Inspection on 07/08/09 for Strawberry Bank

This inspection was carried out on 7th August 2009.

CQC found this care home to be providing an Poor 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Strawberry Bank 04/02/10

Strawberry Bank 17/09/09

Strawberry Bank 08/07/09

Strawberry Bank 16/01/09

Strawberry Bank 24/01/08

Strawberry Bank 26/09/07

Strawberry Bank 15/05/07

Strawberry Bank 04/07/06

Strawberry Bank 19/10/05

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Hawkhills

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Ravensworth Lodge

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

Key inspection report Care homes for older people Name: Address: Strawberry Bank 17 Strawberry Bank Liversedge West Yorkshire WF15 6JT     The quality rating for this care home is:   zero star poor 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: Lynda Jones     Date: 0 7 0 8 2 0 0 9 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 31 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Strawberry Bank 17 Strawberry Bank Liversedge West Yorkshire WF15 6JT 01924410471 01924405070 info@strawberrybankcarehome.co.uk www.strawberrybankcarehome.co.uk Prince Edward Anojan Joseph care home 24 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) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To complete Schedule 1 of the Fire Safety Officers report To forward a Statement of Purpose and Service User Guide within three months of becoming the registered provider. Date of last inspection Brief description of the care home Strawberry Bank provides personal care and support for 24 older people. The home is located at the head of a quiet cul-de-sac, off the main Halifax road into Liversedge. Accommodation is on three floors, with a lounge, and a dining area on the middle floor. A passenger lift serves all floors. There is a mixture of both single and shared bedrooms. There is also a patio to the rear of the property, where people can sit out in the warmer months of the year. In addition to the weekly fee there are additional charges for hairdressing, newspapers, and magazines. Information about the home and the services provided is available from the home in the statement of purpose and service user guide 0 9 0 2 2 0 0 9 0 Over 65 24 Care Homes for Older People Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out to assess the quality of care provided to people living at the home. The last key inspection took place on 9 February 2009 when the service was rated zero star poor service.This means the people who use this service experience poor quality outcomes. Since then we have carried out two unannounced visits to the home because of serious concerns that have been brought to our attention. The first visit took place in March 2009 because we were concerned that the home was not adequately staffed to meet the needs of people living there and it was alleged that there were insufficient funds to purchase food and cleaning materials. The second visit took place in July 2009 because we were concerned about the health and safety of the people living there. Also because Strawberry Bank had been placed in receivership and Administrators from The P & A Partnership in Sheffield had been appointed. Care Homes for Older People Page 5 of 31 Two inspectors visited the home unannounced. This visit lasted over seven hours and included talking the management company, who have been appointed by the receivers to advise upon the day to day management of the home, and the staff about their work and the training they have completed, and checking some of the records, policies and procedures the home has to keep. The registered manager was not present during our visit to the home. We focused on the key standards and what the outcomes are for people living in the home, as well as matters, which were raised at the last inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. At both visits we made requirements were made for the home to be improved. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The management of the home needs to be improved so that staff have a clear sense of leadership and direction to follow. The care plans need to be improved.They lack detail, they are not up to date and they do not give accurate information about the action staff need to take. This means that people may not be receiving the care and support that they need. More care must be taken to ensure that peoples dietary needs are being met. Some people have lost weight but there are no plans in place to ensure that people are receiving the nourishment that they need. People are not always receiving the healthcare that they require. There is no evidence that people are routinely seeing dentists, opticians and chiropodists. Out patient appointments have been missed because staff failed to make escort arrangements. Moving and handling plans are not up to date, this means people could be placed at risk of accident and injury. The home has not been well maintained and is in need of redecoration, repair and refurbishement in several areas. This work needs to be carried out so that it is a comfortable and pleasant place for people to live in. The recruitement procedure must be improved to ensure that new staff do not start work at the home until all of the appropriate checks have been carried out. In addition all of the staff must undertake training about their role in safeguarding people who live Care Homes for Older People Page 7 of 31 at the home. Both of these measures will help to protect people and keep them safe. Staff need better training oppotunities to keep their care practice up to date and to ensure that they provide care and support for people in a safe way. A number of health and safety concerns have been identified. These need to be prioritised and actioned in a timely way so that people are not placed at risk. 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Strawberry bank does not have the necessary staff skills and equipment to meet peoples needs. Evidence: We know from previous inspections that a statement of purpose and service user guide are available on request from the home. These documents give people some information about the facilities and the that can be service provided. We did not look at these documents on this visit. We have asked the provider to agree not to admit people to Strawberry Bank due to our concern that any further admissions will have a detrimental affect on the quality of the care provided at the home. The local authority has also stopped referrals to the home. Care Homes for Older People Page 10 of 31 Evidence: Some people who use the service have specialist needs such as dementia care, pressure area care needs, bowel care management and can be nutritionally at risk. The staff have not been trained properly to meet peoples specialist needs. Records did not show how peoples needs had been assessed in the past. The home does not provide intermediate care. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples healthcare and personal support needs are not being met. Evidence: We looked at a selection of care plans because we wanted to see what individual needs had been identified and what action staff are expected to take to meet these needs. Overall, the plans are poor and lack detail, they do not contain up to date information about the care and support that people require. This means that peoples health could be placed at risk because they may not be receiving the care that they need. We looked at the records because we wanted to know whether people had access to community based health care providers. We could not find any evidence of people routinely seeing opticians, dentists and chiropodists on the records we looked at. On two care plans there were no records of contact with a dentist or optician and the last recorded contact with a chiropodist on both plans was in April 2009. Care Homes for Older People Page 12 of 31 Evidence: People are at risk of malnourishment because there are no nutritonal plans in place when weight loss is identified. The weight records we looked at told us that three people had lost between 4 and 5 kgs in weight over a four month period but the nutritional screening tools for the same people stated that there had been no weight change. We observed two of these people being assisted with their meals. One person could manage to eat with prompting and encouragement from staff, the second person needed help. There was nothing in the care plan about this. We noted that one person had been prescribed Thick and Easy thickening powder to be added to be added to food and drinks. We could not find any evidence of this being administered and there was no reference to the use of this in the care plan. When we asked staff about this they told us it had been used, but as this person was now eating better with assistance, the Thick and Easy was no longer required. There was nothing recorded in the care plan to indicate this. According to the care plans, two of the people mentioned above needed to be weighed weekly but this was not being done. A visiting nurse had left written instructions for food and fluid intake charts to be completed for one person but there was no evidence to show that these had been started. According to the daily records, in July a member of staff informed a visiting GP of concerns about the poor appetite of one person who was losing weight but the nutritonal screening tool for the same month states eating normally and the records indicate that this person was at low risk of malnourishment. Peoples healthcare needs are not being met because they are always not being supported to attend important hospital out patient appointments. A note in the office diary informed staff that one person needed to attend an appointment. We could find no reference to this in the daily records and there was no information in the care plan about the outcome of the consultation. We looked at a letter from the hospital consultant that had been left on the office desk, the letter confirmed that the appointment had been missed and stated it is important that you attend the clinic at regular intervals. Moving and handling plans are not always up to date, this places people at risk of accident and injury. One plan written in April 2009 told us about one individual who walks using a zimmer frame and requires supervision from one member of care staff. When we asked staff about this they told us that this person could take a few steps using a zimmer frame but now needed a wheelchair to transfer from one room to another. The plan had not been updated to show that there had been a change in mobility. When we asked staff about this they said that what was in the care plan did not reflect the support this person required. Care Homes for Older People Page 13 of 31 Evidence: Another plan, also written in April 2009 indicated that one person was at medium risk of falls. A line had been added to the plan in May 2009 stating that this person was now at high risk of falls. There was no information in the plan to suggest why the risk of falls had increased and only a note advising staff to be aware of this persons wherabouts at all times. We know from the daily records that this individual has had a number of falls and we asked to look at the accident records to gather more information about when and where the falls were happening. Staff were only able to locate two reports which were about accidents that had occured in the two previous weeks, no others could be found. The staff on duty did not know what happened to the accident records once they had completed them. Accident records are important, they should be used to analyse the pattern of falls and consider whether any preventative measures can be put in place to reduce the risk of further accidents. The daily records do not reflect the care and support that the staff provide to each person on a day to day basis. Some of the records are brief and repetitive, they do not give a flavour of the life that people lead and they do not show how peoples needs are being met. For example, these are some of the entries we looked at in the daily records bath, hair washed, teeth cleaned, eaten well and glasses cleaned, washed and dressed, listened to music. The staff are kind and caring, they know people well and they try to ensure that people spend their time how they want to. They tend to pass information about peoples needs on to each other verbally. The plans are not up to date and they do not give an accurate picture of the support that people need. If the regular staff at Strawberry Bank were unable to work and agency staff had to work at the home it would be impossible for them to provide care and support with any consistency based on what is recorded in the care plans. The staff now have more time to spend with people and we noticed an improvement in peoples appearance on this visit to the home. People looked much better cared for. We looked at a sample of medication administration records. The records show that medication is entered on the medication administration records correctly when it is delivered to the home and staff are signing to show that people are getting their medication at the correct time. We were informed that there is to be a training session for staff on medication administration on 19 August 2009. If regular agency staff are to be working in the home and admininistering medication, it would be good practice to add their signature to be added to the specimen Care Homes for Older People Page 14 of 31 Evidence: signatures held at the front of the medication administration records. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff have plenty of contact with people and they respect their preferred routines. Evidence: We talked to staff about peoples likes and dislikes and about their preferred daily routines. It is clear that they know people well; they know how they like things to be done, how they like to spend their time, they know what people like to eat and they also know about their family members. Although this information is known to staff it is not necessarily in the care plans. Judging from the good humoured exchanges of conversation we observed between people living at the home and the staff, everyone appears get on well together. One person told us the the staff are lovely. The staff were in evidence in the lounge, assisting and talking to people throughout the day.This is a significant improvement on our findings at the last inspection which took place in February 2009. We noticed that two people who do not speak greeted the staff with big smiles and were clearly pleased to see them. During the morning most people took part in a lively quiz which everyone seemed to enjoy. People were asked if they wanted to join in, some people decided not to and Care Homes for Older People Page 16 of 31 Evidence: the staff respected their decision. There are some people living at the home who do not have the capacity to take part in a quiz, staff need to make sure that activities are available that suit everyones preferences and capacity.Throughout the visit the atmosphere was relaxed and people were friendly. Mid-morning people were asked if they wanted a hot drink of milky coffee or tea. A CD was playing songs that people knew the words to and an impromptu sing a long took place. People tell us that they enjoy all the meals that are provided. One person said I like the food here They said the kitchen staff are good and we get good meals here. We talked to the cook on duty. She was very familiar with peoples likes and dislikes and knew what size portion people preferred. She gave us details of the special diets people require. In the past we have raised concerns about the shortage of food supplies. We talked to staff and checked the food store and freezer and found ample food in stock. Staff told us that this is no longer an issue because regular supplies have now been arranged. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not being properly protected because the staff have not received appropriate training about their responsibility to make sure that people are safe. Evidence: According to the records we looked at, the last time the home received a complaint was in August 2008. This was from a relative and was about the appearance of her family member living at the home. The records do not give details of how this was investigated and we do not know if the complainant was satisfied with the outcome. The complaints log needs to be improved to include details of investigation and any action taken in respect of any future complaints made to the home. Since the last key inspection we have made three safeguarding referrals to the Local Authority because of concerns about the welfare of people living at the home. We have recently been advised that fourteen staff have not received any training about their responsibility to safeguard people in their care. The remaining twelve staff received their training between 2005 and 2008 and they must now undertake refresher training to ensure that they are aware of their duty to protect people. We have been informed that plans are underway to provide this training but we do not have any information about when this will take place. Care Homes for Older People Page 18 of 31 Evidence: Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are living in a poorly maintained home. Many areas require redecoration and refurbishment to improve the facilities. Evidence: The home has not been well maintained in recent years. The road leading up to the home is full of deep holes; it would be extremely hazardous for anyone to negotiate this area if they left the home unaccompanied. The lack of care and investment in the property indicates a lack of respect for the people living there. Work that was once started on an extension to the home was never completed and parts of the outside resemble a building site. Some of the bedrooms overlook the bare breezeblock, part built walls, that have been left unfinished. Inside the home, the decor is in need of attention in bedrooms and shared areas and some of the furniture and fittings need replacing. The carpet in the lounge is stained and the chairs are stained and worn. On a positive note, there is evidence that people have their own possessions around them and it is clear efforts have been made to personalise bedrooms. In addition, we found the home much cleaner on this visit than on the last one. Care Homes for Older People Page 20 of 31 Evidence: Some serious concerns have been brought to our attention in the last month by the management company appointed to advise the Administrators. These include the high temperature of the hot water at various taps within the home and inadequate ventilation to the boiler which provides the homes heating supply. We have been kept informed about the work required to resolve these issues and to ensure that peoples health and safety is not placed at further risk. We have been assured that all of the required work on the boiler room ventilation has been completed and work has also been completed to ensure that hot water temperatures are now within safe limits. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are put at risk because of poor recruitment practices and staff receiving insufficient training. Evidence: Since the home went into administration there has been an improvement in the staffing levels at the home. We looked at the staff rota and we could see that there are now additional staff on duty at all times of the day and night to meet the needs of people living there. Staff were present in the lounge during the day and they had time to talk to people. In this report we have already commented on the improvements that this has brought about in terms of the amount of time that staff are now able to spend with people. An audit of staff files that has recently been carried out revealed that two people recently appointed had started work at the home before they had been appropriately checked. Both staff have since been suspended pending satisfactory checks. The audit also revealed that some of the CRB (Criminal Records Bureau) checks held on staff files had either not been carried out on behalf of Strawberry Bank (two checks) or that the CRB checks were in some cases up to six years old. Plans are now in place for CRBs to be renewed that are more than three years old. These checks are Care Homes for Older People Page 22 of 31 Evidence: carried out to make sure that people living at the home are safe and that staff are suitable to carry out work with potentially vulnerable individuals. The audit of staff files also included a check on all of the mandatory training that staff must undertake to keep their care practice up to date and to make sure that people living at the home are cared for in a safe manner. This has also revealed that there are shortfalls in areas of training such as moving and handling, health and safety, fire safety, infection control and medication administration that must be addressed. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not being managed properly and is not being run in the best interests of people living there. Evidence: In June 2009 the home went into administration and the administrators P and J partnership were appointed as the receivers. They have appointed a management company to advise on the management of the home. The registered manager continues to work at the home alongside the management company. Although we can see the receivers and the management company are working to improve the outcomes for people at Strawberry Bank and they have found and reported to us their conerns to us such as inadequate ventilation to the boiler room; fire safety and fire protection issues; unregulated hot water supplies within the home; a fault with the operation of the passenger lift; poor staff recruitment procedures; shortfalls in areas of staff training; failure to service equipment that is in use in the home and general maintenance issues. All of these matters mean that the health and Care Homes for Older People Page 24 of 31 Evidence: safety of people living at the home has been placed at risk. The home is not well managed. Staff are not receiving appropriate training, supervision and development opportunities and the team lacks leadership. The registered provider has not been sufficiently involved in the business in recent months and there has been no evidence of any strategic planning. The registered provider has not made any arrangements to conduct monthly visits and report on the conduct of the home. These visits must take place take place to check that the home is being managed properly and is being run in the best interests of the people living there. We were informed that the home holds small amounts of money on behalf of some people for safekeeping. If any purchases are made on behalf of anyone, a receipt is always obtained, numbered and attached to the relevant persons personal money record. When we carried out this inspection we could not find any evidence of any current Employers Liability Insurance. The last certificate of insurance that was available expired in June 2009. Staff have only a limited understanding of the accident reporting procedure. We found evidence in the daily records of people having accidents but we were unable to locate the accident reports. We could find no evidence of any quality assurance monitoring, this means that people who use the service and their families are not being asked for their views on the way the home is being run and whether it can be improved in any way. The outcomes from this report and information we have received show us that we continue to have serious concerns about the day to day management of the home and the lack of clarity of lines of management. Care Homes for Older People Page 25 of 31 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 Care plans and risk assessments must be kept up to date and reviewed regularly. This is an outstanding requirement from 24 January 2008. This is to make sure that people receive the care and support they require. 20/03/2009 2 7 15 Care plans must be in place that address peoples ongoing health care needs. This will make sure they get the treatment they need. 20/03/2009 3 8 12 People must be weighed regularly and nutritional assessments and food and fluid intake must be monitored regularly. This is an outstanding requirement from 24 january 2008. This is to prevent the risk of people being malnourished. 20/03/2009 4 18 13 Staff must receive appropriate training to ensure that they are aware of their responsibility to safeguard people in their care. To ensure that people using the service are safe and 20/03/2009 Care Homes for Older People Page 26 of 31 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 protected from abuse. 5 33 26 Arrangements must be made 20/03/2009 to carry out monthly visits to the home and make monthly reports available about the conduct of the home. To ensure the home is being run in the best interests of the people living there. 6 38 8 All of the equipment used in the home must be serviced and in good working order In order that peoples health and safety is not placed at risk. 31/07/2009 Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 A redecoration and refurbishment plan must be put in place with clear timescales for work to be carried out. A copy of the plan must be sent to the Commission by 30/9/2009. This will make sure the home is brought up to standard. 30/09/2009 2 29 19 All staff must be 07/09/2009 appropriately checked before they start work at the home. To ensure that staff are suitable and that people living at the home are safe. 3 30 18 All staff must receive 30/09/2009 training which is appropriate to the work they are to perform. Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that staff are competent and trained to care for peole in a safe manner. 4 33 24 A quality assurance system must be established to seek the views of people who use the service. This will give people the opportunity to comment on the service provided and say if it could be improved in any way. 5 34 25 The correct and current Certificate of Employers Liability Insurance must be in place and a copy sent to the Commission. 19/08/2009 30/09/2009 This is to cover legal liabilities to employees, people living at the home and third parties. 6 36 18 Arrangements must be in place to ensure that staff are appropriately supervised. To identify training needs, monitor care practice and provide staff with support 7 37 17 The homes records and policies and procedures must be kept up to date. 30/09/2009 30/09/2009 Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To safeguard peoples rights and best interests. 8 38 17 A record must be kept of all accidents that occur in the home. To monitor when and where accidents are taking place and put in place preventative action 9 38 13 A plan must be in place with clear timescales to address the health and safety issues that have been identified. A copy must be sent to the Commission by 30/9/2009. To protect and promote the health and safety of people living at the home. 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 07/09/2009 30/09/2009 1 2 3 9 12 16 Specimen signatures should be available in respect of all staff who administer medication. Staff need to ensure that activities are available that match the capacities of everyone living in the home. The complaints log should be improved so that details of any investigation and outcome can be recorded. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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