Inspection on 14/07/09 for Southcrest Nursing Home

This inspection was carried out on 14th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southcrest Nursing Home 23/06/10

Southcrest Nursing Home 16/02/09

Southcrest Nursing Home 23/05/08

Southcrest Nursing Home 22/02/07

Southcrest Nursing Home 14/09/05

Southcrest Nursing Home 18/04/05

Southcrest Nursing Home 03/11/04

Southcrest Nursing Home 02/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Key inspection report Care homes for older people Name: Address: Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG     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: Sarah Blake     Date: 1 4 0 7 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: Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG 01527550720 01527550738 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Kalpana Ananthram,Dr Sabarathnam Ananthram care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Age: Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 40 Physical disability (PD) 40 Date of last inspection Brief description of the care home Southcrest Nursing home is a forty-bedded care home providing general nursing care for older people. Accommodation is provided over three floors in both single and shared occupancy bedrooms. Some bedrooms have ensuite toilets and wash band basin. The home has a passenger lift so that people using the service can access all Care Homes for Older People Page 4 of 30 Over 65 40 0 0 40 2 4 0 2 2 0 0 9 Brief description of the care home parts of the home. There is a variety of aids and equipment available to help people to move about more independently and ramped access to the rear of the building. There are a number of toilets and bathrooms available placed close to peoples bedrooms and the lounges on each floor. There is a small car park available for visitors and staff . The home is near to the town of Redditch and local shops are within walking distance. The home is on a bus route and also in walking distance of Redditch railway station.The weekly fees are not published in the service user guide but are available upon request from the manager. Copies of the most recent inspection reports are availble in the home for people to read if they wish. Care Homes for Older People Page 5 of 30 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 an unannounced inspection. Two inspectors spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for three people. This included observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? The homes Service User Guide is now available in large print and will be available on audio soon. The assessments which the home carries out before people move in are now more comprehensive and contain more detailed information so that staff know how to meet peoples needs as soon as they move into the home. The home has improved their systems for care planning so that people now have detailed care plans which tell staff exactly what care needs to be provided. Medication is managed more safely. The home keeps detailed records of any complaints received and how they have been investigated. Staff have received training in the protection of vulnerable adults, so that they can take their part in protecting people from abuse or neglect. The patio area has a gate so that people are not at risk, and has been upgraded to provide a pleasant space for people to sit out. The home has made sure that fire safety is given a high priority, and regular fire drills are carried out. Care Homes for Older People Page 7 of 30 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 8 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 9 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. The home provides information so that people can decide if they wish to move into the home. Assessments are carried out before people move in, so that people can be confident that their needs will be met. Evidence: The home provides written information for people who are considering moving into Southcrest. This is in the form of a Service User Guide, which clearly sets out what people can expect from the home, and tells people what life is like at the home. At the previous inspection, we recommended that the Service User Guide should be made available in different formats to suit peoples communication needs. We saw that the Service User Guide was available in large print, and the manager told us that she plans to prepare an audio version. We spoke to the relative of one person who had recently moved into the home, and they told us that they had visited the home before their relative had moved in, and Care Homes for Older People Page 10 of 30 Evidence: had been made very welcome by the staff, and that matters relating to the care provided by the home had been discussed with them. We looked at the records for someone who had recently moved into the home. These showed that an assessment of the persons needs had been carried out by a senior member of staff before the person moved in. By carrying out a full assessment, the home can be sure that it can meet peoples individual needs. We saw that the pre-admission assessment included important information, such as the persons mobility needs, their social needs and family relationships. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the home will ensure that their health and physical care needs will be met, although peoples mental health needs are not always met. Medication is generally managed safely so that people receive their medication as prescribed. Privacy is maintained, and staff treat people with respect. Evidence: We looked at records for four people who live at the home. At the previous inspection, we had made a requirement that the home must make sure that care plans are in sufficient detail and are reviewed periodically. We saw that each person had detailed care plans which addressed all their individual needs, and that these had been regularly reviewed and amended as necessary. Therefore, this requirement has been met. The care plans included detailed information about peoples likes and dislikes, and how they like to have their care provided. For example, we saw that people had been asked if they had any preference for the gender of staff providing their care. Care plans were stored securely, and each person had a bedside folder which gave staff Care Homes for Older People Page 12 of 30 Evidence: details of their care needs and included sheets for recording care, such as fluid intake and repositioning in bed. We found no evidence that people or their families are involved in planning and reviewing their care, although the manager told us that she hopes to start this soon. People told us that they receive a good standard of nursing care from staff at the home, and we saw that nurses were professional in their approach to people, and the records showed that the correct care had been given. The records showed that any risks are identified and assessed so that people are not at risk of harm or injury. We saw that one person had been assessed as being at high risk of developing pressure sores. The care plan clearly showed how this risk would be managed, including repositioning within the bed at two to three hourly intervals. The bedside chart showed that staff reposition the person as required, and, during the day, we saw that the person had been repositioned and looked comfortable. We looked at the records for one person who is at risk of malnutrition. The care plan told staff clearly that they should monitor the persons food intake closely, and also offer them milky drinks. We saw that the person had continued to lose weight and that the home had contacted the persons GP for advice. The food intake chart had been completed at every meal by staff, and all fluids had been recorded. The chart clearly showed the persons food and fluid intake. We saw that the person appeared to be well hydrated. We saw that one person had bed rails on their bed with no bumpers. Bumpers are padded covers which help to reduce the risk of injury when bed rails are used, and are required whenever bed rails are used. We saw that there was no risk assessment to explain how the home would manage the risk of injury. We made an immediate requirement that the home should assess the risks and take steps to manage them. One person, who cannot get out of bed, had been assessed as being depressed and the care plan stated B (name of person) gets anxious if left alone and staff should sit with B. During the day, we saw that this person was on their own in their room on at least six occasions. We never saw a member of staff sitting with them. On one occasion, we saw that a care worker was having a social chat with a housekeeper for several minutes outside the persons room, but made no attempt to go in and chat to the person. On another occasion, we saw a care worker go into the bedroom, say All right? and then go out again without waiting for an answer. This shows that the home is not meeting the persons mental health needs. We asked the manager about this, Care Homes for Older People Page 13 of 30 Evidence: and she told us that there is no need for staff to be there constantly, but that they do attend to the persons needs as required. This shows a lack of understanding of the persons individual needs. We looked at medication records, and these showed that people are asked if they wish to take responsibility for their own medication. The manager told us that currently nobody living at the home manages their own medication. We saw that any allergies were clearly documented on the care plans and on the Medication Administration Record (MAR) charts. At the previous inspection, we required the home to make sure that the medicine chart is referred to before the preparation of peoples medicines at all times, and be signed directly after the transaction and accurately record what has occurred. The MAR charts were completed in full with no gaps, which shows that staff sign the charts whenever medication is given, or note down a reason for not giving the medication if it is not given. We found that some painkillers had been recorded as given, but an audit of the amounts left in the box showed that on three occasions, they had actually not been given. This means that staff may believe that people have had their painkillers when actually they have not. When we pointed this out to the manager, she assured us that she would make sure that staff are careful to record accurately and that she would ask the night staff to do a daily audit of medication so that it would be easy to find out when the error occurred. Because the manager has taken action to make sure that medication is recorded and managed safely, we consider that the requirement made at the previous inspection has been met. We observed part of a medication round. The nurse told us that the round can take up to three hours to complete. This is an unacceptable length of time, and could mean that people do not receive their medication as prescribed. We saw that the nurse was washing the medication pots after each person had taken their medication. This meant that the medication round was being delayed. The manager told us