Inspection on 04/11/08 for Shoreline Nursing Home

This inspection was carried out on 4th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shoreline Nursing Home 02/06/09

Shoreline Nursing Home 28/02/08

Shoreline Nursing Home 24/01/07

Shoreline Nursing Home 21/11/05

Shoreline Nursing Home 15/06/05

Shoreline Nursing Home 04/10/04

Shoreline Nursing Home 22/04/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Shoreline Nursing Home 2A Park Avenue Redcar TS10 3AT     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: Katherine Acheson     Date: 2 1 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Shoreline Nursing Home 2A Park Avenue Redcar TS10 3AT 01642488277 F/P01642494582 shorelinenursing@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Lesley Smith Type of registration: Number of places registered: Shoreline Private Home Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home can admit 20 service users age 55 . Date of last inspection Brief description of the care home Shoreline Nursing Home is registered to provide personal and nursing care to a maximum number of 44 people. The home is situated on the sea front and is close to Redcar town centre where there are pubs, shops and other local amenities. The home is two storey, modern and purpose built. The ground floor of the home accommodates twenty people, there are eighteen single rooms and one double room. The first floor of the home accommodates twenty-four people; there are twenty single rooms and two double rooms. Thirty five of the bedrooms have en-suite facilities which comprises of a toilet and hand washbasin, the remainder have a sink. All bedrooms meet the required amount of space. The ground floor of the home has a combined lounge/diner; the first floor of the home has both a lounge and dining room. Toilet and bathing facilities are on each floor. 0 Over 65 44 Care Homes for Older People Page 4 of 31 Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is one star. This means that people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous inspections reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. The key inspection of this home was carried out over three days, the 4th, 20th and 21st November 2008. The inspection visit on the 4th November 2008 was Care Homes for Older People Page 6 of 31 unannounced, the provider was aware of the inspection visit on 20th November 2008. A Regulation Manager accompanied the Inspector on the 4th and 20th November 2008. The visit on the 21st November 2008 was an announced visit to carry out a pharmacy inspection. The reason for the inspection was to see how good a job the home does in meeting the National Minimum Standards set by the Government for care homes. The inspection was carried out earlier than planned as the Commission for Social Care Inspection had received a number of anonymous concerns one of which was in relation to medicine management. On the first inspection visit on 4th November 2008 we found some areas of concern in relation to care planning and medication management, which needed to be acted upon urgently to comply with the regulations and safeguard people that use the service. Immediate requirement notices were issued and left at the home for the provider to take immediate action. On return to the home on 20th November 2008 we re-visited areas of concern and were satisfied that the provider had taken appropriate action to safeguard people using the service. The provider has also informed the Commission for Social Care Inspection in writing of action they have taken. Numerous records were examined including care plans and associated documentation, medication records, risk assessments, complaints and staff records. During the inspection visits five people that use the service and one relative were spoken to at length. General discussion took place with other people that use the service. Discussion also took place with the Deputy Manager, Cook, five Care Assistants and a Director of the home. Fees payable for living at the home at the time of inspection in November 2008 ranged from 446.25 to 555.06 per week. What the care home does well: What has improved since the last inspection? What they could do better: There are a number of improvements needed as the result of this inspection. The provider has given a commitment to address areas identified as needing improvement. Assessments of people using the service and care plans need to be developed to include more detail to help to ensure that care needs are met. The homes statement of purpose needs to include more information so that people are aware of what the home provides. Medication systems and practice is not robust. The lack of safe and effective arrangements means that it is impossible to know that people are receiving their medication correctly. The homes complaint procedure needs to be updated to include all of the required information to ensure that complaints are dealt with promptly and appropriately. The adult protection procedure needs to be updated to include action that staff would take if abuse is suspected. Currently 29 percent of staff have achieved a minimum qualification of NVQ level 2 in care this needs to increase to 50 percent. Water temperatures are taken on a monthly basis to ensure that they are within Care Homes for Older People Page 8 of 31 normal limits. If they were taken weekly this would enhance safety and meet with Health and Safety Guidance. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments of people that use the service are carried out, however some are insufficiently detailed and as such does not help to ensure that care needs are met. Evidence: The home has a statement of purpose/service user guide that was last reviewed and updated in February 2008. The document contains lots of important information that will help people to make and informed choice about the home. The statement of purpose is a pre-printed document which requires the provider to input individual information about the service. The majority of areas have been updated, however some have not. The document also needs to be updated to reflect change in management. Before going into the home people who are to use the service have an assessment that Care Homes for Older People Page 11 of 31 Evidence: is carried out by a social worker or nurse. This assessment is to identify needs and determine if personal or nursing care is required. This assessment is forwarded to the home before admission for the home to review and determine if they can meet the care needs of the person. The Deputy Manager said that the home carry out further assessments on people once they are admitted to Shoreline. Six files of people that use the service were looked at during the visit. Files contained a basic assessment of needs but did not contain enough information about the person. An example being a person was identified as needing help to stand, but the assessment did not detail what that help was or if any mobility aids were needed. The home does not provide intermediate care so standard 6 was not inspected. 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. People that use the service are happy with the care that they receive, however improvements are needed in respect of care planning to help to ensure that the needs of people using the service are met. Medication administration and recording practices at the home are not robust enough to ensure that people will always receive their medication as prescribed. Evidence: At the time of the inspection visit to the home staff were in the process of changing over to new care plan documentation. Six plans of care for people that use the service were looked at during the visits. Three plans of care were those of people who had transferred over to new documentation , three were not. The inspection visits to the home was earlier than originally planned as the Commission for Social Care Inspection had received a complaint regarding care Care Homes for Older People Page 13 of 31 Evidence: planning and medicine management. The complaint received in respect of care planning highlighted that people who were living at the home and required subcutaneous fluids did not have a regime for the prescribed fluids or plan of care. Records examined on the first day of the inspection confirmed that this was the case. This visit resulted in leaving an Immediate Requirement Notice, which meant that the provider had to take urgent action to comply with regulations and safeguard people living at the home. The Inspector was informed by the Deputy Manager that she would take immediate action to address the situation. The Deputy said that she would request a GP visit, ask GP to write a clear regime on the Medication Administration Chart and develop a plan of care. On the second inspection visit to the home on 20th November 2008 records were examined to confirm that appropriate action had been taken. Some plans of care contained a detailed life history about the person receiving care. the history contained important and interesting information including school years, family, marriage, hobbies, likes and dislikes. The content of care plans was inconsistent some were better than others. Some improvement was noted with the content of care plans for those people who had transferred over to the new care planning documentation, however further development was still needed. One plan of care looked at identified a person as needing help with washing and dressing. This plan of care did not detail, what the person could do for themselves, personal preference and help needed. Another plan of care for a person with a Catheter in situ stated perform catheter care twice daily but didnt state what this should be. Of the six care plans looked at four had been reviewed on a monthly basis, the other two had not. Care plan reviews/evaluations did not detail deteriorations or improvements made. A long discussion took place with the Deputy Manager of the service in respect of care planning and improvements needed. It was evident following discussion with staff working at the home that they knew the people they were caring for very well. Staff spoken to were able to describe in detail care requirements, likes and dislikes of people using the service. People who were spoken to during the inspection said, I like it here I get well looked after Care Homes for Older People Page 14 of 31 Evidence: The staff are really nice and caring Everything is nice Ive been in the home for a year. Im treated with respect, the staff are good and the food is very good. People who use the service are assessed on a regular basis by nurses working at the home to determine if they are at risk of developing pressure sores. Pressure relieving mattresses are available for those people assessed at risk or who have developed a sore. Files examined contained information to confirm that GPs, district nurses and other health care professional visited the home regularly. As already highlighted the inspection of the home took place sooner than originally planned as the result of a complaint. The second element of the complaint was in relation to inappropriate use of medication. A visit to the service on the 4th