Inspection on 25/02/09 for St Mary`s Nursing Home

This inspection was carried out on 25th February 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Snydale Care Home

Hawkhills

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Mary`s Nursing Home St Marys 101 Thorne Rd Doncaster South Yorkshire DN1 2JT     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: Ramchand Samachetty     Date: 2 5 0 2 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 29 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 29 Information about the care home Name of care home: Address: St Mary`s Nursing Home 101 Thorne Rd St Marys Doncaster South Yorkshire DN1 2JT 01302342639 01302342639 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leyton Healthcare (No 9) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 56 Number of places (if applicable): Under 65 Over 65 56 old age, not falling within any other category Additional conditions: 0 The maximum number of users who can be accommodated is 56 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 - Code OP, maximum number of places, 56 Date of last inspection Brief description of the care home St Marys care home is registered to provide personal and nursing care and accommodation for up to 56 older people. It is situated about half a mile from Doncaster town centre, overlooking Town Fields. It comprises of two units. One is called the Lodge and has 25 places for people who require intermediate care services for a limited period. The other unit is called the Home and it has 31 places for older people who need either personal care or nursing Care Homes for Older People Page 4 of 29 Brief description of the care home care on a longer or more permanent basis. The accommodation is provided on two floors and there are stairs and a passenger lift to facilitate access between them. We received information from the home on 25 February 2009, that the fees charged ranged between £390.14 and £436.96 per person per week. There were additional charges for hairdressing, private chiropody and other personal items like newspapers and transport. Care Homes for Older People Page 5 of 29 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 key unannounced inspection was carried out on 25 February 2009, starting at 09.45 and finished at 18.00 hours. The acting manager, Sheila Horrocks was present throughout the inspection. The service is registered to provide care for up to 56 older people. Up to 24 places can be used for people who require intermediate care services. There were 52 people in residence at the home at the time of the inspection. Twentyfour people were receiving active therapy in the intermediate care section. This was the first inspection of the home since it changed ownership in August 2008. All the key national minimum standards for Care Homes for older people were assessed. The inspection included a tour of the premises, examination of care Care Homes for Older People Page 6 of 29 documents and other records, including staff rota, medicines management, complaints and maintenance of equipment and quality assurance methods. The care of three people was examined and some aspects of care provision were observed. We also checked some of the information contained in the Annual Quality Assurance Assessment that was submitted to us before this inspection. We spoke to people who used the service and to relatives and staff. We considered comments made to us by other professionals. We gave feedback about our initial findings to senior staff and to the acting manager. We would like to thank all the people living at the home, relatives, the acting manager and her staff for their assistance with this inspection. What the care home does well: What has improved since the last inspection? What they could do better: Although the statement of purpose and service user guide had been reviewed to reflect the change in ownership, these documents need further improvement so that they can give more relevant information to people who use or may want to use the service. Staff should make sure that they receive all necessary documentation regarding assessments of people being admitted in a more timely manner. This will help them decide if they can meet needs of people before they are admitted to the home. The care planning system must be reviewed to make sure that individual care plans are based on all identified needs and risks. Care plans must be properly evaluated and reviewed. The storage, handling and administration of medicines must be improved in order to better safeguard the health and wellbeing of people who use the service. Staff should review and improve the provision of social and recreational activities with regards to the needs, preferences and capabilities of people who use the service. This will help to further improve their quality of life. The management of complaints needs to be improved to make sure that investigations and outcomes are clearly recorded and communicated to relevant parties and that they are effectively used in overall service improvement. Although, we noted improvement in the physical environment, staff must make sure that all communal parts of the home and in particular, the dining areas, are kept in hygienic conditions. Although, we noted that the home management did undertake some checks on newly appointed workers, there is a need to ensure that all the required pre-employment Care Homes for Older People Page 8 of 29 checks are sought and obtained before staff start working at the home. There is also a need to review the care staffing level, including nursing, in order to ensure that sufficient staff are deployed as necessary.We also advised on the practice of observing diversity within the composition of the workforce, for the benefit of people who use the service. There is a need to ensure that all health and safety measures are implemented and that staff are provided with regular training on these issues. The quality monitoring and quality assurance systems should be reviewed and improved so that they can assist in continual service improvement. 