that, from now on, the pots will all be washed at the end of the round, thus saving a considerable amount of time. We saw that the home stores medication safely. We saw that a medication called Oramorph 10mg in 5ml was stored in the medication trolley. Although this medication is not a Controlled Drug, it is good practice to store Oramorph 10mg in 5ml in the Controlled Drugs cabinet, and to record it in the Controlled Drug register. During the inspection, we saw that staff were kind and caring when they were working with people at the home. For example, we saw that one person became very Care Homes for Older People Page 14 of 30 Evidence: distressed and a care worker knelt down beside them, held their hand and spoke calmly to them to calm them down. Care plans contained information about how staff should make sure peoples privacy and dignity were promoted. For example, one care plan stated talk gently to C (name of person) to reassure her or hold her hand and always maintain privacy and dignity by using the curtain. We saw that, at mealtimes, people were wearing blue plastic disposable aprons. This does not promote dignity, as people are not being treated as individuals. Care Homes for Older People Page 15 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. The home provides a range of activities which do not always meet peoples individual needs. The food at the home provides a nutritious and balanced diet. Evidence: On the day of our visit we observed people watching the television, having their hair done by the visiting hairdresser, chatting with staff and receiving visitors. We were told that one person who remains in bed due to their medical condition enjoys listening to their radio, and the activities coordinator told us that she would chat to people who remain in their rooms, read books, reminiscence or read poetry. We saw book cases with books in around the home and by the signing in and out book there was a newspaper. Staff told us The music man visits, the exercise person and occasionally people go out. We looked at the records of activities, which informed us that at Easter people painted an egg, on a day to day basis there were soft ball exercises, knitting, music, colouring, reading, music and chatting. Staff told us that there are no organised activities at weekends and records also reflected this but we were told by the activities coordinator These must happen because I find the colouring book out when I return to work. Care Homes for Older People Page 16 of 30 Evidence: Although the care plans included details of peoples interests and hobbies, we saw no evidence of any activities which are planned on an individual basis. There was also no evidence of how social and leisure activities could be used in a therapeutic way to support people with a dementia illness, and no evidence of planned and regular opportunities for exercise. The activities displayed on the notice board informed visitors of what was happening in the home, such as cake decorating, bingo and music, church coffee morning and a fashion display. We asked how activities were organised as the living environment is spread over three floors. We were informed by staff that the newly decorated lounge on the third floor would eventually be a dedicated activities room for all people who live in the home. At the present time the activities coordinator works Monday to Thursday and normally tries to vary where the activities are held so that all people living in the home have an opportunity to participate on alternate days. However, we were informed that people living in the home do access the local community: one person goes to the local pub and some people attend the coffee morning at the local church. Also a church service takes place in the home which is planned a month in advance. We were informed by staff that no day trips have been planned and the activities coordinator told us she does not remember any since starting work at the home in October 2008. We observed breakfast being served to people who live in the home on the day we visited. Staff told us that choices are given to individuals, such as porridge, cereals, bacon sandwich and toast. Staff were assisting some people who required some assistance to eat their breakfasts. We saw that this was done in a respectful way, such as staff sitting at the same level as the person, giving people time to digest their food, maintaining eye contact and chatting. People who live in the home were wearing blue plastic aprons which were also worn by staff. We looked at the menu on the day of inspection and saw that lunchtime meals vary and include cheese and potato pie, tomatoes and jacket potatoes, chicken curry and rice or beef stew, cheese or tuna, corned beef and tomatoes, quiches and salad, omelette, fish cake and beans. Supper was assorted sandwiches or potato soup with desserts of fruit with cream or ice cream. Staff told us I eat the meals, not too bad, quite tasty, not much meat on plate but always plenty of vegetables and pudding and food was served cool but now it is hot Care Homes for Older People Page 17 of 30 Evidence: and generally pretty good. We saw that people seemed to be enjoying their food at breakfast and lunchtime. Care Homes for Older People Page 18 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 can be confident that any concerns or complaints will be taken seriously and will be resolved. The home makes sure that people are protected from the risk of abuse. Evidence: The home has a clear and comprehensive complaints policy and procedure. This is given to everyone who moves into the