Inspection on 01/04/10 for Stambridge Meadows

This inspection was carried out on 1st April 2010.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stambridge Meadows 05/10/09

Stambridge Meadows 16/04/09

Stambridge Meadows 09/10/08

Stambridge Meadows 04/05/08

Stambridge Meadows 09/01/08

Stambridge Meadows 23/08/07

Stambridge Meadows 15/01/07

Stambridge Meadows 03/05/06

Stambridge Meadows 31/01/06

Stambridge Meadows 28/09/05

Stambridge Meadows 01/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Love     Date: 0 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 41 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 41 Information about the care home Name of care home: Address: Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR 01702258525 01702258229 stambridge.meadows@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 49 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: 49 The registered person may provide the following categories of service only: Care home only - Code PC 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: 49 Dementia - Code DE, maximum number of places: 21 Date of last inspection Brief description of the care home Stambridge Meadows is a care home for up to 49 older people. The home is situated approximately three miles from Rochford Town Centre and is set in pleasant country surroundings. The home has 40 single bedrooms, 33 with en-suite facilities and 5 Care Homes for Older People Page 4 of 41 Over 65 0 49 21 0 Brief description of the care home double bedrooms, 2 of which have en-suite facilities. The home has three lounges, one of which has a designated dining area. The home also benefits from a visitors lounge area/reminiscence on the ground floor. The spacious grounds are maintained, with several paved areas. The home is in good decorative order with high quality accommodation for residents. Inspection reports are readily available for visitors to the care home and are displayed in the main reception area. Upon request, prospective residents and/or their representatives can have a copy of the last report and this can also be provided on audiocassette. The range of weekly fees as confirmed by the administrator are £390.39 to £750.00. Respite/Short Term Care is charged at £140.00 per day and after 7 days this reduces to £110.00. If residents are funded by social services then a top-up fee for rooms may be applicable depending on the room chosen and will need to be discussed with the project manager/manager of the home. Additional charges to residents include chiropody, hairdressing, newspapers and magazines, personal toiletries and telephone charges. Care Homes for Older People Page 5 of 41 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 9 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. In addition a pharmacist inspector examined medication practices and procedures. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to people who live at the home, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of care staff were Care Homes for Older People Page 6 of 41 spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for people who live at the home, staff and relatives were requested to be sent to the home for distribution. At the time of writing this report we had received 5 completed staff surveys, 5 from people who live at the home and 1 survey from a relative. Where comments have been recorded these have been incorporated into the main body of the report. The manager, administrator, other members of the staff team and 2 managers from other Southern Cross Healthcare homes assisted the inspector on the day of the site visit. Feedback on the inspection findings were given to the managers and the opportunity for discussion and/or clarification was given. Prior to this inspection we were advised by the organisation that due to an unforeseen emergency occurring at another Southern Cross Healthcare establishment (Memory House), 26 people from this home would be temporarily placed at Stambridge Meadows from 7th March 2010. We were advised following the site visit that people returned to Memory House on 19th April 2010. Since the last key inspection to the service in October 2009, we have approved the organisations application to vary the homes registration to admit people who have a formal diagnosis of dementia. Care Homes for Older People Page 7 of 41 What the care home does well: What has improved since the last inspection? What they could do better: Practices and procedures for the safe handling, administration and recording of medicines must be improved to ensure that people are protected. Staff supervision needs to be improved as this has not been undertaken regularly. Staff require refresher and updated training in both core and specialist subject areas. The deployment of staff within the care home and staff interactions with people who live there need to be improved. All people living at the home must receive a varied social care programme that meets Care Homes for Older People Page 8 of 41 their needs. Ensure improvements are made to the home environment (first floor) and that it is suitable to specifically meet the needs of people who have a diagnosis of Dementia. Information relating to the homes Statement of Purpose and Service Users Guide is reviewed and updated and that information recorded within these documents is accurate. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 41 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 41 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. People are assessed so as to ensure the service can meet the prospective persons care needs. However people cannot be assured they will be given accurate information about the services and facilities at the home. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. Records also showed that formal assessments are also completed in relation to dependency, moving and handling, pressure area care, nutrition and continence. The AQAA confirms that a pre admission assessment is carried out and people are only accepted if the management and staff team of the home believe it can meet the persons needs. We received 5 completed surveys from staff who work in the home. Out of these 2 recorded they are always Care Homes for Older People Page 11 of 41 Evidence: given up to date information about the needs of people in the home, 2 recorded usually and 1 recorded sometimes. As part of this site visit the care files for two people newly admitted since the last key inspection to the home in October 2009 were examined. Records showed that a pre admission assessment was completed for each person by the deputy manager. There was evidence to show that the information recorded as part of the pre admission assessment process was informative and in conjunction with assessments undertaken by other stakeholders forms the basis of the persons individualised plan of care. Consideration should be given to ensure there is clear evidence available to demonstrate that the prospective person has been actively involved in the admission process and that their views have been incorporated where possible as this was unclear from