Inspection on 20/03/09 for St Anthony`s Nursing Home

This inspection was carried out on 20th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Anthony`s Nursing Home 1 Kew Road Weston Super Mare North Somerset BS23 2NP     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: Vanessa Carter     Date: 2 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: St Anthony`s Nursing Home 1 Kew Road Weston Super Mare North Somerset BS23 2NP 01934629378 Telephone number: Fax number: Email address: Provider web address: admin@stanthonys.demon.co.uk www.europeancare.co.uk Name of registered provider(s): European Care (Combined) Limited care home 34 Type of registration: Number of places registered: 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 34. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home St Anthonys Nursing Home is a double fronted, two storey victorian property, situated in a quiet residential area of the seaside town of Weston-super-Mare, North Somerset. It has a large garden and sun terrace to the front and car parking to the rear. The seafront, town centre, parks and gardens are within half a mile and a bus stop is approximately 50 yards away. The majority of rooms are single and several of them Care Homes for Older People Page 4 of 31 Over 65 34 0 Brief description of the care home have en-suite facilities. The four double bedrooms each have en-suite facilities. The home is spacious with lots of communal rooms. The home shares a wheelchair accessible minibus with a sister home, St Anthonys Court Nursing Home. 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 is the first inspection of this service under the new ownership of European Care. St Anthonys Nursing Home was previously run by a family but is now owned by a large corporate care provider. We undertook an unannounced inspection of this service. Prior to the inspection we asked for an Annual Quality Assurance Assessment (AQAA) to be completed (in October 2008). The AQAA is a self-assessment document that we ask care services to complete, that focuses on how well they are doing, where they have improved and what they could do better. We also sent out some survey forms and had these returned from just four people who live in the home. We collated the evidence from these sources, and used the information to plan how we were going to conduct the inspection. During the inspection visit, we spoke to the home manager and members of the staff team who were on duty. We also spoke with some of the people who live in the home Care Homes for Older People Page 6 of 31 and visitors who were in the home with their relatives. We looked at care records, other home records and some staff files. The fees are currently set at between 551 - 600 pounds per week. Additional charges may be made for extra services and these will be advised by the home manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 31 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. Information about the home and the pre-admission assessment processes will ensure that placement is only offered to people whose needs can be met. Evidence: The Statement of Purpose contains all the necessary information to enable any person who wants to know about the service, to make an informed judgement about whether the home is appropriate for them. The four people who returned CSCI survey forms said that they had received enough information about the home and that they had received a contract. The manager is in the process of reviewing the Statement of Purpose and is therefore keeping it under regular review. We were told that a contract of admission is only set up between St Anthonys nursing care home and people who are funding their own care entirely. Those who are part funded by a local authority do not get a copy of the terms and conditions of admission. One person wrote on a CSCI survey form I want more information about Care Homes for Older People Page 11 of 31 Evidence: extra costs. It would be nice to have an information pack for residents and their families, outlining policies and procedures for example communication after GP visits, arrangements for hospital visits and visiting restrictions. This needs to be addressed so that everyone is aware of the terms and conditions of their stay. Prior to any admission being arranged, the home manager will undertake an assessment of needs in order to make sure that the home is able to meet their care needs. The assessment completed for the most recent admission was seen and provided a very clear picture of the persons needs and identified the nursing equipment that was needed to care for the person. It is the homes policy to obtain as much information about the person from social services and healthcare professionals and that placements are reviewed within six weeks. Relatives of, or the person themselves where possible, are asked to visit the home prior to admission. Where possible all admissions are planned in advance, however if someone came in as an emergency, as much information would be gathered and a review of the placement would take place within 48 hours. One visitor in the home on the day of the inspection told us that thay had been along to look at the home, whilst their relative was in hospital, and that they had liked the homely feel of the house and the friendly welcome by the staff. 