home, and is displayed in the home. People told us that they knew how to complain. At the previous inspection, we made a requirement that the home must have arrangements in place so that records of all complaints are in sufficient detail. We looked at the records of complaints kept by the home. These showed that the complaints which the home had received had been dealt with according to the policy. The home has kept detailed records and had made sure that people were kept informed of the progress of any investigations. The home has shown that they are aware of the local procedures for protecting vulnerable people from abuse or neglect. The manager has good relationships with the local Social Services Department and knows how to pass on any concerns about peoples safety and welfare. We, the commission, have not received any complaints about the home since the last Care Homes for Older People Page 19 of 30 Evidence: inspection. Staff receive training in the protection of vulnerable adults, and the homes recruitment procedures help to protect people by making sure that only suitable staff are employed. Care Homes for Older People Page 20 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. The home provides a safe environment for people to live in, but some aspects of the home do not meet peoples needs. Infection control is well managed. Evidence: The home has accommodation over three floors, with each floor having a lounge. The ground floor lounge has an adjacent small room, which is referred to as the quiet lounge. This would be a pleasant area to sit, if it was not half filled by wheelchairs, Zimmer frames and a hoist. The home should try to find alternative storage for these items, as storing them in a lounge takes away from the available space and does not provide a homely atmosphere. At the previous inspection, we commented on the fact that there is not enough dining space for everyone to eat at a table if they wish to. This is still an issue, and we saw that most people ate their meals from small individual tables in the lounges. This does not promote peoples socialisation. The dining rooms each contained one large dining table, and the tables were laid with plastic mats. This does not provide a homely environment in which to eat. We saw that peoples bedrooms were clean and tidy, and that people had personalised their bedrooms with their own ornaments and articles of furniture. Care Homes for Older People Page 21 of 30 Evidence: Toilet doors had pictorial signs on them to help people recognise them, but we did not see any other evidence that the home has carried out the recommendation in the previous inspection report that they should implement the research which has been done about colour schemes and signage so that people with dementia or memory loss will find it easy to find their way around the home. At the previous inspection, we made a requirement that the home must make arrangements so that the external grounds could be safely accessed by people living at the home. We saw that the patio area by the main entrance now has a gate so that people are less at risk. The patio area is a small space, which has been pleasantly laid out with colourfully planted pots and two garden chairs. The manager told us that people had really enjoyed sitting out there in the recent good weather, and that she plans to buy more chairs. She also told us of plans to make the garden area at the front of the house more accessible by widening the paths and putting a gate across the exit. The home is kept clean and tidy, and we saw staff using personal protective equipment, such as gloves and aprons, appropriately during the inspection. The home manages infection control well, and training records show that staff receive training in this area. Care Homes for Older People Page 22 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. The homes recruitment systems help to protect people by making sure that only suitable staff are employed. There may not always be enough staff to meet peoples needs. Staff receive the training they need to ensure that they have the skills and knowledge to meet peoples needs. Evidence: People who live at the home and their relatives were positive about the staff. One person described the staff as doing a good days work. The staffing rotas showed that there are usually enough care staff on duty to meet peoples needs, but we saw that there was only one nurse on duty on each shift. Staff told us if staff are off poorly then they are stretched a bit. Because all medication must be administered by a nurse and the medication round can take up to three hours, this means that there is effectively no nurse available for up to three hours whenever a medication round is being carried out. The manager is a registered nurse, but she is not always supernumerary and therefore is sometimes the only nurse in the home. We do not consider this level of staffing is sufficient and may place people at risk of not having their needs met. The manager told us that she uses the dependency charts to assess the level of needs of the people living in the home, and if these show an increased need, extra nurses would be brought in. Care Homes for Older People Page 23 of 30 Evidence: We looked at the records for three members of staff. These showed that the home had carried out all the required checks to make sure that staff are suitable to work with vulnerable people. These include a Criminal Records Bureau (CRB) check and two written references, one of which must be from a previous employer. Records showed that there is a wide range of training opportunities, as well as the mandatory training which all staff must do on a regular basis. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the home is run in their best interests. Health and safety is generally well managed. Evidence: The service employs two people who are responsible for the day to day running of the home: the general manager is responsible for everything which is not care-related, and the care manager is responsible for the clinical care. Although the care manager informed us in February that she would be applying to be registered with the commission, we have not yet received an application from her. It is an offence to manage a care home without registering with the commission, and we have reminded the manager of this. This management structure should give the home a sound basis for carrying forward the improvements which have already been started. Records showed that the home had sent out customer satisfaction surveys to people Care Homes for Older People Page 25 of 30 Evidence: living at the home, their relatives and other people connected to the home. The comments in these surveys were mainly positive, and included a very welcoming home the care staff show the utmost care, attention and patience and the staff are patient and kind. The manager told us that the home would be repeating this quality assurance exercise every six months. We looked at the records of accidents within the home, and saw that these were completed correctly. The general manager showed us a monthly analysis sheet which she completes to identify any trends and to see if any risks can be identified and managed. At the previous inspection, the home was required to make staff aware of the agreed procedures for detecting fire. Records showed that staff have attended fire safety training, and we saw that fire drills had been carried out recently, and that fire alarms are being tested weekly. The home does not take responsibility for peoples personal finances. We saw that the home had held a meeting for people living at the home and their families three months ago, and the manager told us that they had been disappointed that so few people had attended, and were planning to publicise the next meeting more widely. Notes of the previous meeting showed that one person had asked if they could help around the home, and the manager told us that this person now helps by folding napkins and has also baked cakes with staff assistance. The home has shown that health and safety are generally well managed, but there are some concerns about medication and the safe use of bed rails, which have been described earlier in the report in the section on Health and Personal Care. The general manager and the care manager showed that they were receptive to suggestions as to how the home could be improved. Their response to the requirements from the previous inspection shows a genuine commitment to improvement and good practice. We discussed our judgment that the home has a rather institutional atmosphere, and that best practice for the care of people with dementia is not being implemented consistently. We have been told that the care manager will be taking part in a leadership course specialising in dementia care. Care Homes for Older People Page 26 of 30 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 27 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 7 12 (1) You must ensure that the 16/07/2009 use of bed rails is governed by a full written risk assessment. This is so that people are not at risk of harm or injury. 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 9 13 (2) You must ensure that an 14/08/2009 accurate record is kept of all medication which is to given on an as required basis. This is so that people receive their medication as prescribed. 2 27 12 (1) You must ensure that 14/08/2009 the numbers and skill mix of qualified/unqualified staff are appropriate to the assessed needs of people living at the home, taking into account the size, layout and purpose of the home, at all times. Care Homes for Older People Page 28 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 so that people can be confident that their needs will be met in a timely manner. 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 8 You should ensure that peoples mental health needs are met by the appropriate use of resources, such as staff time to sit and chat. This is so that people are not left alone for long periods of time. You should ensure that Oramorph 10mg in 5ml is stored in the Controlled Drugs cabinet, and the use of it is recorded in the Controlled Drug register. This is to ensure safe keeping of medication. You should ensure that peoples dignity is promoted at all times. This is so that people can be confident that the service promotes dignity. You should ensure that activities are planned to take into account peoples individual needs and wishes. This is so that people can enjoy their social and leisure activities. You should ensure that people have opportunities to exercise and to keep themselves fit. This is so that peoples health and wellbeing is maintained. You should consider the evidence about good practice for colour schemes and signage when redecorating the home. This is so that people with dementia or memory loss can easily find their way around the home. You should ensure that recreational areas, such as lounges, are not used routinely for the storage of equipment. This is so that people can use the space. 2 9 3 10 4 12 5 12 6 19 7 19 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. 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