Inspection on 28/05/09 for St Saviours Residential Home

This inspection was carried out on 28th May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Saviours Residential Home 22/05/07

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 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Saviours Residential Home 12 Morton Road Exmouth Devon EX8 1AZ     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: Teresa Anderson     Date: 2 8 0 5 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 30 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 30 Information about the care home Name of care home: Address: St Saviours Residential Home 12 Morton Road Exmouth Devon EX8 1AZ 01395264127 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : gtcare@tesco.net GT Care Services Ltd. care home 18 Number of places (if applicable): Under 65 Over 65 0 18 dementia old age, not falling within any other category Additional conditions: 18 0 The maximum number of service users who can be accommodated is 18. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia aged 65 years or over on admission (Code DE(E)) Date of last inspection Brief description of the care home This service was last inspected on 22nd May 2007. St Saviours offers care and accommodation for up to 18 people who have needs relating to old age and/or mental health problems including dementia. It owned by GT Services Ltd, a family company, who have one other care home in Exeter. The home is made up of three large terraced houses that have been converted and adapted for use as a care home. The home is situated within level walking distance of Care Homes for Older People Page 4 of 30 Brief description of the care home local shops and the seafront. It is also very close to the town of Exmouth and the amenities offered there. There is good local transport including a train service. Communal areas are made up of a dining room and two lounges on the ground floor. Bedrooms are on the ground, mezzanine and first floors. The upper floors can be accessed by a through floor lift, stairs and stairlifts. The home is not purpose built for those with mobility problems but there are many aids and adaptations throughout the home, and the home has recently undergone extensive refurbishment and redecoration. There is a small patio garden to the rear of the property. This provides seating areas, shade and it is secure. There is limited on road parking available. The current fees range from 332.00 - 585.00 pounds per week. Fees do not include items such as papers, magazines, toiletries, hairdressing or chiropody. Further information about this service is available directly from the service. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place as part of the normal programme of inspection. It was undertaken by one inspector over two days, as the manager was on annual leave on the first day. Prior to visiting the home the manager provided information to us in a pre-inspection questionnaire. Surveys were sent to people living here, asking for feedback and comments, and five were returned; to staff and three were returned and to health and social care staff and none were returned. Feedback received is included in this report. During the visit to the home we spoke with or saw the majority of people living here. We looked closely at the care and accommodation offered to three people as a way of Care Homes for Older People Page 6 of 30 helping us to understand the experiences of people living here. We observed the care and attention given to people by staff. We spoke with the owner, the manager and with three other members of staff. We visited all communal areas of the home and saw approximately 11 bedrooms. Records in relation to care assessment, care planning, medication, training and recruitment were inspected. What the care home does well: What has improved since the last inspection? What they could do better: The detail and depth of assessment and care planning is not sufficient to ensure peoples needs are met in a person centred way or in a way that addressess all their needs and/or preferences. Care Homes for Older People Page 8 of 30 Care planning and care delivery does not include robust risk assessments and actions relating to the risk of developing pressure sores as it should. The way that medicines are managed has improved, however further improvements are needed to ensure these and peoples monies are managed completely safely. Regular checks are not made on the water system to ensure that the system in place for preventing Legionella is working. The way that peoples social interests and their need to be engaged with the world are addressed means that people might be bored. 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs could be better met in a more individual way if more information were collected about each person during the assessment process. Evidence: In surveys people told us they had enough information about the home which help them to make a choice about where to live. During our inspection we overheard a conversation between the owner and someone who was looking for a care home for their relative. The owner invited the caller to visit whenever it suited them and without an appointment. He arranged to send the caller information about the home and recommended that this person visit at least three homes so that they could compare the services offered. This is good practice. We talked to people about how they came to live here. People we spoke with could not remember if they had had their needs assessed or if they had been given information Care Homes for Older People Page 11 of 30 Evidence: about the home. However, all the people we spoke with also told us they had been helped