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 may not receive the care and support that they need, because care plans are not prepared with enough specific detail. Medication procedures have been improved and are now safe. The home needs to look at their procedures for recording end of life decisions. Evidence: The care plans of four people were looked at to determine the processes involved in preparing individual personal plans for each person. The plans were based upon a comprehensive assessment of needs. The sample looked at each needed to be improved in various ways. The first plan looked at covered a range of different needs, but vague and meaningless instructions were recorded. For example, care staff were advised to ensure that his allergies are avoided and blood sugar levels are to be monitored. There was no indication what the allergies were and what the upper and lower limits for the blood-sugar levels should be. For this same person, who had not lived at the home for long, there was a report from a healthcare professional and the specific nursing care instructions for the person, had not been incorporated in to their plan of care. The plans were not person centred and were not based upon individual Care Homes for Older People Page 13 of 31 Evidence: needs. It was not possible to determine if there had been any involvement of the person, or their representative in the drawing up of the plans. Along with the care plans, risk assessments are completed in respect of the likelihood of developing pressure sores, nutritional needs, continence, the probability of falls, and to identify the risks involved in any manual handling procedures. These risk assessments may not always be reviewed on a regular basis and this means that an increasing level of risk may therefore not be picked up. We looked at wound care planning documentation for two people and saw that there were good plans in place that detailed how often dressings were to be changed and what products were to be used. When wounds are attended to, a written record is made but may not be done on each occasion. There is no process for monitoring progress or deterioration of the wounds, however we could evidence that the district nurses had been consulted regarding wound care. There needs to be regular measurements, mapping or photography to see how the wound is doing. People who live in the home and visitors who were spoken with during the course of the inspection, said that people got the care and support that they needed - as relatives we are very satisfied with the care she is receiving, I am very well looked after and I have not lived here for long but I am very settled and content. A GP who has patients who live in the home stated that they were generally satisfied with the overall care provided to people who live within the home and that medications are appropriately managed. We looked at the records the home keeps for the ordering, receipt, storage and administration of medication, and we consider that safe working practice is now followed. A short inspection visit was made to the home in July 2008 after we had received concerns about medication practice. At that time we found a number of areas of poor practice and two requirements were issued. We were told that registered nurses have had additional training in the safe management and recording of medications and that the homes policy and procedure is now being followed in full. We observed registered nurses giving out midday medications. They were following the correct procedures. Staff were observed to respect peoples privacy and dignity and were attentive to peoples needs. We saw that they knocked on room doors before entering and that they supported one person in a caring and genuine way, when they became anxious. One visitor said that the staff team were very kind and that their relative always commented how polite and courteous the staff were. Care Homes for Older People Page 14 of 31 Evidence: Care planning documentation includes information about a persons end-of-life care needs, where this is relevant. For two people a Gold Standards Framework Care Homes Advanced Care Plan had been prepared. In both cases it was recorded that the person was not for resuscitation but there was no indication that this had been agreed with the persons GP. One persons plan had been signed by their relative. There must be evidence of proper communication between all relevant parties when these decisions are being made. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home will be able to participate in some activities and they will be provided with an adequate diet. Thought needs to be given to ensure that both meet the expectations of people who live there Evidence: There are some activities that are planned to take place in the afternoons, that people can choose whether or not to participate in. We were told that representatives from the churches visit the home when they are requested to do so, rather than on a regular basis. One person told us that they like to go out walking in the local vicinity and like to sit out on the sun terrace when the weather is warm enough. Visitors to the home said their relative enjoyed interacting with those others who could converse and with the staff team. A number of people are confined to their rooms because of poor health. Others choose to remain in their rooms - I prefer to stay in my room watching TV. I like watching all the daytime television. One person who completed a CSCI survey form said I have poor eyesight and hearing and Id rather keep myself to myself. There is no link between what activities are arranged and what people might like to do, although during the inspection no one expressed any real concerns about the lack of activity, this is because many were very tired, elderly and frail. Care Homes for Older People Page 16 of 31 Evidence: Visitors are welcome in the home at any reasonable time. Two separate visitors were spoken with during the inspection. Both said that their relative was very well looked after and they had no concerns about the care and support received. Due to the level of dependency of each person in the home, they are each reliant upon the staff team to meet their daily needs. We observed people being offered choices though, about where they spend their time or what they have to eat. On the