inspection of their pre admission assessment and both people were unable to clarify to us if they had been involved in the assessment process. Records showed that neither person visited the home prior to admission as they were admitted on the same day as the pre admission assessment was undertaken. The manager confirmed that usual practice is for the prospective person and/or their representative to be given the opportunity to visit Stambridge Meadows prior to admission so as to look around the premises, to have a meal, to meet people who already live in the home and to meet staff. We spoke with both people who had been newly admitted to the home and they confirmed that the admission process to the home had been smooth and they had been made to feel welcome by staff. The AQAA tells us that visits to the home by a prospective person and/or their representative do not require prior arrangement. This is to allow people to obtain a true working reflection of the home. At the time of the last key inspection to the service in October 2009 we were aware that an application to vary the homes registration had been submitted to us in relation to admitting people to Stambridge Meadows who have a formal diagnosis of Dementia. A site visit by us was made to the home on 27th January 2010 and at this time the Statement of Purpose had not been updated to reflect the change of category. The registration report detailed that an updated version of the Statement of Purpose be forwarded to us however at the time of completing the registration report in March 2010 and subsequently at this site visit, this had not been completed or received by us. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services and facilities provided. However it was evident that some elements within each document contain unreliable information. Since the last key inspection to the home there have been changes to the Care Homes for Older People Page 12 of 41 Evidence: organisational structure within Southern Cross Healthcare, managerial changes and other factors which affect Stambridge Meadows. On inspection of both documents it was noted that not all information recorded was accurate and up to date. This refers specifically to the name, qualifications and experience of the Responsible Individual and Home Manager, the category of registration does not currently reflect the home is now able to accept people who have a formal diagnosis of Dementia, the contact details for the Care Quality Commission are incorrect and refer to the previous registration authority and the information on How To Make a Complaint is not accurate. Both the Statement of Purpose and Service Users Guide contained conflicting information in some areas which did not concur. On inspection of both occupied and unoccupied rooms, copies of the Statement of Purpose and Service Users Guide were on display. We received 5 completed surveys from people who live at the home and all confirmed they were given information about the home prior to them moving in. Care Homes for Older People Page 13 of 41 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. Peoples needs are generally recorded within an individual plan of care however shortfalls in the management of medicines means that their health and welfare cannot be assured. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. In addition to the care plan, formal assessments are completed in relation to manual handling, nutrition, pressure area care, falls, continence and dependency levels. Of those people case tracked, each person was observed to have a plan of care and these were devised from information undertaken as part of the pre admission assessment and as stated previously, from other associated information provided by external stakeholders. As part of the inspection process we looked at 3 peoples care files (2 in full (Stambridge Meadows) and 1 (Memory House) in relation to a specific healthcare need). Care Homes for Older People Page 14 of 41 Evidence: Records showed that since the last key inspection improvements have been made to the care planning system so as to ensure they provide clearer information about the individual persons care needs, provide appropriate guidance to care staff as to how the persons care needs are to be met, ensure that identified risks to the individual person are recorded and proactively managed and there is a clear audit trail of care and interventions provided by care staff and other healthcare professionals and agencies as required. Each care plan was seen to be written in plain language and was easy to understand. In general terms each of the care plans was seen to be regularly reviewed and where changes had occured the care records were amended to reflect this. For example the care plan for one person recorded them as requiring several courses of antibiotics at intervals over a 3-4 month period. On each occasion a plan of care was completed detailing the rationale and specific treatment for each course of antibiotics. We discussed with the manager during feedback that the outcome and/or success of the treatment must also be recorded for completeness. Records also showed that efforts have been made by staff to make the care records more person centred and to include peoples wishes and personal preferences. This was particularly noticeable within their personal hygiene and sleep and rest elements of their care plan documentation. For example both care plans examined (sleep and rest) included the persons specific wishes e.g. window to be left open or closed, the time they retire to bed and preferred time they rise in the morning, whether or not they like a drink before going to bed and the wish of one person to have a nap during the afternoon. We raised with the manager during feedback of where further improvements to the homes care planning system need to be made. One persons pre admission assessment and care plan made reference to them being at risk of falls and the rationale for their incidence. A risk assessment for falls was completed and this provided guidance for staff as to how to reduce the risk. However on further examination of their care file we noted that no manual handling assessment was completed. This means there is no information recorded for staff should the person sustain a fall as to the most suitable arrangements to ensure a safe system for moving and handling. Another care file examined recorded the person as being at risk of falls. The care plan was observed to have a detailed manual handling assessment completed. This was discussed with the manager during feedback and they confirmed that it is the expectation of the organisation that all people living at the home should have a manual handling assessment completed, especially where they have been identified as at risk of falls. No rationale could be provided as to why this had not been completed on this occasion. Care Homes for Older People Page 15 of 41 Evidence: Three other issues around care planning and completion of care plan documentation were also discussed with the manager during feedback. This related to one persons care file making reference to them having a