November 2008 substantiated the complaint and as such an Immediate Requirement Notice was left at the home requiring that urgent action be taken to comply with regulations and safeguard people using the service. Following the inspection the Responsible Individual of the service has written to the Commission for social care Inspection to advise of action taken. A pharmacy inspection of the home was carried out on 21st November 2008. It was identified at this inspection that there are poor systems in the home for recording, handling and storage of medicines. The lack of safe and effective arrangements means that it is impossible to know that people are receiving their medication correctly. Not receiving medication as prescribed may have an affect on their health and wellbeing. Liquid medication with a short shelf life when opened did not have the date of opening marked on the container. This could result in medication being used beyond expiry date as recommended by the manufacturer. Records of creams prescribed to people using the service were poorly recorded on Medication Administration Charts (MAR). MAR charts did not contain directions for use. MAR charts only contained a tick instead of the initials of the person who had administered them. The home has a medication policy, however this does not reflect the current practice followed by staff working at the home. Care Homes for Older People Page 15 of 31 Evidence: Hand written MAR charts were signed but not countersigned. It was not possible to audit the majority of MAR charts looked at during the visit because quantities of medication received into the home were not recorded or carried over from one month to the next. Controlled drugs were stored securely and appropriate records reflecting the usage were kept. Medication storage rooms were warm and the temperature of the fridge in which medication requiring cool storage was kept was too high. There was a large amount of excess stock and in several cases medicines for the same person both in blister package and also in boxes. There was medication stored that was no longer prescribed. Medication should be removed and disposed of to prevent incorrect administration. Following the inspection arrangements were made for the Primary Care Trust Pharmacy Adviser to visit the home and provide guidance and support on medicine management to staff working at the home. Since inspection of the service the Deputy Manager has advised of a number of improvements that the home have made following the pharmacy inspection. Continued commitment has been given to improve medicine management within the service. Care Homes for Older People Page 16 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. Appropriate and enjoyable activities do take place at the home and people are able to exercise choice and control. Food provided is enjoyed, providing people that use the service with a varied and well balanced diet. Evidence: The home employs and activity co-ordinator to plan, arrange and take part in activities at the home for people that use the service. The activity co-ordinator works sixteen to twenty hours a week over four days, the days of which can vary. Activities taking place include bingo, card making, crafts and dominoes. The mobile library visits on a regular basis offering a large selection of books for loan. The Deputy Manager said that the home organizes regular in house events. On the first inspection visit to the home a birthday party was taking place for a person that used the service. Staff, relatives and other people living at the home had come together to celebrate. People were observed to be enjoying the plentiful supply of food and music. On the second day of the inspection people who use the service were enjoying the singing of an entertainer. Those people who were able were dancing with Care Homes for Older People Page 17 of 31 Evidence: staff with others happily joining in with the singing. People that use the service enjoy walks along the sea front and in the town centre particularly in the nicer weather. The home was busy planning for the Christmas party on the 15th December. The home employs a hairdresser. No charge is made for cutting hair, sets and blow drys, however a charge is made for perms. Comments made by people using the service included, I am happy enough and I enjoy the entertainers I like my own company and choose to spend time on my own. I like to watch television in my own room Theres plenty going on in here for me Visitors are made to feel welcome at anytime. A relative spoken to during the inspection said, I visit every day. Im always made to feel welcome, I can go anywhere, ask anything and I always get a cup of tea. People who use the service are supported to practice their religion. There are monthly visits from representatives of the local Church of England and Roman Catholic churches. Some people are visited more often and receive communion. People that use the service enjoy the food that is provided. There are two choices at each meal time. The lunchtime menu on the second day of the inspection was roast gammon and pineapple or roast turkey and stuffing. Dessert was either strawberry gateaux or rice pudding. A discussion with the cook highlighted that she is very passionate about the food that is provided. Lists of likes and dislikes were available within the kitchen for each person. There was lots of home made cakes for people to eat. Diabetic diets are catered for. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service are confident that their complaints would be listened to and acted upon, however the complaint procedure needs to be updated to include the required information so that complaints can be dealt with promptly and appropriately. Evidence: The home has a complaints procedure, however this does not include all of the required information. The procedure does not include details of stages of the complaint, timescales for action and who and where to complain to. The home keeps a record of complaints. In the last twelve months there have been six complaints in total either made to the home, the Commission for Social Care Inspection or the Council. People spoken to during the visit said that they would feel comfortable in raising any concern that they may have with staff working at the home. The home has an adult protection procedure/policy, this is not specific to the home and does not include details of action that staff should take if abuse is suspected. The Deputy Manager said that a number of staff working at the home have received adult protection training, however she is aware that some staff still need updates. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home is good providing people that live there with a homely and comfortable place to live Evidence: Shoreline is a two storey, modern, purpose built facility that is situated on the sea front at Redcar. The home provides personal and nursing care to a maximum number of forty four people. There are thirty eight single bedrooms and three double bedrooms. The Inspector walked around the home with the Deputy Manager and one of the Directors of the home. Communal lounge areas have recently been decorated and fitted with new carpets. Lounge areas were warm, homely and inviting. Appropriate furniture was contained within. The ground floor lounge/dining room has a new large flat screen television. There are also two new large sofas which have been put into the corner of the lounge area to creating a pleasant seating area. Tables were covered with red tablecloths with a table centre on each. The first floor of the home has a separate lounge and dining room. At the time of the Care Homes for Older People Page 20 of 31 Evidence: visit the dining room was also being refurbished. Communal areas and many of the bedrooms have beautiful views of the seaside. Bedrooms visited were personalized, many having benefited from new curtains, bedding and carpets. Appropriate laundry facilities were in place, new flooring had been fitted to the laundry room. Staff spoken to said that there was a plentiful supply of protective clothing which included pinnies and gloves to help to prevent the spread of infection. The home was observed to be clean and odour free. One person spoken to during the inspection said, The cleaners are fantastic and fun. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedure is robust, which helps to ensure that people are protected. Insufficient staff at busy times could impact on the care given to people that use the service. Evidence: At the time of the inspection visits there were thirty four people using the service, twenty one who needed nursing care, thirteen of who needed personal care. The homes duty rota showed that there were two nurses on duty and six care staff during the day and evening. On night duty there was one nurse and either three or four care staff. Three people spoken to during the visit made comments that they did not think that there were enough staff on duty particularly at peak times. Comments made included, Sometimes you have to wait, but not often and, Sometimes I have to wait and I notice buzzers going on for a long time. A discussion took place with the Deputy Manager and Director in respect of this. The Deputy Manager said that 29 percent of care staff working at the home have achieved an NVQ level 2 in care. The homes recruitment procedure is robust. Records were available on staff files Care Homes for Older People Page 22 of 31 Evidence: looked at during the visits to confirm that appropriate checks are carried out before staff start working at the home. Files examined contained evidence of Criminal Record Bureau checks, proof of identity and references. Staff files contained evidence of induction, however this did not meet with the required standard. Staff files contained certificates to confirm that staff had received mandatory training which included, fire, food hygiene and moving and handling. The Deputy said that some staff were due to receive updates to training and that she was in the process of organizing this. One file looked at during the visit was that of a nurse working at the home. On commencement of employment checks had been made with the Nursing Midwifery Council to confirm eligibility to practice but not on a yearly basis thereafter. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety is promoted by regular servicing of appliances. Weekly testing of the water temperatures would further enhance this. Evidence: At the time of the inspection the home were in the process of actively recruiting a Manager. Interviews for the position have taken place. Until a new Manager is appointed the Deputy Manager is taking charge. The Deputy Manager said that meetings are held on a regular basis for people that use the service and their relatives. She said that meetings enable the home to inform people of important information, discuss future events, discuss any concerns and talk openly about the home. Independent auditing is carried out on a yearly basis to ensure that the home is run in the best interests of people that use the service. The home have in the past carried out their own quality assurance exercise