day of inspection the lunchtime meal was fish, traditionally served on a friday, or a beef burger, with vegetables. The days menu is displayed on a board by one of the dining rooms. There was a mixed response in the CSCI survey forms about the meals - I really enjoy all the meals and Meals are of a poor standard being the two extremes of opinion. One of the complaints that the home has dealt with featured dissatisfaction with the meals offered. We looked at the menus - roast dinners are served twice a week, fish is served on a friday and chicken and red meat dishes are included. One person told us during the inspection that they do not like fish, therefore had only had vegetables for their lunch - they had not been told there was an alternative meal available. There needs to be a review of meal arrangements to ensure that each persons dietary requirements and preferences are being met. 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. The procedures for dealing with any complaints that are made will ensure that people are listened to and the appropriate action is taken. People will be safeguarded from harm because the staff team will protect them. Evidence: The complaints procedure is included in the statement of purpose, is displayed in the main entrance of the home and will be included in the service users guide when this has been prepared. The four people who completed CSCI survey forms said that they knew how to make a complaint. Those people who live in the home, and visitors who were in the home during the inspection, made positive comments about how any concerns that they have had, have been dealt with. One person said all the staff do their very best and do what I want whilst another said there is nothing really to complain about but if I do mention something, it is acted upon. The GP who completed a CSCI comment card stated that they had not received any complaints about the home. It is evident that people are able to raise any concerns they may have and that their concerns will be taken seriously. The complaints log showed that the manager has received two formal complaints since she has been in post - there was a record of what action had been taken as a reult of the complaints. We have received one complaint regarding this service recently and we undertook a visit to the home to look at the issues raised. We were told that there were a number of irregularities regarding the management of medications. These have been referred to under standard nine. Two requirements were issued and the home has shown Care Homes for Older People Page 18 of 31 Evidence: compliance with each of them. This is again evidence that the home takes action to get things right. There is a Protection of Vulnerable Adults (POVA) policy, which is in line with the North Somerset Councils No Secrets policy. A copy of this document is kept in the main office. Staff spoken with during the course of the inspection demonstrated an awareness of adult protection issues and also what actions they would take if abusive behaviour, or bad practice came to their attention. The manager told us that they have been involved in safeguarding strategy meetings,looking at the ongoing care of two people who live in the home. 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. St Anthonys is comfortable, well maintained and nicely furnished. It meets the needs of the people who live there, but there must be adequate numbers of moving and handling equipment, to meet the collective needs of the people who need to rely upon the equipment. Evidence: St Anthonys nursing home is a large detached house located on the hillside above the seaside town of Weston-super-Mare, with sea views from some windows. It has an outside sitting area to the front of the property and car parking is available to the rear. Various outbuildings house the administrators office and the laundry. European Care the owners of the care home took over the running of the home in the spring/summer of 2008. The home is spacious and there are plenty of communal areas for people to spend their days. There are three lounges and two dining rooms. There are plans to tone down the decorations in all parts of the home as at present the home is very floral in its decorations throughout. Some of the seating in the communal rooms is not suitable for people who may be incontinent, as it not easily cleaned. Consideration should be given to the replacements having water-proofed covers, so that they can be effectively cleaned as needed. Care Homes for Older People Page 20 of 31 Evidence: There are a total of four bathrooms in the home, and eight toilets. Some of the toilets are inaccessible for a person with mobility aids or who would need assistance from a carer to use the toilet. There is a plentiful supply of commodes in the home and all those bedrooms that do not have en-suite facilities, are supplied with a commode if needed. There are two specialist parker baths, both rooms need to be kept in a state that makes them usable. On the day of inspection one bathroom was storing a lot of nursing equipment. There are a number of specialist beds plus a selection of different types of pressure relieving mattresses to prevent pressure sore development. Other items of equipment include raised toilet seats, grab rails and a passenger lift to the first floor rooms. There is one sluice room with a bed pan/urinal washer that will sterilise and clean items. We were told that there are a number of hoists and Standaids but because one is not available and has not been returned following repairs, this impacts upon peoples care and the way the staff can meet their needs. There must be equipment in sufficient numbers, at all times, to meet the care needs of the people who live in the home. There are 26 single bedrooms of which 11 have en-suite facilities of a toilet and