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Inspection on 09/03/09 for St Georges Hall & Lodge

Also see our care home review for St Georges Hall & Lodge for more information

This inspection was carried out on 9th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home employs a full time activities coordinator who works within each unit offering a range of activities. The grounds of the home are nicely laid out and are easily accessible. The furniture that is provided for people is good quality and people said they liked their rooms. One person commented that ` I like to sit and look out of the window because I am at the front of the building I can see all the comings and goings`.

What has improved since the last inspection?

The statement of purpose and service user guide have been up dated, however there were no further improvements noted since the last inspection.

What the care home could do better:

There have been a lot of requirements and recommendations made at this inspection. It is a priority for the manager to concentrate on the most important requirements first. For example the ones that potentially effect the health and safety of the people who live at the home. People are not properly reassessed prior to them being readmitted to the home. The care plans are not written in sufficient detail to allow staff to care and support people properly. Medication dosages are not always recorded properly in the right format which potentially puts people at risk of harm. The home was not hygienically clean and some people`s bedrooms were very dirty. The soak aways from the en suite showers facilities in some bedrooms were not working properly and people were having to walk through standing water. The nurse call bells in some bedrooms were not accessible or had been removed. This means some people were not able to summon help quickly if they needed assistance. Some equipment to make people more comfortable when they are in bed was not working properly. Although there appeared to be sufficient staff on duty they are not given a proper induction training to care, this coupled with poor management of staff indicates that people are not receiving care from properly trained and supervised staff. More details of the inspection findings and requirements and recommendations made from the visits can be found in the full inspection report.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Georges Hall & Lodge Middleton St George Hospital Site Middleton St George Darlington Co. Durham DL2 1TS     The quality rating for this care home is:   zero star poor 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: Bridgit Stockton     Date: 0 9 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 Georges Hall & Lodge Middleton St George Hospital Site Middleton St George Darlington Co. Durham DL2 1TS 08456032558 01325335487 stgeorgeshall@try-care.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Orchard Care Homes.Com Limited Name of registered manager (if applicable) Mrs Alison Clare Pemberton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 83 The registered person may provide the following cateory 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: Dementia Code DE, maxuimum number of places: 62 Old age, not falling within any other category - Code OP, maximum number of places: 21 Date of last inspection Brief description of the care home St Georges Hall and Lodge is a residential care home with nursing, newly built in 2006. The layout of the building is split into three units that run with distinct staff teams but share some facilities such as the kitchen, laundry and garden areas. Care Homes for Older People Page 4 of 31 care home 83 Over 65 0 21 62 0 Brief description of the care home There are 83 individual rooms each with en suite bathroom . All rooms are equipped with TV and DVD player. The home also has assisted bathing facilities in communal bathrooms. There are several communal lounges and dining areas. There is a landscaped garden at the rear of the building for people to use and an outside summerhouse for people who smoke to shelter from the elements. The home itself is no smoking. The home is situated near the Durham Tees Valley airport site and is not in easy reach of community facilities such as shops, banks, leisure facilities and pubs. However there is a hotel nearby. 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The purpose of this inspection was to assess the quality of the care and support received by the people who live at St Georges Hall and Lodge Care Home The methods we used to gather information included visits to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. We looked in detail at the care and records of people, examined other records and looked around the home. We spent three days at the home. On the second day of the inspection we were joined by a contract officer from Darlington Borough Council. The manager also completed some paperwork for us called an annual quality assurance assessment. This provides valuable information to help us form a judgement about the Care Homes for Older People Page 6 of 31 quality of service offered at the home. 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. 