specific healthcare need pertaining to their dietary needs. While we acknowledge there were two separate care plans in place, one for the specific healthcare need and one in relation to their nutritional care needs, there was no information recorded as to how one impacted on the other and the potential significance of ensuring the person maintains a healthy diet. The care file for the other person recorded them as at risk in relation to their nutritional care needs since their admission to the home and their risk assessment stated they should be weighed each month. On inspection of their weight record this showed they were last weighed in January 2010 and over a 4 week period they had lost 4KG in weight. We looked at their daily care records, nutritional records and professional visitors records and these suggested no evidence to show that during this period they had been unwell or a rationale as to the sudden weight loss noted. No records were available to show that the above weight loss had been picked up by care staff or that a healthcare professional had been contacted for advice and/or further investigation. The pre admission assessment for one person recorded them as having a history of severe degenerative joint disease and recurring urinary tract infections and chest infections. It was unclear as to why no plan of care was in place pertaining to their joint disease and the impact this has on them and why the other two care plans were not completed until 3 weeks after they were admitted to Stambridge Meadows. Records showed that people living at Stambridge Meadows have access to a range of healthcare professionals and services as and when required, both at the care home and within the local community. These include District Nurse Services, GP, attendance at hospital appointments, Optician, Chiropody, Phelebotomist etc. We spoke with staff from both Stambridge Meadows and Memory House. It was evident from our discussions that staff know the care needs of people in the home. During the morning and for part of the afternoon we observed people in the home within the ground floor lounge/dining area and in the 2 lounge areas on the first floor. Where care staff interacted with people in the home and provided care and support, this was seen to be positive and undertaken in a respectful and dignified manner. However it was observed that many interactions by staff on both the ground floor and first floor remain centred primarily around tasks and routines e.g. providing personal care, assisting people to eat their meals or to have a drink. During the day within the ground floor lounge/dining area there were 2 occasions whereby this was left unsupported by staff for up to 20 minutes. In addition staffs verbal interactions with Care Homes for Older People Page 16 of 41 Evidence: people who live at the home were observed to be insufficient and some staff were often observed to enter the lounge areas and walk out without talking to people. We discussed this with both the manager and a visiting manager from another home and they confirmed that they too had noticed this. It was positive to note that following this, interactions by staff with people in the home improved and there was more staff presence in the communal areas during the afternoon. People who live at the home were observed to enjoy the interactions and to become more animated. One survey from a relative who visits the home recorded It would be nice if a carer could spend a bit more time in the lounge especially of a weekend as you havent got any office staff around so you havent got people walking about. Another survey under the heading of What does the home do well recorded my relative is well looked after and I am very happy with the home. Two surveys returned to us from people who live at the home recorded The staff are good with me and have the time to talk to me and The carers are all very good. The only negative comments received from resident surveys were in relation to 2 people expressing their concern that they sometimes have to wait a long time to be toileted. One survey told us that they had had to wait for 40 minutes to be toileted and found this to be unsatisfactory. The manager team of the home must look at ways of managing this so as to ensure people receive personal care in a more timely manner. Practices and procedures for the safe use, handling and recording of medicines were examined by a pharmacist inspector. The majority of medicines are stored securely for the protection of residents but we found some prescribed creams and ointments in peoples rooms which were not locked away and could be accessible to other people. We also found a prescribed cream openly accessible in the nursing station on the first floor. The temperature of the medication storage room on the ground floor is monitored and recorded regularly to ensure medicines are of suitable quality. However, there was no monitoring of the temperature of the storage room on the first floor and at the time of this inspection it was above the recommended maximum of 25C. The use of medicines stored outside the recommended temperature could result in people receiving medicines that are ineffective and we have made a requirement about this. A dedicated refrigerator is used to store medicines which require cold storage and the temperature of this is monitored and recorded regularly and we found this acceptable. However, the fridge contained a medicine in use which clearly carried the instruction after its first use...do not refrigerate. It is important that staff follow instructions for the correct storage of medicines. The storage cupboard on the first floor is cramped and the medication trolley in use is not of sufficient size to hold all peoples medication. This has resulted in some medicines being taken out of their original dispensed container and so there is no indication of who these are prescribed for, or the dose to be given. The cupboard used to store controlled drugs on the Care Homes for Older People Page 17 of 41 Evidence: ground floor does not comply with the relevant regulations. This has been raised on previous inspections and, in the past, the home had complied with a requirement for such storage to be provided but this cupboard has since been removed. We looked at the medication and medication records for several people in the home, on both floors. Records are made when medicines are received into the home and when they are disposed of. These records were of an acceptable standard. We also looked at the records made when medicines are given to people and found a number of problems with these records, including, but not limited to: unexplained omissions giving no record of whether medicines had been administered or not, and if not, the reason why was not recorded; medicines given at different times to the time printed on the medication record form but the actual time it is given not recorded and we saw that this resulted in people being given medicines too close together; discrepancies in the quantity of medication remaining if the records made were accurate; a medication prescribed to be given for 5 days was