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 9 of 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who used the service had sufficient information to help them choose the home. However, there is a need to improve the information that the home provides to make sure that people are better informed of the service. Peoples needs were usually assessed before they were admitted. However, relevant assessment information was not always obtained on time. Evidence: .A statement of purpose and service user guide was available to people living at the home and to those who were interested in using the service. The documents contained information about the home, its facilities, aims and objectives and details of the new owners. relatives told us that they had sufficient information to help them choose the home. We checked a copy of these documents. We noted that they had some gaps in the information they provided. There was, for example, no mention of the provision of intermediate care, the criteria for admission and arrangements for care reviews. Care Homes for Older People Page 11 of 29 Evidence: We checked the care files of three people who had recently been admitted to the home. Two of them were placed at the home by social workers, but their files did not contain any care management assessment. Staff at the home had carried out a preadmission assessment for the people concerned. Also, we noted that staff had started to assess their care needs but both assessments were incomplete. There was, therefore, insufficient information to guide care staff about their specific needs. Staff explained that they normally receive assessments before admitting people. In this instance, they were waiting for the assessments. The third person who had been admitted in the intermediate care section, had an assessment undertaken by an occupational therapist prior to her admission. The information contained in the assessment was appropriately used in developing a care plan for the person. The intermediate care service was provided in a separate and dedicated wing and by a multidisciplinary staff team. There were adequate facilities and equipment to allow people who used the service to benefit from recuperation and rehabilitation. People who used the intermediate care service told us that they were satisfied with the care they were receiving in order to regain their independence and to return home. Care Homes for Older People Page 12 of 29 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 using the service said that they were satisfied with the care they were receiving. The planning, provision and review of care was not always satisfactorily carried out. There were some shortfalls in the management of medicines. These could affect the health and wellbeing of people who live at the home. Evidence: People who used the service and who were able to express their views told us that they were well looked after by care staff. They described staff as good and friendly. We spoke to a few relatives and they said that the care was generally good. Some relatives felt that there were not enough staff to provide the care and attention that their loved ones needed. One person said residents are often left in the lounge for a long of time, without staff being around. People who used the service and their relatives also stated that personal care was always provided in private. We looked at the care plans of three people who used the service. They were broadly based on their identified care needs and risks. In general, the care plans addressed personal care Care Homes for Older People Page 13 of 29 Evidence: needs fairly well. However, areas of social and psychological care needs were less well addressed. Risks were identified but were not always acted upon. There was, for example, little action taken to address the identified risk of poor nutrition and weight loss for one individual. The care plan of a person who was using the intermediate care showed that her relevant medical, nursing and her planned rehabilitation needs were appropriately addressed. We looked at the review of individual care plans. Although care plans were regularly reviewed, in some instances only some aspects of the plan had been reviewed. In one instance, the care review of a pressure area had not been recorded and this lack of communication could affect the care of the person. The care plans that we checked indicated that people using the service were supported in accessing appropriate community health care services. The district nursing and community psychiatric team were involved in the health care of people who needed their assistance. In the intermediate care section, there was close working between the home staff and health care professionals who formed part of the multidisciplinary team. We looked at the way medicines were handled and administered at the home. Medicines were stored in three areas of the home. We checked the storage in the main home. The storage space was inadequate and not well lit. Staff said that the area was used only to keep the drug trolley. Medicines received were appropriately recorded. The medicines administration record (MAR) sheets were satisfactorily maintained. On the intermediate care section, medicines belonging to each individual, were stored in a plastic bag, with their name, room numbers and their NHS number. Theses bags were then kept in a large lockable metal trolley and some in a locked cupboard. Medicines received from the dispensing chemist