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 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 9 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. Whilst people have up to date information about the home and are assessed prior to admission, the assessments are not always suitable in determining the level of care and resources a person needs. Evidence: The home has updated its Statement of Purpose and copies of information about the home were seen in the different bedrooms that we visited. We saw copies of assessments completed by the qualified nurses in the home. These assessments help to identify the level and type of care needed to support the individual person concerned. However, we looked at one persons care file who had been readmitted to the home and placed on a different unit. This person had not been re-assessed prior to their return to the home. There was no evidence of any reassessment prior to this persons return or justification as to why the person had Care Homes for Older People Page 10 of 31 Evidence: been moved from one unit to another. Care Homes for Older People Page 11 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of sufficient details in care plans, coupled with poor practice in some areas regarding medication administration puts some people at significant risk. Evidence: We looked at several care plans in detail. We then talked to the people concerned and those who were responsible for their care to see if the care plans were being followed. The care plans were inconsistent. Some important information had been omitted from the plan but included in the daily reports. The staff we spoke to were able to describe the care that they had provided but not all could confirm that they had read the care plan taking their instructions only from the qualified nurse on duty. Generally the quality of recording was not good, for example it was not clear that care plans had been evaluated on a monthly basis and some staff signatures were missing. When reading care plans we saw that for one service user that the wound assessments and plans were not being recorded properly. For example, there were no dates on the plan to show when a wound had been reassessed and there was no mapping of a second sore that had been referred to in the daily notes. We looked at some audits completed Care Homes for Older People Page 12 of 31 Evidence: on the weights of service users and noticed that for two consecutive months that the person completing the audit had identified that ten people had lost weight. There was no evidence of any action plan to show what investigations were taking place to identify if there were any reasons for this weight loss. We also noticed that some instructions given by a dietician had not been followed. Although risks had been identified in the care plans that we inspected we saw no evidence that the risks to peoples health and welfare had been managed properly. There was no written guidance for staff to follow. The records we looked at showed evidence of GP and other health care professional visits. The quality of these recordings was poor and must be improved to provide more detail about the purpose of the visit and or the changes made to a persons care plan as a result of the visit. During our first visit we became aware of a pressure-relieving mattress that was sounding an alarm indicating that it might be malfunctioning. We raised our concerns about this and were told it would be looked at. The area manager later told us that this mattress was now working correctly, but that it was not part of the regular service agreement and as such would not receive regular maintenance checks by a professional. We expressed concerns about this and asked that the mattress be included in a service contract or replaced. Relatives told us that people were often left wet and this was confirmed by some of the complaints that the home had received. In addition there was no detailed instruction written in care plans for staff to follow regarding the management of peoples continence. During our first visit to the home we found pots of cream in rooms of people that they had not been prescribed for. This is not good practice, as medicines should only be used for the person they are prescribed for. We also found lotions in one room that had been prescribed for the person in January 2009 but as yet they had not been entered on to the medication administration-recording chart. On our second visit we checked the medication held in two of the nursing units. In the dementia unit we found that the stock check was accurate and only one signature was missing. In the general nursing unit we found that one medication administration-recording chart had a post it note stuck to it. This post it was being used to give instructions to staff about the altered dose of some medication as instructed by the specialist nurse. We expressed concerns that the post it could have become detached, which may have resulted in the incorrect dosage being administered. The medication sheet had not been altered to reflect these changes, which had occurred six weeks earlier. We asked that this Care Homes for Older People Page 13 of 31 Evidence: reduction in dosage be managed better and asked that the home discuss the possibilities with the G.P. or pharmacist. We also noticed that a pill cutter was being used to split a tablet. This cutter was dirty and unlabeled. Although we never directly observed anyone speaking harshly or disrespectfully to the service users in the home, we did at times over hear staff talking over people. For example one lady asked for a drink, which was followed by a member of staff telling another member of staff she has already had one. We also observed blue plastic aprons being placed over people at lunchtime without anyone being asked if this was what they wanted. We observed that in a lot of rooms call bells were tucked down the sides of beds and one was behind a picture frame. This meant that people did not have easy access to the call bells and would not be able to call for help. This deprivation of access will be mentioned in another part of the report and a requirement made. Care Homes for Older People Page 14 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. Individual preferences were documented however; there was no evidence to suggest that these preferences were being followed. Mealtimes in some parts of the home were institutionalised, and did not suit the needs of the people with dementia. Evidence: Some of the care plans that we looked at did identify individual preferences and choices. For example times for getting up and going to bed. This evidence was difficult to confirm as when we asked staff about the people they had assisted up that morning we were surprised to find out that most people had been assisted by the night staff who finished work at 8am. We noticed that there were some activities provided in the home for example large print playing cards, DVDs, newspapers etc. The home also has a full time activities coordinator