt the home could do better, increase their awareness of palliative care in residential homes. The AQAA, completed by the owner, told us 95 of staff hold their NVQ 2 in Care. It identified as something they could do better enrol staff on more training courses and more in-house training. However, the two files we looked at did not contain Care Homes for Older People Page 23 of 31 Evidence: certificates to demonstrate the staff had obtained their NVQs. In total there were twelve members of staff, which identified there could be discrepancies in the information. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had confidence in the management of the home, but quality assurance systems were not in place that would highlight improvements that were needed for the health, safety and welfare of people and staff. This would reduce the risk of harm to them. Evidence: When we spoke to the manager she told us she commenced employment on 1 September 2009. She has been a registered manager for 31/2 years and holds the registered managers award and NVQ 4. There was no evidence of this on her file, but the owner stated she had seen confirmation. When we spoke to the manager there was no evidence of quality assurance processes in place that she was aware of, but could provide her own procedures that she was going to implement. This should give the service a better understanding of how the service can improve. The service held monies on behalf of people, but only the senior held the key to Care Homes for Older People Page 25 of 31 Evidence: access the money. This meant people did not have access to their monies at all times, should they want it. The record of the financial transactions didnt include information about why money was spent or receipts. Also, the storage could be improved as currently where the money was stored meant it could easily be removed. Also, the key was kept on the bunch of keys passed between staff to gain access to the room where it was kept. This was insufficient to safeguard people. There had been four deaths at the home and there was no evidence these had been received by the Commission. The owner assures us these have been sent. There wasnt a copy of these on site as required by the regulations. Likewise the AQAA was not received prior to the inspection, but the owner states it was sent. She was able to provide a copy on the day of inspection, however, it needed to be more comprehensive to demonstrate how they meet the National Minimum Standards, what the service does well, how theyve improved and future developments. Also, there were discrepancies between the AQAA and what we found when we checked some of the information it told us about the service. We looked at a sample of maintenance and service records. These were up to date and current to the services provided. The fire safety officer visited on 26 August 2009 and their visit stated satisfactory, which meant the service were adhering to systems being in place to safeguard people in the event of a fire. We spoke with staff about the moving and handling needs of people. They were knowledgable in how to do this and could describe how they moved everyone safely. They said they had undertaken in-house moving and handling to confirm what are safe practices when moving people. A risk assessment had not been completed to determine the training required for staff to be able to deal with accidents and emergencies as recommended at the last inspection. Neither had staff received recent training in how to do this, which could place people at risk of harm. When we looked at staff files it told us training opportunities were provided, but they identified the majority of staff needed refresher training in most areas. This does indicate a lack of importance attached to keeping training up to date, which could place people at risk of harm. Radiator guards had been placed on radiators to reduce the risk of burns to people. Care Homes for Older People Page 26 of 31 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 7 13 This relates to Regulation 13 18/01/2009 (4) (c) It is also applicable to the outcomes for standard 28, qualifications, standard 30, staff training, standard 31, day to day operations and standard 38, safe working practices Moving and handling risk assessments must be up to date, take into account previous moving and handling assessments and involve appropriate professionals. So that people are moved safely. Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments in regard 13/12/2009 to moving and handling, nutrition, pressure areas and falls must be completed. To identify unnecessary risks to the health and safety of people and so far as possible eliminate them. 2 8 12 Peoples weight must be obtained on admission and then on a periodic basis. To monitor peoples health and take action where necessary. 13/12/2009 3 9 13 There must be a record, authorising changes to peoples prescribed medication. So that people are protected by the homes policies and procedures for dealing with medication. 13/12/2009 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 9 13 All controlled drugs must have a witness signature. So that people are protected by the homes policies and procedures for dealing with medication. 13/12/2009 5 9 13 All medication received into the home and returned to the pharmacy must be recorded. So that people are protected by the homes policies and procedures for delaing with medication. 13/12/2009 6 35 13 Monies held on behalf of people must be securely stored. So that people are protected from abuse. 20/12/2009 7 35 13 Financial transactions must include the purposes for which monies have been used and receipts. So that people are protected from abuse. 20/12/2009 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 9 Medication should be stored in accordance with current safe custody regulations. Page 29 of 31 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 12 Consult with people about what activities might be carried out with them to engage them in meaningful daytime activities they wish to enhance their well-being and include these in their plan of care. Some aspects of the environment should be refurbished and repaired, so that the home is a tidy and well maintained environment for people to live. Employ ancillary staff, so that care staff have more time to involve people in their chosen individual social pastimes. Training and induction that staff undertake should be verified on their files. This would confirm they were receiving training in how to meet peoples needs and keep them safe. Quality assurance systems should be established. This should provide the service with information about how they can improve the service for people and meet regulations and National Minimum Standards. The system for dealing with financial transactions should include people having access to their monies at all times. There should be a record of the notification of events at the care home as required by the regulations. This enables checks to be made of the action taken in regard to the events and that it is sufficient to keep people safe. Staff should receive training or refresher training in fire safety, first aid, food hygiene and infection control. This would provide them with training appropriate to the work they perform so people and themselves are not placed at risk of harm. 3 19 4 5 27 28 6 33 7 8 35 38 9 38 Care Homes for Older People Page 30 of 31 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). 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