were appropriately recorded. Some amendments on medicines administration record (MAR) sheets were not signed and dated and their authorisations could not be checked. A number of people were administering their own medicines. They had been risk assessed as able and willing and to do so. They confirmed that they had been provided with a lockable facility in their own bedroom to store their medicines. The nurse in charge told us that medicines were checked on a weekly basis. However, there was no record of the outcomes of those checks. The acting manager stated that a yearly audit of medicines was also carried out by the dispensing chemist. The last such audit was carried out 12 February 2009 and no major issues had been identified. Care Homes for Older People Page 14 of 29 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 living at the home were able to benefit from some of the recreational activities that were available to them. There were some shortfalls in the way meals were served and in the standard of hygiene in dining areas. Evidence: During our visit, we observed people who lived at the home, spending time in lounges and in their rooms, watching television, listening to music and in some cases being entertained by their visitors. We noted that staff interactions with people living at the home, were mostly related to care tasks they were undertaking. An activities coordinator was providing nail and hand care to a few people. People who were using the intermediate care service said that they were mostly occupied with their rehabilitation exercises and had sufficient social stimulation. The activities co-ordinator stated that she kept a record of activities that were provided to people living at the home. It included details of activities like sing-alongs, indoor games, video sessions, a monthly church service and reminicense sessions. We noted that a number of people were not capable of or interested in, taking part in such activities and that their planning were not always based on individual social care needs assessment and often did not take peoples preferences into account. Care Homes for Older People Page 15 of 29 Evidence: We spoke to relatives who were visiting their loved ones. They said that they were always welcomed at the home. They told us that they felt the routines at the home were flexible. Their loved ones could, for example, get up and retire to bed at times that suited them. Some relatives said that care staff were very good with people, when they could afford the time to spend with them. During our visit, we observed the serving of lunch, which was the main meal of the day. It comprised of cottage pie, sausages, chips, mash potatoes and mixed vegetables. Deserts consisted of jam sponge and ice cream. The food was plated from hot trolleys in the dining rooms and served to people at tables. A trolley was used in one dining room, to clear food remnants away from plates whilst people were still eating their lunch. This practice affected the dignity of people. Some people chose to eat in their own rooms. We observed staff bringing and leading people to the dining rooms to be seated and served. We spoke to a number of people about their meals. A few people told us that they did not find the food of good quality. Two persons said that they hardly had any choice. However, staff explained that people were informed of the menu and they could express their preference. The food choices of each individual was recorded. One person told us that she had difficulty with cutting and eating their food and had not received any assistance from staff. We noted that the food trolleys, microwaves and cupboards in the dining areas were not clean and hygienic. This could affect the health and safety of people who lived at the home. Care Homes for Older People Page 16 of 29 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. Although people who used the service and their representatives were provided with sufficient information about the homes procedures, the management of complaints was not satisfactory. This could affect the welfare of people who use the service. Evidence: There was a complaints procedure in place and copies of it had been provided to people who lived at the home and their representatives. People said that they were aware of the procedure and would use it if they needed to do so. The acting manager had stated in the Annual Quality Assurance Assessment document that was sent to us before the inspection, that the home had received five complaints in the last twelve months. We checked the way three more recent complaints had been managed. We found that the records of investigations and outcomes were inadequate and unclear. In one instance, there was no evidence that a complaint had been followed up. The acting manager confirmed that staff were following the local adult safeguarding procedures. There had been one referral to the local safeguarding team, which had investigated and satisfactorily concluded the matter. We spoke to staff about adult safeguarding procedures. Some members of the care team were aware of the procedures. Some care staff had not yet received training on the subject but we noted Care Homes for Older People Page 17 of 29 Evidence: that efforts were being made to provide this training. Care Homes for Older People Page 18 of 29 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. Although the physical environment was improving with regards to the provision of furniture and decoration, there were shortfalls in the standard of hygiene. This could affect the welfare of people who live in it. Evidence: We checked the premises in the company of senior staff. The building comprised of two floors and there were a set of stairs and a passenger lift to facilitate access between them. There