to come to live here by a relative or other supporter, so this may explain this. We looked at records relating to the assessments of need which had been carried out prior to people coming to live here. These show that the manager carries out all assessments and that a standard format is used to help the assessor to look at important needs. We also saw that this assessment is built upon over time and that each person has a plan of care based upon their needs assessment. However, the amount and depth of information recorded during the assessment is not enough to show what each persons needs are. For example, one mental health needs assessment recorded this person had dementia, but does not detail how this affects this person or their behaviour. Another assessment records that the person is interested in church activities, but does not specify what these are and there is no indication as to whether this need can be met at this home. When we spoke with the manager about this, she was not sure what activities these were. In addition, some people coming to live here might be at risk of developing pressure sores, but this is not assessed during the assessment process and does not therefore form the basis for a plan of care on how to prevent this. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The way that care is planned and delivered could be further improved so that people have their needs met in a more rounded and individual way. People are helped to remain healthy and are treated with respect. Medicines are managed safely, although some improvements could be made. Evidence: In surveys people told us they get the care in the home that they need and that they get medical attention when this is needed. We looked in care plans to see what records are kept in relation to meeting needs and to look at directions given to staff about how to meet needs. We saw that each person has a plan of care and that these are written in a way that is easy to understand. We also saw that staff make referrals to specialist doctors, to the GP, to opticians and chiropodists as needed, and in a timely way. We saw that one person has been referred to the GP on numerous occasions and is being helped to establish a medication regime that will help them to be as well as they can be. We also saw that Care Homes for Older People Page 13 of 30 Evidence: another person has been referred to a specialist to help them with some problems they have. However, the plans of care are not always written in enough detail or breadth to ensure that peoples needs are met. For example, due to the changing doses of medicines one person is very sleepy in the morning. We saw that this person did not eat their breakfast and that this was taken away, uneaten, by a member of staff. The member of staff did not offer anything else to eat during the morning. Staff report that being sleepy and not eating in the morning has become a pattern for this person and that they eat well at lunch time. We looked in the care plan to see if the risks associated with this sleepiness had been identified and how they were to be managed. We expected to see risks relating to not eating, to potential weight loss and to potential pressure sore problems. Some of these risks had been identified. However, the plan as to how these risks are to be managed is vague stating that this person was to be encouraged to eat and drink effectively. We did not see staff encouraging this person to eat their breakfast. We also saw that this person has not been weighed for over 2 months, and that the last time they were weighed they had lost weight. A referral made relating to this persons behaviour recommended that this person have one to one interventions when they became agitated. We did not see this happening on the day of inspection and records do not show that this has been planned for this person. However, we did see in the plan of care that this person is helped to go to bed when they are ready and indicate that they wish to go. This means that this person goes to bed when they are tired and is therefore most likely to sleep well. When this person does wake in the night, staff report that they are supported to do what they want to do which often means getting out of bed and sitting with staff. This is good practice. None of the care plans we looked at contain risk assessments or management plans relating to the risk of people developing pressure sores. We saw in the information provided to us by the manager that it is expected that District Nurses will do this (and deal with continence issues). The manager confirmed to us that she does not carry out such assessements. This is not in line with the commissions expectations of the services that this type of care home should provide. We saw that one person is nursed on a pressure relieving mattress and we saw that some people sit on pressure releiving cushions to prevent sores. We also saw that a number of people sit in one place for long periods of time and do not sit on pressure releiving cushions. We asked the manager how she assessed who needed this type of equipment. She said staff observe for those who sit for long periods, and report if anyones skin becomes red or sore. She again confirmed that an objective tool for this Care Homes for Older People Page 14 of 30 Evidence: type of assessment is not used. We asked one person if they were comfortable as they sat in one chair for a long time. They told us that their bottom does get sore. It is important to note that no one living at this home has a pressure sore. As this care home provides care for people with dementia, we would expect care plans to contain specific information about how this illness affects each person and their