recored as given, and given to the person, for 7 days without any recorded justifiable reason for the variation in the prescribed instructions or that this had been discussed with the prescriber. We have made a requirement about the need for accurate records of medicines adminstration and left an immediate requirement to ensure that medication is only given in accordance with prescribed instructions. We have made a requirement previously about the need for variations in prescribed instructions to be done with the documented agreement of the prescriber and this has not been met by the given timescale of 30/11/09. Further failure to comply with this requirement may result in enforcement action. We saw that some hand-written changes or additions to medication records were not always signed and dated by the person making the entry and were not always signed as being checked by a second person. The recommendation made about this on the last inspection has not been implemented in full. Although this has not been repeated in the recommendations table of this report, it remains a strong recommendation that this is implemented. We watched medicines being given to some people during the morning and at lunchtime and saw the member of staff assemble medication by hand to give to residents and did not wash or cleanse her hands between people. This significantly increases the risk of contamination and cross infection and we left an immediate requirement notice about this. A number of people are prescribed medication on a when required basis and on the last inspection we made a requirement for there to be clear guidelines for staff to follow when using these medicines. We looked at the care records for 3 people who Care Homes for Older People Page 18 of 41 Evidence: were prescribed such medicines and found in only one case that guidelines had been provided. For another person the guidelines simply stated pain relief but gave no details, for example, of the type of pain, where this may be and there was no care plan for pain management, for the third person there were no guidelines or pain management plan in place at all. This requirement has therefore not been met in full and has been given a new timescale for action. We looked at the training records for people authorised to give medicines and saw that the majority had not had any training within the last 12 months. Given the issues raised above in this report, the need for further training of staff on the safe use, handling and recording of medicines must be considered and people must be assessed that they are competent to peform this task. The home undertakes regular audits of the medication and medication practices and this is good practice but the audits had not picked up the problems referred to above. Care Homes for Older People Page 19 of 41 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. There are limited opportunities for people to have their recreational needs met and further improvements need to be made to ensure that all people who live at Stambridge Meadows have a positive dining experience. Evidence: At the time of the last key inspection to Stambridge Meadows in October 2009 an activities co-ordinator had been newly appointed for 40 hours per week Monday to Friday. We were advised at this inspection by the manager that the activities coordinators employment at the home had been brief and Stambridge Meadows has been without an activities co-ordinator since this time. The AQAA detailed that in the absence of a contracted activities co-ordinator an extra member of staff is on occasions rostered to assist with activities during the afternoon where possible. Out of 2 peoples care files case tracked, neither of them had a plan of care detailing the persons social care needs. When discussed with the manager he confirmed this was correct. The AQAA details under the heading of What we could do better To ensure that each person has an individualised plan of care for their daily social activities. On a tour of the premises and from inspection of 8 peoples bedrooms on the ground floor we observed that the activity programme displayed was out of date (8th Care Homes for Older People Page 20 of 41 Evidence: February 2010) and not reflective of activities currently being provided and/or available. This issue was highlighted at the previous key inspection to the service and remains outstanding. On the day of the site visit no activities were provided to people on the ground floor throughout the morning and for a proportion of the afternoon period. People within the main communal lounge were observed to watch television or to fall asleep in their chair. During the afternoon efforts were made by 2 members of care staff to provide 1 to 1 support to some people and two people were observed to participate in the activity of colouring. As stated previously at the time of the site visit the first floor was occupied by people from Memory House. We spoke with 5 people who live at the home and all confirmed they were disappointed with the lack of activities provided at Stambridge Meadows. Comments included nothing to do, we used to have activities but its gone downhill and its so boring. Out of 5 surveys returned to us from people who live at the home, 3 made comments about the lack of activities provided. Comments included the activities are very few and far between. These could do with improvement, provide more activities and If the opportunity arose I wouldnt mind going out in the mini-bus for an outing. Out of 5 surveys returned to us from staff who work at the home, 3 made comments about the lack of activities provided. Comments under the heading of What could the home do better included provide entertainment and activities, Provide more things for the service users to do to keep them entertained and I think activities, although it is starting to improve regarding things to do or make. Minutes from a relatives/friends meeting held in February 2010 recorded disappointment by people who live at the home in relation to the lack of activities. The AQAA confirmed that efforts are being made by the organisation to recruit an activities co-ordinator so as to improve peoples quality of life however it is recognised by the management team of the home that there has not been a significant improvement in this area since the last key inspection. There is an open visiting policy at the home whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. We observed the dining experience for people who live at the home on both the ground floor and first floor. No menu detailing the choice of meals provided for the day were noted to be displayed on either the ground or first floor. Out of 4 people spoken with on the ground floor only one person was able to tell us the choices available. We were advised by the project manager at the last key inspection of steps being taken to devise a pictorial menu so as to enable people who can no longer read the menu to Care Homes for Older People Page 21 of 41 Evidence: make an informed choice. There was no evidence at this inspection of this having been undertaken. The dining experience for people