was wheelchair access at the front and side of the building. The home is organised in two sections. One section is dedicated to the intermediate care service and has its own facilities. The communal areas included three lounges and dining areas. People, in each section, were able to choose where they spend their time. We noted that the new owners had started a programme of refurbishment. A number of bedrooms had been decorated and in some areas, new carpets had been provided. New radiators with low temperature surface had been installed.These changes had helped to make the place more comfortable and more pleasant. We found that some communal areas, in particular the dining areas to be unclean. Some cupboards in the dining areas were not clean. There were a few bins without Care Homes for Older People Page 19 of 29 Evidence: liners and covers and they could give rise to cross infection. We also noted that there were no mechanical or electrical sluicing facility at the home. Staff had to carry out sluicing manually, with the help of gloves and other protective clothing. We viewed a few bedrooms with the permission of people who occupied them. Most of the rooms were clean and tidy. However, there were some malodours in two bedrooms. In general, people said that they were satisfied with both the communal and private accommodation. The surrounding grounds were appropriately maintained for the time of the year. Care Homes for Older People Page 20 of 29 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 deployment of care and nursing staff did not always ensure consistency of care to people who used the service. There were shortfalls in the recruitment and selection procedures. These issues could affect both the overall quality of care being provided and the welfare of people using the service. Evidence: The home was organised in two separate sections. One of the sections was for people who used intermediate care service. It had its own dedicated staff team but was managed with the other section as one service. At the time of this inspection, there were 52 people in residence at the home. Twenty-four (24) people were receiving intermediate care. Twenty-eight (28) were on longer term placement and 24 of them had nursing needs. We looked at the duty rota. It showed that besides the acting manager, there were two qualified first level nurses in each section of the home. The rota indicated that there were usually four care workers on the morning shift and three in the afternoon, for each section. Two first level nurses and three care workers were usually deployed on night duty for both sections. There were other support staff, which included a part time activities co-ordinator, a receptionist, cooks and domestics. In discussion, a few people who could express their views and some relatives told us that they felt there were not sufficient care staff to provide the care and support that Care Homes for Older People Page 21 of 29 Evidence: was needed. People who lived at the home stated that they often had to wait long to receive attention and this happened mostly at busy times. During our visit, we observed some delay in staff helping people during meal times. The acting manager explained that two care workers had to help a person who had just returned from a hospital appointment and this led to the meal times being less supervised. There was little staff interaction with people living at the home. There was no indication that the level of care and nursing staff deployed on duty was based on the dependency needs of people using the service, the lay out of the building and also staff skills. We looked at the files of three care workers who had been recruited to work at the home since the last inspection. In two instances, the appropriate disclosures had not been obtained before the care workers started working at the home. However, they had been checked against the Protection of Vulnerable Adults (POVA) before they were put on duty. All other pre-employment checks were satisfactory. We noted from the information supplied in the homes annual quality assurance assessment document that was submitted to us before this inspection, that the current workforce did not appropriately reflect the the diversity of people who used the service. We spoke to care workers about the training they had received to equip them with the skills and knowledge to provide care. One new care worker told us that she had followed a one day induction course and one session of training on moving and handling people since starting employment in November 2008. A few care workers said that they had received training on a number of topics, including adult safeguarding, food hygiene, first aid and health and safety. However, some care workers confirmed that they had not received training in a number of areas, including adult safeguarding, mental capacity act and the deprivation of liberty safeguards. In discussion, the acting manager explained that a number of training courses for care staff had been organised and would be provided. The acting manager stated that 26 out of 41 permanent care workers at the home had achieved their National Vocational Qualifications (NVQ) level 2. A number of care workers were also undertaking this training course. Care Homes for Older People Page 22 of 29 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. Adequate management arrangements were in place to ensure the day-to-day running of the home. However, there were some shortfalls in the use of quality assurance measures and in the promotion of general health and safety practices. Evidence: There has been no registered manager at the home for almost a year. However, there has been a change in the ownership of the service in August 2008. The new owners have intoduced new