and professional entertainers are organised. Some people engaged in individual activities. For example one lady told us that she goes for a long walk every day. We noticed quite a few people visiting relatives in the home. Due to the location of the home, links with the wider community are limited and are reliant on transport being arranged. Visitors were able to join their relatives in communal areas or in the privacy Care Homes for Older People Page 15 of 31 Evidence: of individual bedrooms. The bedrooms that we saw showed that people were encouraged to bring their personal possessions in with them including large items of furniture. There was a choice offered at mealtime. For example for lunch people could choose from soup, sandwiches, jacket potato and salad and for the evening meal it was sausage and mashed potato or a pasty. During our first visit we commented on the lack of fresh fruit available in the home. This was put right by the time we made our second visit. We were also concerned that people were not receiving regular drinks during the day and again this was put right by the time of our second visit. We were not happy with the atmosphere of the dining room in the dementia care unit. The dining area was bare of any table dressings for example condiments, cutlery and place-mats. People were left sitting for quite some ime before they were offered anything to eat. One relative told us that jacket potatoes were often served dry When we gave feedback about our observations we were told that this was an area that would be improved. Care Homes for Older People Page 16 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. Complaints are not always recorded in detail and not all are responded to within the appropriate timescales. Poor reporting and failure to follow the company complaints procedure puts some people at unnecessary risk of harm. Evidence: We looked at the complaints file and noted that complaints and their outcomes were not always recorded in full. We also noticed that the response to one complaint had taken longer than it should have done. We were concerned to note that the majority of complaints looked at related to people being left wet and staff attitude. The manager has made a number of adult protection referrals and referrals to the Nursing and Midwifery Council which shows that they are aware of the procedures that must be followed concerning abusive or poor practices. The home has also informed the Commission for Social Care Inspection via the regulation 37 requirement of notification when this has happened. These notifications are sometimes limited in detail and on investigation do not truly reflect the full extent of the incident reported. The staff we spoke to told us that they had been trained in Adult Protection. Care Homes for Older People Page 17 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of the furnishings in the home is good but the standard of cleanliness and maintenance is not and needs to be improved. Evidence: During our first visit to the home we looked around the environment and found that the home was not as clean as it should have been. Nearly all of the rooms we looked at had wet rooms that were flooded. The manager told us that this was a design fault and that the rooms were draining the wrong way. We expressed our concerns about this and during our second visit we were told that staff had been told not to use the wet rooms until a solution had been found. We were also very concerned when we found a room that had evidence of dried urine and faeces on the bedding and was generally in quite a poor state of cleanliness and tidiness. Other rooms we looked in were dusty and had fridges that needed defrosting. We also noticed that nearly all of the emergency call bells were tucked down the side of the bed or that the cords were missing. Some of the call bells in the wet rooms had been wrapped around the shower frame. When we tried to use them they became ineffective due to the tightening of the cord around the frame. We noticed that in some bedrooms beds were positioned in a way that prevented staff from having easy access on either side of the bed when it was needed. This meant that the bed and the person Care Homes for Older People Page 18 of 31 Evidence: needed to be moved each time a nursing task had to be completed. The fire doors were not closing properly and the lift was out of action. There were also some strong odours present in some of the corridors and rooms. The water coming out of the taps we tested was tepid. We were told that clinical waste bags were not used in communal toilets and bathrooms; however, on one unit we saw a full clinical waste bag left in a communal toilet. During our second visit we were told that the home had addressed some of the issues. For example the lift was now working and the fire doors had been checked. Three Hoovers and been repaired and the home had bought a second carpet cleaner. The home was also planning to reintroduce cleaning schedules. The fridges in bedrooms had been defrosted. A plumber had also been to check the water temperatures and found that the pressure needed adjusting. Although we noticed some improvements during our second visit those improvements must continue and be maintained. Care Homes for Older People Page 19 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. Staff are not deployed effectively, this coupled with poor supervision and lack of a detailed induction training means that peoples needs are not being met properly. Poor practice in the recruitment of staff means that some people are put at risk. Evidence: We were told that the staffing arrangements for the home are as follows. For the 20 bedded residential unit there is one senior carer and two carers on during the day and one senior carer and one carer on during the night. On the 21 bed general nursing care unit there is one qualified nurse and between two and three carers on during the day and one trained nurse and one carer during the night. For the 43 bedded nursing dementia unit there are two trained nurses and four carers on during the day when occupancy is 30 or