on the ground floor was observed to be positive. Thirteen people were seen to eat in the main dining room and the atmosphere was calm and relaxed. The tables were attractively laid with tablecloths, placemats, cutlery, glasses, serviettes, vase of flowers and condiments. People were given a choice of drinks and choice of meals. The lunchtime meal given to people on the ground floor was seen to be provided in sufficient quantity and looked appetising. Where people require additional aids to ensure they maintain their independence to eat their meal, these were provided e.g. plate guards or special cutlery. People were asked if they required assistance and where support was provided this was undertaken in a respectful manner. The above was in contrast to the dining experience for people on the first floor. In the main dining room there were 14 people and between 1 and 4 members of care staff at any one time providing assistance. As discussed at the previous key inspection to the service in October 2009, the dining room was observed to be cramped and provided limited space for people who currently live at the home and care staff to manoeuvre, potentially placing people at risk. In a smaller lounge on the first floor 5 people who require physical assistance and/or prompting by staff to eat their meal were seated. Although each table in the dining room on the first floor had a tablecloth placed on it, there were no placemats, cutlery, serviettes or condiments placed on the table. While we acknowledge there may be some people who as a result of their dementia and/or poor cognitive ability may touch or remove items placed on the dining table, consideration should be made to ensure that others are empowered to maintain their abilities and skills where possible. Verbal interactions by staff with people during the meal time were observed to be limited and where some people had stopped eating they were not given prompt assistance or support to continue to eat their meal. On several occasions it was the manager of Memory House who intervened and provided support. The manager confirmed to us that it was not staffs usual practice and she was surprised as to why this was happening. We also observed the teatime meal on the first floor. Staffs verbal interactions with people was seen to improve and people who live at the home were noted to enjoy the verbal exchanges and friendly banter provided. People were offered a choice of hot or cold teatime meal e.g. soup and/or assorted sandwiches or baked beans on toast. During the teatime meal 2 people were observed to not want their sandwiches however no alternative meal choice was initially offered until discussed with the manager and they intervened and an alternative meal Care Homes for Older People Page 22 of 41 Evidence: provided. The hot trolley did not contain any toast and as a result of the chef completing their shift, staff had to go down to the main kitchen and make some toast to go with the baked beans. For people who require a soft/pureed diet the only choice available was a plate of mash potato, pureed peas and pureed baked beans. Care Homes for Older People Page 23 of 41 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 who use the service are able to express their concerns and are protected from abuse. Evidence: Information relating to how people can make a complaint or raise concerns was displayed at Stambridge Meadows within the main reception area. On inspection of this the complaints procedure requires reviewing and updating to accurately reflect the Care Quality Commissions office address and the correct details of a named person within Southern Cross Healthcare who can be contacted. People who live at the home are aware of how to raise concerns and said they would discuss this with their member of family, a member of care staff or the manager. People spoken with also indicated they were confident to raise issues and felt their concerns and/or worries would be listened to and dealt with. The AQAA states there is an open door policy at the home so most concerns are brought to the managers attention at a very early stage and are dealt with immediately. In addition there is now a Quality Advisor within the organisation who can provide guidance and expertise in relation to complaints and safeguarding issues. On inspection of the complaint log, records showed that since the last key inspection to the service in October 2009 there have been 2 complaints which relate to staff conduct. The manager advised that as a result of the complaints an investigation by Care Homes for Older People Page 24 of 41 Evidence: him has been instigated and this remains on-going at this time. Records of compliments were available and comments included I would like to extend sincere thanks to yourself and your excellent staff for the care and kindness you showed to our relative and Thank you for the care you gave to our relative over the last 6 months. They always said they were content and thought that everyone on the staff was wonderful. As a family we knew they were safe and cared for and appreciate all you did for them. We also saw a letter from a person who currently lives at Stambridge Meadows thanking staff for their prompt care and attention when they recently had an accident. There are appropriate safeguarding policies and procedures in place. There has been 1 referral made by the management team of the home under safeguarding procedures since the last key inspection. We were made aware of this by the manager and are satisfied that appropriate measures were taken to refer this to the local safeguarding team. The manager confirmed at this site visit that he has not yet been notified of the outcome of the investigation by the safeguarding team. Staff spoken with demonstrated an understanding and awareness of safeguarding procedures and stated that should an issue arise, information would be passed to the senior in charge of the shift and/or the manager. On inspection of the staff training matrix this showed the majority of staff have got up to date SOVA (Safeguarding of Vulnerable Adults) training however there are some staff who require refresher training and for 2 members of staff newly appointed in February 2010 they have yet to receive this. To ensure our findings were accurate we cross referenced the latter with both staff members training folder and found no record of SOVA training having been undertaken. The AQAA details under the heading of What we could do better SOVA training is lower than we require and this needs to be improved. The outcome of the organisations Key Outcome visit on 1st March 2010 also confirms that SOVA training statistics are below the required standard. Care Homes for Older People Page 25 of 41 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. People who use the service live in a safe, well maintained and comfortable environment. Further consideration needs to be made by the organisation to ensure the dementia unit on the first floor is suitable to meet peoples needs. Evidence: A partial tour of the premises was undertaken on the day of inspection. At the time of the site visit there were 