managements arrangements to improve the day- to- day running of the home. One of the senior nurses has been acting as the home manager and was supported by an area manager of the company. The acting manager was a first level general nurse, with wide experience of managing care services. In discussion, staff stated that they felt that they were working well as a team for the benefit of people who used the service. We looked at quality assurance methods that were being used to collect feedback from Care Homes for Older People Page 23 of 29 Evidence: people who used the service and their representatives in order to evaluate and improve the service. The acting manager stated that some audits were carried out and cited those of care plans and medicines as examples. However, there was no evidence of clear outcomes from such audits. We advised that regular audits of care plans and of medicines management should have highlighted some of the shortfalls we observed in these areas. The acting manager stated that people who used intermediate care were given a quality review questionnaire in order to obtain their views of that service. The outcomes of these questionnaires were sent to the Primary Care Trust and to local Social Services contract compliance team. We looked at the monthly reports of the providers visits to the home. These contained action plans and were used as a management tool to improve the service. The acting manager explained that procedures were in place for the maintenance and servicing of appliances and equipment in use at the home. There were regular health and safety checks and fire safety drills. However, we noted that the passenger lift had not been serviced and certified by the required date. The acting manager agreed to have the work carried out. We spoke to some members of the staff team about their training on health and safety issues. In discussion, we noted that not all staff had received training or refresher training in these areas. Arrangements were in place to support people living at the home with the management of their monies. All financial transactions undertaken on behalf of the people concerned were appropriately recorded, witnessed and signed and receipts were kept. All individual accounts were regularly audited and balances were correct. Care Homes for Older People Page 24 of 29 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 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Individual care plans must 30/11/2009 be improved to ensure they are appropriately developed, implemented, evaluated and reviewed. Risks that people face must be appropriately assessed and managed. This will ensure that all identified care needs are addressed. 2 9 13 The storage, recording, handling and administration of medicines must be improved. This will help to avoid medicines errors and protect the health of people living at the home. 30/11/2009 3 15 12 Dining areas and related equipment must be kept clean and hygienic. This will help to make the environment pleasing and safe. 30/11/2009 Care Homes for Older People Page 26 of 29 4 16 22 Complaints must be 30/11/2009 appropriately acknowledged, investigated and recorded. Outcomes of complaints investigations must be appropriately communicated to complainants and records kept. This will ensure that issues raised and dealt with, can contribute in the improvement of the service. 5 19 23 All parts of the home must be kept in clean and hygienic conditions. This will help to avoid potential cross ifection and help in making the place safer and more pleasant. 30/11/2009 6 29 19 Appropriate disclosures must 30/11/2009 be sought and obtained before staff start working at the home. This will help to further promote the safety and welfare of people using the service. 7 38 13 All relevant health and safety measures must be appropriately implemented and staff must be provided with regular training. This will help to promote the safety and welfare of people who live and work at the home. 30/11/2009 Recommendations Care Homes for Older People Page 27 of 29 These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service user guide should be improved to include all the relevant information and this should help people in making informed choices. Information regarding assessments of needs for people being admitted should be sought and obtained before their admission. This would guide staff in planning care more effectively. Staff should ensure that they establish the preferences and capabilities of people who use the service, when planning and organising social and recreational activities. The practice of clearing food remnants away whilst people are partaking their meals should be carried out away from dining areas. The care staffing level should be based on the dependency needs of people living at the home, the lay out of the home and the skills of staff. The deployment of staff should also be reviewed to ensure that they are appropriately allocated so that peoples needs are met in a timely manner. Efforts should be made to ensure that the staff team reflects more appropriately people of diverse backgrounds, in particular, the male gender, for the benefit of people who use the service. Efforts should be made to appoint a home manager and for the person to be registerd with this commission. The use of quality monitoring and quality assurance measures should be improved so that they can produce clear outcomes to assist in overall service improvement. The passenger lift at the home should be appropriately and regularly serviced and well maintained to ensure its good and safe working order. 2 3 3 12 4 15 5 27 6 29 7 8 31 33 9 38 Care Homes for Older People Page 28 of 29 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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