in which they send questionnaires out to people that use the service to see if they are happy with the care Care Homes for Older People Page 24 of 31 Evidence: provided, however this has not been done for some time. The Deputy said that she plans to do this after Christmas. It was not possible to look at how the home manages to look after the money of people that use the service, as records could not be accessed at the time of the visits. A random sample of health and safety records were examined. Records were available to confirm that the fire alarms, gas boilers and hoists had been serviced within the last twelve months. Weekly tests of the fire alarm service were recorded. Records were available to confirm that water temperatures were taken and recorded monthly. A discussion took place with the Deputy Manager regarding the health and safety guidance in which to take water temperatures weekly. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Person must ensure that for those people who are prescribed subcutaneous fluids they have a plan of care and regime for the prescribed fluids To ensure health, safety and wellbeing 06/11/2008 2 9 13 The Registered person must ensure appropriate use of medications at the home To comply with regulations and safeguard people who use the service 06/11/2008 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 ensure that care plans are developed further to ensure that they are individual to the person. Care plans need to include limitations, preferences and assistance required. 28/02/2009 Care Homes for Older People Page 27 of 31 This will help to ensure that the health safety and well being of people using the service is promoted 2 9 13 Medication must be stored securely and safely at temperatures reccommended by the manufacturer. A system must be in place to check expiry dates of medicines(including thiose with limited life) and to add the date of opening when necessary This is to make sure that medication is safe to administer when needed 3 9 13 Medication must be given as prescribed and a record must be made at the time it is given This will make sure that people receive their medications correctly and the treatment of their medical condition is not effected 4 18 13 The Registered Person must ensure that all staff receive adult protection training on a regular basis To ensure that staff are aware of what to do if abuse is suspected 28/02/2009 21/11/2008 20/12/2008 Care Homes for Older People Page 28 of 31 5 35 17 The Registered Person must ensure that pocket money records for people using the service are available for inspection To enable examination of records and ensure that the financial interests of people using the service are safeguarded 30/01/2009 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 1 The homes statement of purpose/service user guide should be updated to include all of the information as listed in Schedule 1 of the Care Homes Regulations The Registered Person should ensure that assessments for people using the service are sufficiently detailed to ensure that care needs are met Care plans should be evaluated on a monthly basis or more often as required. Care plan evaluations should include details of deteriorations or improvements made. The pharmacy should be advised of medication not in use and asked to provide up to date MAR charts. This makes sure people are only getting medication that is currently prescribed Hand written entries and changes on MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed A system should be in place to record all medication coming into the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels The medicine policy should be updated in line with current guidance so that staff understand how to handle and administer medicines safely The complaints procedure should be updated to include stages of the complaint, timescales for action and who and where to complain to to ensure that complaints are dealt Page 29 of 31 2 3 3 7 4 9 5 9 6 9 7 9 8 16 Care Homes for Older People with promptly and appropriately 9 18 The adult protection procedure should be updated to include action that staff should take if abuse is suspected to safeguard people who use the service The registered person should carry out an assessment on people using the service to determine if there are enough staff on duty particularly at peak times. This will help to ensure that the care needs of people using the service are met The Registered Person should develop an action plan in which to achieve 50 of staff qualified to NVQ level 2 in care The Registered Person should carry out checks on nurses working at the home with the Nursing Midwifery council to confirm eligibility to practice The Registered person should provide induction that meets standard as set by Skills for Care. This will help to ensure hat staff are appropriately trained The Registered Person should appoint a manager who is qualified, competent and experienced to run the home. This will help people that use the service to benefit from a well managed service The Registered Person should carry out a quality assurance exercise on a yearly basis based on the views of people who use the service. this will help to ensure that the home is run in the best interests of people using the service The Registered Person should give consideration to the Health and Safety Guidance in which to monitor water temperatures weekly to help to ensure safety of people using the service 10 27 11 28 12 29 13 30 14 31 15 33 16 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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