wash handbasin. There are four shared rooms and each has an en-suite room. All of the bedrooms were seen during the inspection. Many have already been redecorated. There were a number of rooms vacant, some are in need of upgrade, reparation work and/or redecoration. These rooms will not be used until this work has been done. The home was warm and well lit and furnished with domestic style furniture. People are encouraged to bring in any small items of furniture and personal items for their rooms to make them feel at home. A tour of the home evidenced a good standard of housekeeping, with all areas, clean tidy and free from offensive odours. We saw that good infection control measures were in place where appropriate. The laundry rooms are located in an external outbuilding - there were two commercial washing machines, both capable of disinfecting soiled laundry, one domestic washing machine, and two tumble driers. The laundry is attended to by two part time laundry assistants plus the care staff, as needed. 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. The people who live at St Anthonys will be looked after by staff who have been recruited safely, and are able to meet their needs. However, the recruitment of additional care staff would reduce the need for agency staff and would mean that people would always be cared for by staff who are familiar with their needs. Evidence: At the current time there are only 23 people in residence at St Antonys and the staffing rotas showed that the mornings are generally covered with four care staff and one registered nurse, the afternoon and evening with three care staff plus a registered nurse, and overnight a registered nurse and two care staff. Staff expressed the view that this level of staff was appropriate based upon the care and support needs of the current people in the home. As part of the care planning process the dependency levels of each person is assessed and staffing levels are adjusted accordingly. A number of staff have been working at the home for many years. Some shifts are covered by agency staff because there are a number of staff vacancies. We were told that where possible the agency will send agency workers who are already known to the home. This would ensure that people are cared for by staff who are familiar with their care and support needs. The home manager is already actively recruiting for new staff to join the team. At the present time some of the care staff have already achieved a National Vocational Care Homes for Older People Page 22 of 31 Evidence: Qualification (NVQ) at Level 2 in Care. Other staff will be expected to do the training. We were told that kitchen staff are doing NVQs in catering and one member of the care team is working towards a level 2 care award. There is an expectation that half of all staff hold this qualification therefore there needs to be an ongoing committment to achieving this. This would ensure that people are always looked after by trained and competent staff. The staff files of five staff members were looked at to determine the process the home follows to ensure they only employ suitable people to work in the home. Each person had completed an application form, had attended for interview and completed a medical questionnaire. Two satisfactory references and CRB and POVA 1st clearance is obtained. These are safe recruitment procedures and will safeguard people from being looked after by unsuitable staff. There is at present no training plan although the manager has arranged a number of training sessions. An appraisal of each staff members training and development needs is in the process of being completed and the information gleened will be fed into the training. There are currently no training files available for inspection but we did see some evidence that staff have received training in manual handling, fire awareness, food hygiene, first aid and protection of vulnerable adults. 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. Although there is currently no registered manager, the person in charge has the necessary qualifications and experience to run the home. There needs to be a formal review of the quality of the service to make sure that the home is being run in the best interests of the people who live there. Improved compliance with health and safety procedures would safeguard people. Evidence: There is currently no registered manager for this service although a home manager has been in post since October 2008. She is in the process of making application to the Commission to be the Registered Manager. She is a Level 1 registered nurse specialising in mental health, has been qualified for nine years and has experience of working in both the NHS and the care home sector. She was previously an acting home manager in a small EMI care home in North Somerset. We were told that she will be undertaking the managers qualification in the future. European Care took over this home in March 2008 and will be completing their first Care Homes for Older People Page 24 of 31 Evidence: annual customer survey very soon. This will involve the views and opinions of people who live in the home and their relatives/representative. Regular monitoring visits are made by a senior programme manager for European Care - the report about the last visit evidenced that the organisation is aware that there is a lot to do to achieve compliance. The manager is planning to introduce informal quarterly questionnaires to ensure that people who live in the home are satisfied with the service they receive. The manager is also hoping to re-introduce regular resident meetings as these have fallen by the wayside recently. A health and safety audit completed in January 2009 highlighted a number of improvements that needed to be done and we were told that only two issues are still outstanding. The