18 people residing at Stambridge Meadows on the ground floor. On inspection of the ground floor this continues to be maintained, decorated and furnished to a good standard and is both homely and comfortable to meet the needs of people who live there. Furnishings and fittings were domestic in nature and were of a good quality and in keeping with the environment. There is sufficient communal space and this refers specifically to a large lounge/dining area. There is a smaller lounge area opposite the main kitchen however at the time of the site visit this was being utilised as a staff room. There are sufficient bathing and communal toileting facilities available on the ground floor which enable immediate access and these are fitted with appropriate aids and adaptations. A random sample of residents bedrooms on the ground floor were inspected and all were observed to be personalised and individualised. People spoken with told us they are happy with their personal space. As detailed in the summary of the report due to unforseen circumstances 26 people from another Southern Cross Healthcare home were also staying at Stambridge Care Homes for Older People Page 26 of 41 Evidence: Meadows. The majority of people (23) were being cared for on the first floor and 3 people were being cared for on the ground floor. Since the last key inspection to the home in October 2009 an application to admit people who have a diagnosis of Dementia was agreed by us at the beginning of March 2010. At the inspection of October 2009 we discussed with the project manager the planned proposals relating to the environment of the dementia unit. At that time we were advised that appropriate signage to aid peoples orientation was to be purchased and placed within the unit and visual cues to be placed within the unit e.g. memory boxes, objects of reference, sensory items and items that might remind and/or trigger memories of the past and more recent events. As already discussed we also raised concerns about the proposed dining room as this could potentially be too cramped for the numbers of people residing on the unit and the staff required to support people during meal times. We also discussed in general terms the use of colours to break up the layout of the unit e.g. long corridors and same coloured doors. Each of the stairwells and exits on the first floor have key pads in place for added security and safety. There is sufficient communal space and this includes 2 lounge areas and 1 dining room. In addition there are sufficient bathing and communal toileting facilities available which enable immediate access and are fitted with appropriate aids and adaptations. The bedrooms are all fit for purpose and enable people to bring in their own private possessions. However at this site visit there was little evidence of appropriate signage in place to better support recognition and orientation for people living with dementia. In some instances signage on display was observed to be placed inappropriately which could potentially aid peoples confusion e.g. signage for the dining room was placed outside a bedroom and in two places down a long corridor and some distance away from the dining room. Consideration should be made that not all signage in place may be easily recognised by some people and other pictorial and visual cues may be more appropriate however too much signage in one area may not be helpful for the individual person trying to find their way around the unit. While there are one or two pictures on the wall in the corridors, these do little to break up the space and the long corridors and doors to individual peoples bedrooms are of a similar colour. In addition the doors of the communal bathrooms are also of a similar colour and this potentially means that some people may find it difficult to distinguish between the different rooms. There was little evidence that sensory items for the unit had been purchased and/or were in use. All areas of the home on the day of the site visit were observed to be clean, tidy and odour free. A random sample of hot water from baths and wash hand basins were Care Homes for Older People Page 27 of 41 Evidence: tested and the hot water temperature was seen to be satisfactory and within recommended levels. One health and safety issue was highlighted and this related to the sluice on the first floor being unlocked and cleaning fluid being easily accessible to people on the dementia unit. The manager was advised of this at the time and appropriate action taken to ensure peoples safety. A maintenance person is employed at the home Monday to Friday however their hours are flexible to cover emergencies at evenings and weekends. There is a maintenance programme within the home so as to ensure that the home environment and equipment is well maintained and records to evidence this are kept up to date. A random sample of fire records and other maintenance records were inspected and these were observed to be satisfactory and in date. Care Homes for Older People Page 28 of 41 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. People living at the home can expect to be cared for by staff in sufficient numbers and who are robustly recruited, however people cannot be assured that staff will have up to date training to meet their needs. Evidence: The manager told us there were 18 people living at Stambridge Meadows and current staffing levels are 4 staff between 08.00 and 14.00 (includes a senior member of staff), 3 staff between 14.00 and 20.00 and 2 waking night members of staff between 20.00 and 08.00 each day. The managers hours are supernumerary to the staff roster and there are additional ancillary staff employed and these include a chef, kitchen assistant, housekeeper and domestic staff. On inspection of 4 weeks staff rosters, records showed that the above figures have been maintained. We checked the staff roster on the day of the site visit and this reflected accurately the staff on duty. The staff rosters show that no agency staff have been used at the home for some considerable time. However as detailed within the Health and Personal Care section of the report the deployment of staff within the home needs to be improved so as to ensure that people have access to staff at regular intervals throughout the day. On the day of the site visit this was more obvious as a member of care staff had been taken off the floor to accompany a person to attend a hospital appointment and this left the numbers of staff available short by one person. Care Homes for Older People Page 29 of 41 Evidence: We were told by the manager that people from Memory House were being supported by their own staff team and the manager from Memory House was providing daily support to ensure continuity of care. This was evident on the day of the site visit. Three staff files were viewed for those people newly employed at Stambridge Meadows since the last key inspection. The purpose of this was to check the recruitment process in the home. Records showed there is a good recruitment procedure and process in place and required documentation is received prior to the employee starting work. Each