behaviour, what their abilities are and what might engage or interest them. Care plans do not contain this information. We casetracked one person who has been identified as being at risk of dehydration. However, the plan of care did not instruct staff as to how much this person should drink in one day, records of how much this person has drunk are vague e.g. sips and there no instructions for staff about what to do if this person does not drink enough. We spoke to the manager who told us that each day this person has a fresh 1 litre jug of water placed in their room and that staff help this person to drink this. During our discussions the manager recognised that this might not be enough, especially during the warmer weather. We also saw that despite some people having changing needs and changes to interventions, that the care plans record that there is no change. We would expect to see an analysis of the information relating to each person so that it can be determined if a change to the care plan is needed and what this change should be. We looked at the way medicines are managed in the home. We saw that there is a good system in place to ensure that everyone gets the medicines they are prescribed. We also saw that they are stored safely and securely and that there is restricted access to medicines. We saw that all medicines given are signed for by the person who gives them and that records are up to date. We also saw that one person living here administers their own insulin. This is good practice as it promotes independence and control. However, the assessment completed to determine this persons ability has not been carried out by a person competent to do so. This person does not have a plan of care based on the guidance produced by the local Primary Care Trust (Care for Life) meaning that it is unclear that they are getting a comprehensive package of care to keep them healthy. We saw that although records provide a generally good auditable system that the manager orders,recieves and returns the medicines into and from the home. She should check the medicines into and out of the home with a second person. In addition, when the medicines arrive into the home, for a short length of time they are Care Homes for Older People Page 15 of 30 Evidence: not locked away as they should be. We saw that people living here are treated with respect and have their privacy promoted. For example, all care is delivered in private, staff knock on doors before entering and people are asked about what name they would like staff to use when addressing them. People are discreetly supported to have their clothes changed if they are marked with food for example and we saw that people who wear glasses have these cleaned and that people are helped to have their hair done if they wish, meaning they are well presented. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here generally make choices, have autonomy, and enjoy a varied diet. However, peoples social lives could be further improved. Evidence: In surveys people told us that there are sometimes activities that they can take part in. When we visited the home we asked people what activities these were. They told us that three times a week a carer, between 2pm and 3pm, offers to do activities with people living here. However, people tend to decline because the staff dont gently persuade us. We talked to the owner about this. He told us that he has tried to recruit an activities co-ordinator unsuccessfully, but continues to try. During out conversations he came up with a number of ideas that might improve the way activities are managed at the home for the benefit of people living here. We saw that activities offered include quizzes, skittles, darts, bingo, baking sessions and once a month there is a tea dance. In surveys staff told us they would like more time to take people out of the home. There was no evidence to show that people go for trips or walks unless these are arranged by the family, or unless the person is able to go themselves. Records show that this does not include approximately two thirds of the people living here. On the day we visited the home the weather was lovely and some Care Homes for Older People Page 17 of 30 Evidence: people sat outside in the patio garden at the rear of the home. We looked at records to see if peoples interests are recorded and saw that these sometimes are. For example one person enjoys church activities and another person likes to interact with soft toys. However, records do not show how these preferences are to be met or if they are being met. In addition, one person who it is recorded would benefit from one to one interventions with staff, does not have these. We saw that people have easy access to their visitors and that visitors are made to feel welcome and comfortable. We also saw that people are offered choices such as what to wear, what time to get up and when to go to bed. This shows that people are helped to make choices and that the home has flexible routines to suit peoples individual needs. We asked people if they like the food served at this home and they said yes. One person said that they would like more salt in their food but that staff made sure there were condiments on the table for them to use. We saw that at breakfast that each person chooses what they eat. Choices included toast, cereal, fruit and bread and butter. We talked to the carer who was cook for the day (this was the cooks day off).They told us that they had completed their food and hygeine course, that they felt confident cooking that days meal which was a full roast dinner and that sandwiches would be available at tea time. We asked people if they had enjoyed the dinner and they told us they had. We asked if anyone was a vegetarian and were told no. However, we saw in one care plan that one person living here is vegetarian and is eating meat. We asked if anyone is a diabetic, and therefore need a special diet, and staff seemed to have a good knowledge about this and ensured that people had their special diet. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and are safe. Evidence: People we spoke with told us that they feel safe living here, and that staff are kind and helpful. They say they have no complaints but can speak informally to any of the staff, the manager or the owner if they want something done or changed. This service has not received any formal complaints, and the commission has not received any complaints about it either. The information given to us by the manager says that all care have had training in safeguarding adults (abuse). We spoke with staff who demonstrate a good understanding of what abuse is and what to do if they suspect or see it. Some people have their movements restricted when in bed by the use of bed rails. Risk assessments are in place to ensure their use is appropriate and safe. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in home that is clean and homely, and which has been adapted to help people with mobility problems to get around more easily. Evidence: Since the last inspection this home has undergone a programme of extension, refurbishment and redecoration. Additions to the facilities include an assisted bathroom (with a hoist into the bath) for those with mobility problems, as well as a wet room. Eleven rooms now have ensuite facilities and the majority of rooms have been redecorated. The home now has a through floor lift as well as stair lifts. This helps people with mobility problems to get around the home. In addition, some toilets are raised for easier use and there are hand rails to help people get around. The communal areas have been completed redecorated and new furniture has been bought for both the lounge and the dining room. The kitchen has been completly refitted and is now easy to clean and the cook on the day says it is easy to cook in. Care Homes for Older People Page 20 of 30 Evidence: There is a patio area to the rear of the home with furniture, shade and pot plants. In surveys people told us the home is always fresh and clean. Comments include the home is clean, attractive and pleasant. When we visited the home we found that it was clean throughout and smelled fresh. We looked in the laundry area and saw that used laundry is stored safely in bags ready to go to the laundry. People say the laundry system works well and that their clothes are clean and returned to them. We saw that there are plenty of hand washing facilities throughout the home with liquid soap and paper towels being used to help prevent the spread of infection. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by sufficient numbers of staff who have the skills needed and who are recruited robustly. People would further benefit if staff had training in caring for people with dementia. Evidence: In surveys staff are described as attentive, caring, helpful, happy and friendly. People say they are always or usually available when needed and that they always or usually get the care and support they need. During out time in the home we saw that people have relaxed and respectful relationships with staff. We also saw that staff respond quickly to requests for help and also saw that when one person felt unwell, staff immediately called for the doctor. In staff surveys staff told us that they received induction training that mostly or very well covers what they need to know about their job. They say they receive training that is relevant to their role and keeps them up to date with new ways of working. They say that they always get the information they need about people living here and how their needs are to be met. They say they feel well supported by the manager and that the way that information is shared with them about people living here works well. In the information provided by the manager we are told that there are usually 2 or 3 Care Homes for Older People Page 22 of 30 Evidence: carers on duty between 8am and 8pm (for 18 people), together with the manager who works office hours, a cook and at least one cleaner. The home also has a maintenance manager. In total there are 7 care staff, 5 of whom have successfully completed a National Vocational Qualification (NVQ) in care to level 2. This is above the governments target of having 50 of the carers in each home trained to this level. In addition 3 staff are working towards achieving NVQ level 3, 1 of the cleaners has achieved NVQ level 2 in housekeeping and the cook also holds an NVQ qualification. The manager also tells us that staff receive mandatory training and updates. However, only 2 staff have received additional training in caring for people with dementia. In surveys staff say they usually feel they have enough support, experience and knowledge to meet the different needs of people who live in this home. We looked at 2 staff files to check recruitment procedures. We found that all staff have undergone checks as recommended. For example, each file contained 2 written references, a completed enhanced police check and proof of identity. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, comfortable and well managed home that is run in their best interests Evidence: This care home is managed by Charmaine Brice. She was approved by the commission as the registered manager in July 2008. Ms Brice has worked in care settings for nearly 20 years and has successfully achieved a National Vocational Qualification (NVQ) in care to level 4 and is currently studying for the Registered Managers Award. Ms Brice is also an NVQ assessor and is an assessor for moving and handling. Ms Brice is supported in the day to day running of the home by the owner Graham Thornton. They clearly work well together. In surveys staff say that Ms Brice supports them well and when we spoke with them they say she is approachable. People living here say that Ms Brice is lovely and does Care Homes for Older People Page 24 of 30 Evidence: lots of good things for the home. In the information supplied to the commission by the manager prior to this inspection, we were told that all staff receive moving and handling training as well as updates. The manager is trained to deliver this training meaning that she can keep an eye on how staff carry this out and provide extra training or supervision is needed. Good systems are in place for carrying out checks such as checking that the fire alarm works, and staff demonstrate a good knowledge about what to do if this happens. We talked to the owner about how the hot water system is managed to ensure that water is stored at a temperature hot enough to prevent Legionella disease, but is delivered at a safe temperature into baths and showers. The owner explains the whole heating system has recently been upgraded to achieve this, but that staff check water temperatures before bathing takes place and that he would also ask the maintenance man to carry out checks for Legionella to ensure the system is working as it should. We checked how people are supported to help feedback their views about the services offered. The manager reports that the home has an annual quality review system which includes as people who live here, relatives and health and social care professionals for their feedback. We saw some of this feedback and it was all positive. In addition the home holds regular meetings with both staff and the people who live here. We looked at how people are supported to manage their monies. We found that some people look after small amounts of monies themselves and are encouraged to keep this safe and locked away. We looked at how the home manages two personal accounts for people living here. We found that all monies spent are recorded and that all receipts are kept. We checked if the amount of monies recorded matched that in the accounts, and found that they did. We noticed that when staff receive monies into the home on behalf of people, they do not always check this with a second person as they should do. All monies are kept safely and securely. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 (1) (2) All the people living here 31/08/2007 should have a plan of care which gives enough detail to staff to ensure that each person receives consistent person centred support that meets their needs and which helps them to retain their skills. This must be kept under review and updated when needed and in line with each person?s changing needs. People who live here should be given opportunities for social stimulation to prevent them from becoming bored or withdrawn. 30/06/2007 2 12 16 (2) (m) Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 Each person living here must 30/10/2009 have a plan of care which details their care needs, physical, which states how these needs are to be met and which is reviewed using all the information available about that person. This will help to ensure that each person has all their needs met in a way that suits them and their preferences and that changes are made according to changing needs. 2 8 12 Each person living here must 28/08/2009 be assessed to determine their risk of developing a pressure sore. This assessment must form the basis of a preventative plan of care. This will help to ensure that people are comfortable and that they will be protected, Care Homes for Older People Page 27 of 30 as far as possible, from developing pressure sores. 3 9 13 Medications must be 31/07/2009 managed in accordance with the Royal Pharmaceutical Guidelines. Two people should check and sign them into the home, and they should always be kept securely, even when they are first delivered to the home. This will ensure that there is a clear audit trail for medicines and that medicines are always stored safely in the home. 4 12 16 People should be supported 02/09/2009 to live a socially interested life that suits them and their preferences. This will help to improve the quality of peoples lives. 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 3 People who come to live here should have their needs assessed in a way that helps those needs to be met in a way that suits them, and which addresses all their needs. When someone administers their own insulin they should be assessed as competent by a person who is qualified and competent to this. Records regarding administration of this insulin should clearly state who has administered it. Where it has been identified that someone has a particular preference such as joining in with church activities or would benefit from a particular activity, efforts should be made to meet these preferences or needs. 2 9 3 12 Care Homes for Older People Page 28 of 30 4 5 6 15 35 38 Where it is recorded that someone is a vegetarian, they should be supported to continue with this lifestyle choice. Any monies received into the home on behalf of people living here should be counted and checked by two people. Regular checks should be carried out on the water stored in tanks to check that the system in place to prevent Legionella is working. Care Homes for Older People Page 29 of 30 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. 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. 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