Environmental Health Officer last visited in September and the two recommendations made for good and safe practice have been taken on board. The home looks after personal monies for a number of people and has good administrative systems in place to safeguard peoples finances. Transactions in and out of each account are recorded along with any receipts. Three acounts were checked and the amounts held tallied with the records. There are currently no formal arrangements in place to formally supervise the staff team and the home manager is aware of the need to set this up. She plans to have a cascade system of supervision with registered nurses supervising a group of care staff, with her overseeing the registered nurses. She is aware that there will be a need to maintain records that must be available for inspection. Staff spoken with during the inspection said that they felt well supported and that they received a good handover report before they started duty. Some of the records that the home is expected to maintain are not currently being kept. There is no service users guide and staff training files are not kept. The manager is already aware of this and has begun working on the preparation of an information pack for the home. The home employs a part time maintenance person. Minor repairs, decorating and some of the checks around the house have been delegated to him to complete. The checks of the fire alarm system, fire extinguishers and emergency lighting were all up to date and staff have received fire awareness training in the last two months - this was confirmed by those staff members spoken with. It has been a while since a practice fire drill has been undertaken and these need to be arranged on a more regular basis. Staff are aware of the homes fire procedure. We saw that a number of people have bed rails installed to maintain their safety whilst Care Homes for Older People Page 25 of 31 Evidence: they are in bed. For one person the use of this equipment had been consented to, but a risk assessment had not been completed to ensure that this was an appropriate means of protecting the person. For another, a risk assessment had been completed however their use had not been agreed. The home manager must ensure that before bed rails are used, a risk assessment is completed and consent is obtained from the person or their relative. A manual handling risk assessment is completed for each person and a safe system of work is devised. A copy of this is kept in the persons care planning file and also displayed in each persons bedroom. This is good practice. We noticed during a tour of the home that the hoists and Standaids were overdue for a service. The registered person must ensure that this equipment is serviced and tested as stipulated recommended as being six monthly but at least on an annual basis. Care Homes for Older People Page 26 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 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 2 5 The registered person shall 20/05/2009 provide each person/relative with a service users guide This is so that they have information about the terms and conditions of their stay, including any extra costs that may be applied. 2 7 15 The registered person must ensure that care planning documentation is meaningfully reviewed. This is so that any new needs are appropriately planned for and met. 20/05/2009 3 7 15 The registered person must 20/05/2009 ensure that a care plan is drawn up for each person that states how individuals specific needs are to be met. This is so that care staff know what actions they have to take and peoples needs will be met. 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 22 23 The registered provider must ensure that appropriate amounts of moving and handling equipment is available to meet the collective needs of people This is so peoples needs can be met as and when needed and staff have access to the equipment they need. 30/04/2009 5 33 24 The registered person must complete a quality review audit of this service with the aim of improving practice This is so that people experience better quality outcomes. 20/06/2009 6 36 18 The registered person must ensure that staff are appropriately supervised. This is to ensure that all staff work within the policies and procedures of the home. 20/06/2009 7 38 23 The registered person must ensure that all equipment in the home is regularly tested and serviced This is to ensure that it is kept in safe working order 20/04/2009 Care Homes for Older People Page 29 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 8 38 13 The registered person must ensure that the use of bed rails is risk assessed and consented to. This is so that the use of bed rails does not present additional hazards to users and the action is agreed upon. 02/05/2009 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 8 There should be systems in place to monitor the progress or deterioration of any wounds. Records should be kept to track what is happening as a means for reviewing treatment provided. Review activity arrangements to make sure they meet peoples expectations, as part of the overall quality assurance mechanisms. Review meal arrangements to make sure they meet peoples expectations and dietary requirements. There should be a programme of replacement for armchairs that are upholstered so that wipe-clean chairs are provided. The home needs to increase the numbers of staff who have achieved a National Vocational Qualification in Care at Level 2. Staff should be supervised formally at least six times a year and records kept, available for inspection. Fire Drills should be carried out on a regular basis to maintain of staff awareness of the fire procedures. 2 12 3 4 5 15 20 28 6 7 36 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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