member of staff was noted to have received the homes in house induction (Day 1 and 2) however we were advised by the manager that Skills for Care Inductions have not yet commenced. In addition we asked to see the managers employment records however these were not available. We are aware that it is the companys policy for all managers information to be held at the organisations head office. The manager was advised that where the decision has been made to hold records centrally, a proforma should be held on the file in the home detailing the date an application form was received, the date written references were received, confirmation that the person is fit to undertake their role and confirmation that all records have been seen. During the day all records as required by regulation were forwarded to the home and these were seen to be in order. There was no evidence of the manager having received an induction but he told us this had been undertaken by the operations manager and project manager upon commencement of his employment. We requested a copy of the staff training matrix and advised the manager this would be examined following the site visit. The manager confirmed the training matrix details show a decline in up to date training for staff. Records showed that several members of staff require refresher training in core subject areas such as fire safety awareness, food hygiene, moving and handling, COSHH (Control of Substances Hazardous to Health), health and safety and infection control. Additional training for staff needs to be considered and provided for those conditions associated with the specific needs of older people e.g. Diabetes Awareness, Parkinsons Awareness, pressure area care, nutrition, sensory impairment etc. It is of concern from discussions with the manager and a senior carer and from evidence of the staff training matrix that the majority of staff have only received a short course (2 hours) relating to Dementia awareness and challenging behaviour. The manager confirmed that it is his intention to enrol several members of staff on the ASSET Dementia course at Chelmsford College as soon as possible. The AQAA told us that in the next 12 months it is hoped that a full time independent trainer will be employed to provide Care Homes for Older People Page 30 of 41 Evidence: training to staff at Stambridge Meadows and 3 other Southern Cross Healthcare homes in the local area. National Vocational Qualification (NVQ) records provided to us by the manager show that out of 14 care/senior staff employed at the home, 5 have completed NVQ Level 2 and 2 have completed NVQ Level 3. Care Homes for Older People Page 31 of 41 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to benefit from developing management systems that will promote positive outcomes for the people who live at Stambridge Meadows. Evidence: Since the last key inspection a new manager has been appointed for Stambridge Meadows, commencing employment on 12th October 2009. From discussions with the manager he told us he has attained NVQ Level 4 in Health and Social Care and has completed an ASSET course in Dementia Care. He also stated he has 3 years experience as a deputy manager for a large 62 bedded home in Essex whose registration category included people with a formal diagnosis of Dementia. The manager was able to demonstrate a clear understanding of the ethos, aims and objectives of the service that he wishes to provide at Stambridge Meadows. The manager confirmed this as providing a professional, dedicated and quality care service to people who wish to live at Stambridge Meadows for as long as their care needs are able to be met. The manager is fully aware of the homes inconsistency Care Homes for Older People Page 32 of 41 Evidence: with compliance to meet previous regulatory requirements and the gaps in service provision. He feels that time is required to address the identified shortfalls so as to ensure they are met and improvement sustained, to strengthen and empower the existing staff team while ensuring staff feel valued and have a voice and to attend to some of the institutional care practices within the home which he has witnessed. The manager told us that since being employed at the home he has observed a more positive attitude from staff and feels that the overall feel and atmosphere within the home has changed for the better. Both care staff and people who live at the home were very complimentary about the manager stating they found him to be approachable and understanding. It was evident at the site visit that he has a good rapport and relationship with people who live there. From evidence of relatives surveys and from discussion with 2 relatives at the time of the site visit, they are very pleased to have a manager in the home who wishes to remain at Stambridge Meadows and who wants to improve and raise standards. One relative survey returned to us recorded He seems to be very happy working at the home and we feel that he is here to stay. One staff survey returned to us recorded We have a new manager and he is proving to be an asset to the team at Stambridge Meadows. A managers surgery where people who live at the home, their representatives and staff can meet individually with the manager to raise concerns or to discuss issues has not yet started. The manager told us that his door is always open and he is keen to promote an honest open culture within Stambridge Meadows. It is evident from this inspection that while there are some positives and outcomes for people are generally good in some areas, further development is required in relation to improving medication practices and procedures, ensuring information as detailed within the Statement of Purpose and Service Users Guide is reviewed, updated and is accurate, staff deployment and interactions with people in the home are improved and people have the opportunity to participate in a varied programme of social activities which provide occupation and stimulation that meets their individual needs. In addition improvement is required to ensure that staff receive appropriate training and regular supervision. Improvements to the home environment on the first floor (Dementia Unit) is required so as to ensure this meets peoples specific needs. All sections of the AQAA were completed and the document returned to us when requested. The AQAA lets us know about the changes they have made, where they still need to make improvements and how they are going to do this. The evidence to support the comments made is generally satisfactory, although some of the information does not fully concur with our findings. A copy of the staff supervision record for 2009/2010 was provided to us by the Care Homes for Older People Page 33 of 41 Evidence: manager. This showed that the majority of staff have not received regular formal supervision in line with the recommendations as detailed by the National Minimum Standards for Older Poeple. In general terms the records were seen to be good however as discussed with the manager, consideration should be given to ensuring there is a clear audit trail depicting actions agreed at the supervision, confirmation