below. If occupancy increases to above 30 then there will be two trained nurses and six carers on duty. During the night there is one trained nurse and three carers when full and one trained nurse and two carers if occupany is 30 or below. In addition to care staff the home also employs four domestic staff, two laundry assistants, one activities coordinator and a handyman. We are aware that the home has had some staffing difficulties and had brought staff in from other homes to help out. Relatives have also told us about the concerns they had over the level of staffing within the home at times. We discussed the deployment of staff with the manager and area manager, in particular the domestic staff that work daytime only. Care Homes for Older People Page 20 of 31 Evidence: Care staff are enrolled onto National Vocational Qualifications in Care. The Annual Quality Assurance Assessment document shows that 17 staff have a National Vocational Qualification in Care at level 2 and 19 staff are working toward achieving one. We looked at some recruitment files for staff. We were concerned about the lack of detailed notes and risk assessments in place supporting some recruitment decisions that had been made. For example where criminal record bureau checks show that a prospective member of staff has a criminal conviction then notes are written and a risk assessment is put into place showing why the decision has been taken to employ that person and what safeguards if any have been put into place to safeguard the people who live at the home. The staff we spoke to confirmed that they were offered training. One person told us that they were about to start an National Vocational Qualification in Health and Safety. When we examined the certificates that staff had been given for training we noticed that some people had only been offered minimal training in short sessions. We expressed our concerns about the level and depth of training provided particularly for people new to care work. We were told that a request had been made to the training department to provide more in depth training for staff. We were also told that staff were being offered an open learning programme in dementia care and that all kitchen staff and managers had completed the Focus on Food training. There was no evidence that the recommended Common Induction Standards were being used in the home for new staff. Care Homes for Older People Page 21 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of leadership and a fragmented management team has led to some people being put at risk and exposed to receiving a poor standard of care and service. Evidence: We were told that the registered manager has previous experience of managing a care home, is a registered nurse and has gained the registered managers award. As well as a registered manager the home has a second manager who is responsible for the dementia care unit and four deputies. We were concerned that in spite of this management structure, improvements were not being made within the home. The home is audited against a corporate Quality Assurance process consistent within the Orchard Care group. This process consists of a range of different audits that cover the national minimum care standards. We looked at some of these audits For example the area managers monthly reports that are required by regulation 26 of the Care Homes Regulations 2001, care plan audits, medication audits, infection control and Care Homes for Older People Page 22 of 31 Evidence: weight audits. We noticed that the audits were quite detailed and action points had been identified for improvement. There was no evidence that any significant improvements had been made and some issues were being repeated each month. We looked at 27 records of peoples finances and found that 13 of them had discrepancies. Three were significant and had been brought to our attention by the area manager before the audit began. There was no evidence of any proper record keeping or regular auditing taking place. There were examples of many bad practices. A referral has been made to the police by the area manager for them to investigate. We looked at some staff supervision records. The records that we looked at lacked detail and could be improved by detailing how individual staff are to develop their skills and responsibilities. The staff we spoke said that they got regular supervision. We looked at the records that showed the range and frequency of maintenance checks in the home. We asked that some of these checks be more detailed for example a checklist used for bed rails indicated that all had been checked. This was misleading as not all beds have bed rails. There was an entry in the repair book concerning a broken mattress but there was no indication of the type of mattress or where it was located. The records should have been more specific for example identified by room number. The home was able to produce evidence of regular servicing contracts for most of the equipment in use. As stated earlier, pressure care mattresses were not included. A Health and Safety Audit and Environmental Health Audit was completed by the Local Authority in November 2008. We read copies of minutes from two health and safety meetings held in April and August 2008. We were concerned that staff had raised concerns about issues that had not been dealt with and that we had identified during our inspection. For example, as we have stated earlier in this report, we observed that nearly all of the emergency call bells were tucked down the side of the bed or that the cords were missing. Some of the call bells in the wet rooms had been wrapped around the shower frame. When we tried to use them they became ineffective due to the tightening of the cord around the frame. Staff had previously complained about problems with call bells during the health and safety meetings. We were told that the deputies were responsible for managing these meetings and that the issues identified should have been passed on to the area manager and head office but that this had not happened. Care Homes for Older People Page 23 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 24 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 3 14 All people admitted or 17/04/2009 readmitted to the home must have a full assessment of need carried out by a suitably qualified person. This will ensure that peoples assessed needs can be met by the resources available to the home. 2 7 13 When a risk is identified appropriate strategies must be documented within individual care plans to demonstrate how the risk is managed or eliminated. This will ensure that staff will know what to do to keep people safe. 17/04/2009 3 7 15 Care plans must contain sufficient detailed instructions for staff to follow to ensure that peoples needs are fully met in a consistent manner. 