as to who is responsible for completion of the action and evidence of an outcome.The manager confirmed he was aware of the shortfall and is in the process of addressing this to meet requirements. The AQAA told us supervisions need to take more of a priority within the home. Sometimes supervisions can be pushed aside for other reasons. The organisation have several ways of monitoring the quality of the service provided at Stambridge Meadows. These include monthly Regulation 26 visits, medication audits, health and safety audits and a Key Outcome Audit that is comprehensive, detailed and based on outcome groups as detailed within the National Minimum Standards and Care Homes Regulations for Older People. The manager confirmed that a recent audit on 1st March 2010 was completed by the organisation and this concluded that the home was achieving an adequate level of compliance to meet not only the Care Homes Regulations for Older People but meeting the organisations aims and objectives. We requested records of Regulation 26 visits and noted these have not been undertaken as regularly as they should e.g. since October 2009 only 2 reports were available. Where improvements are highlighted by us at this inspection as requiring attention, it was positive to note that these have been highlighted for action within the organisations Key Outcome Audit. Minutes of resident/relatives and staff meetings were available for review and showed that the manager was actively encouraging people to comment on the home, care provided and care practice issues. The manager told us that he is hoping to conduct regular staff meetings every 6 to 8 weeks and for resident/relatives meetings to be undertaken every 3 months. The manager also told us that in February 2010 a quality assurance survey was carried out independently by internal auditors. At the time of the site visit the results of the survey had not been collated and the results forwarded to the manager. These were requested by us and prior to the completion of the inspection report the results forwarded to us via email. The results told us that overall 63.6 of people at Stambridge Meadows are very happy with the care and support they receive and 36.4 of people are quite happy. People are satisfied with the home environment, laundry arrangements and meals provided. The only negative areas related to the lack of activities and lack of staff on occasions to provide assistance. Prior to this inspection we had been advised by the home about 2 notifiable events Care Homes for Older People Page 34 of 41 Evidence: under Regulation 37. One related to a medication error by an agency member of staff and one related to an injury sustained by a resident. However at the inspection and on examination of the homes Regulation 37 notification log, we found there have been a further 8 notifications going back as far as January 2010 that we were not aware of. These related to 3 medication errors (2 of which were by an agency member of staff), 4 admissions to hospital and 2 deaths. The manager stated that all notifications were forwarded to us. Corporate health and safety policies and procedures were observed to be in place within the home. Care Homes for Older People Page 35 of 41 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 9 12 and 13 Where people are prescribed 30/04/2010 medicines on a when required basis or in variable doses there must be clear guidelines for the use of these medicines. This will ensure people receive the medicines as prescribed for them. This is a repeat requirement, previous timescale of 30/11/09 not met in full. 2 12 16(2)(m) and All people living at the home 01/06/2010 (n) must receive regular opportunities to engage in a varied programme of activities which meet their social care needs. This will ensure that people have their social care needs met. Previous timescale of 1/12/2009 not met. Care Homes for Older People Page 36 of 41 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be given to 01/04/2010 people in a hygienic manner. This will reduce the risk of contamination of medicines and cross infection. 2 9 13 Medication must be only be given to residents in accordance with prescribed instructions and any variations in prescrined instructions must only occur with the documented and prior agreement of the prescriber. This will ensure people receive their medicines as prescribed. This requirement was not met by the given timescale of 30/11/09 02/04/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines must be locked away when not in use. This will ensure they are not accesible to people they are not prescribed for. 30/04/2010 Care Homes for Older People Page 37 of 41 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 2 9 13 Records made when 30/04/2010 medicines are given to people must be accurate and complete. If medicines are omitted, the reason for the omission must be clearly recorded. This will demonstrate that people receive their medicines as prescribed and prevent people being given medicines too close together. 3 9 13 Medication must stored under suitable environmental conditions and records must be kept to evidence this. This will ensure medication used for the treatment of residents is of suitable quality. 30/04/2010 4 9 13 Medicines controlled under the Misuse of Drugs Act must be stored in accordance with the Act and associated Regulations. This will ensure compliance with legal requirements and reduce the risk of diversion. 30/05/2010 5 19 23 The home environments 30/06/2010 design and layout must ensure it meets the needs of all people in the home. This Care Homes for Older People Page 38 of 41 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 refers specifically to the Dementia Unit on the first floor. So that it meets the needs of people in the home. 6 36 18 Ensure that staff receive regular supervision and there is evidence to demonstrate this. So that staff feel supported. 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 31/05/2010 1 1 Ensure that the Statement of Purpose and Service Users Guide is reviewed and updated and information recorded within both documents is accurate. Ensure that every person who lives at the home has a completed manual handling assessment. Ensure that where people are at risk of losing weight or lose weight, there is a clear audit trail as to the rationale and interventions provided. Consideration needs to be given to improving the dining experience for people on the Dementia unit. Ensure measures are undertaken to empower people to maintain skills and abilities. Ensure that the complaints procedure is reviewed and updated to reflect the correct contact details of the Care Quality Commission and contact details of someone within Southern Cross Healthcare. Ensure that all staff receive refresher and updated training in both core and specialist subjects areas. So that staff are trained and competent to do their job. Page 39 of 41 2 3 8 8 4 5 6 15 15 16 7 30 Care Homes for Older People Care Homes for Older People Page 40 of 41 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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