17/04/2009 Care Homes for Older People Page 25 of 31 This will make sure that people are in receipt of proper planned care. 4 8 12 All pressure relieving 17/04/2009 equipment used in the home must be in good working order and appropriate to the assessed needs of individual service users. This will prevent people from developing pressure damage. 5 9 13 All medication must only be used for the person it is prescribed for. This will prevent people from being harmed from the use of medication that has not been prescribed for them. 6 9 13 All changes to peoples 17/04/2009 medication must be recorded on the medication administration record. This must include the recording of the correct dose, date and authorisation of changes. This will make sure that people are in receipt of the right medication. 7 18 17 All documentation regarding 17/04/2009 the safeguarding of people living at the home must give accurate details. This will make sure that the responsible authorities receive accurate information that will enable them to take the most appropriate action. 17/04/2009 Care Homes for Older People Page 26 of 31 8 19 13 The registerd person must 17/04/2009 provide the Commission with a schedule of remedial works and an assurance that individual risk assessments are in place until all the flooring work has been completed. This will ensure that the Commssion can efectively monitor the progress of the remedial works and ensure that people are kept safe whilst the work is being carried out. 9 19 23 The flooring and drainage system in the en-suite facilities of each bedroom must be repaired and made useable for the people living at the home. This will ensure that people living at the home can safely use the use the facilities they have paid for including the right to privacy and independence. 17/06/2009 10 26 23 All parts of the home must be kept clean. So that people are living in a clean home. 17/04/2009 11 26 16 The home must be kept free from offensive odours. This will make sure that people live in a fresh smelling home. 17/04/2009 Care Homes for Older People Page 27 of 31 12 31 12 The home must be conducted and managed so as to promote and ensure the health and welfare of service users. This will make sure that staff know what is expected from them and people living at the home at not put at risk through ignorance. 17/04/2009 13 33 24 Any shortfalls identified by the quality assurance process must be responded to and records kept showing the actions that have been taken. This will make sure that the quality of services for people living at the home are improved in a timely manner. 17/04/2009 14 35 20 Money belonging to a person 17/04/2009 living at the home must not be paid into a bank account unless the account is in the name of that person. This will protect people from possible financial abuse. 15 35 17 Accurate written records of peoples finances must be kept. This will prevent people from being at risk from financial abuse. 17/04/2009 16 38 12 There must be clearer 17/04/2009 records kept of maintenance checks and repairs that are reported and carried out in the home. Care Homes for Older People Page 28 of 31 This will make sure that people are living in a home that is safe and well maintained. 17 38 12 Call systems with alarm facilities must always be available and accessible for people to use. This will make sure that people can summon help if and when they need it. 17/04/2009 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 2 3 10 14 15 Staff should be given further training that will help them to promote and respect peoples dignity. Staff should receive further training in the promotion of peoples independence and choice in their daily routine. Given the diagnosis of some people that live at the home, healthy snacks and drinks should be readily available on all units. The manager should review the current dining experience that is offered within the units with a view to making meal times more pleasant. Following the investigation into a complaint, all complainants should be written to and informed of the findings. There should also be evidence that the complainant is satisfied with the actions that the home has taken. Different layout options in bedrooms should be considered for example moving beds so that there is sufficient room on either side of the bed to allow staff and any equipment they have to use, easy access. Address the recent recommendations made by the Environmental Health Department regarding the provision of a legionella risk assessment. Infection control procedures should be communicated to all Page 29 of 31 4 15 5 16 6 23 7 25 8 26 Care Homes for Older People staff. The manager should make sure that staff follow those procedures. 9 10 35 35 Personal finances held for people living at the home should be audited by an independent person on a regular basis. There should be clear lines of accountability and responsibility regarding the management of peoples personal finances and the procedures that should be followed. All financial transactions should be clearly recorded and signed for by two people. More detailed records should be kept for staff supervisions sessions. These records should show evidence of discussions taking place about all aspects of practice; philosophy of care in the home and career development needs. 11 12 35 36 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. 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