Inspection on 24/06/09 for Sunnyside Rest Home

This inspection was carried out on 24th June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunnyside Rest Home 27/01/10

Sunnyside Rest Home 29/09/09

Sunnyside Rest Home 07/07/08

Sunnyside Rest Home 10/09/07

Sunnyside Rest Home 24/07/06

Sunnyside Rest Home 18/10/05

Sunnyside Rest Home 04/05/05

Sunnyside Rest Home 06/10/04

Sunnyside Rest Home 11/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sunnyside Rest Home Coupland Close Whitworth Lancashire OL12 8QQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hargreaves     Date: 2 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Sunnyside Rest Home Coupland Close Whitworth Lancashire OL12 8QQ 01706659917 01706659917 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) : Whitworth Elderly And Disabled Care Trust care home 11 Number of places (if applicable): Under 65 Over 65 11 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category 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 The maximum number of service users who can be accommodated is: 11 Date of last inspection Brief description of the care home Sunnyside is a purpose built care home situated near to the local amenities in Whitworth. The home has a small garden for residents who wish to sit outside when the weather permits. There is also a small car park for staff and visitors. Sunnyside offers 24-hour personal care for up to 11 residents. Accommodation is provided in single and twin-bedded rooms. Communal rooms include a lounge and dining room. Sunnyside is linked to a busy and thriving day care centre, which plays an active part in the close knit local community. Residents from Sunnyside are invited to participate in the activities available at the day care centre. The current fees charged at Sunnyside are £425 per week. Additional charges are payable for hairdressing and newspapers. Care Homes for Older People Page 4 of 31 Brief description of the care home A copy of the statement of purpose and service user guide is available to prospective service users and their relatives on request. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: A key or main unannounced inspection, which included a visit to the home, was conducted at Sunnyside Rest Home on 24 June 2009. As part of the inspection process we looked at all the information we have received about Sunnyside Rest Home since the last key inspection which took place on 7 July 2008. Information about the last key inspection can be obtained from Sunnyside Rest Home or www.cqc.org.uk The manager completed an annual quality assurance assessment several weeks before this visit to the home. This document is a self-assessment that focuses on how well outcomes are being met for people who use the service. It also gives us some numerical information about the service. Care Homes for Older People Page 6 of 31 Three completed surveys were returned from people using the service and three from members of staff. At the time of this visit nine people were living at the home. A tour of the premises took place and we looked at staff files and care records. We also spoke to members of staff on duty, people who use the service and visitors. Discussions also took place with manager and deputy manager regarding issues raised during the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Prompt action must be taken to improve care planning. Care plans must identify the health and personal care needs of each person using the service and provide clear directions for staff to follow in order to ensure their needs are met. To make sure members of staff have up to date information about the care needs of each person care plans and risk assessments should be reviewed monthly and must be updated when the needs of the person change. Risk assessments for nutrition and the development of pressure sores must be completed for each person using the service. This will enable a care plan to be developed explaining exactly what staff need to do in order to effectively manage any identified risks. To promote the health and wellbeing of people using the service medication must be given at the right time in relation to food. To ensure people using the service can be given their medication when they need it a member of staff qualified to administer medication should always be on duty during the Care Homes for Older People Page 8 of 31 night. When a variable dose of medication is prescribed the actual amount given should be recorded on the medication administration record. All containers of medication should be dated when they are opened. This will enable accurate checks to be made to ensure people are given their medication correctly. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. To promote the safe handling of medication a system must be put in place to regularly check all aspects of the management of medication including staff competence. To ensure all members of staff know exactly what to do if allegations of abuse are made the procedure should be amended to state the correct action they must take. To enable the manager to fulfill all her responsibilities it is strongly recommended that she is allocated more time when she is not required to provide hands on care for people using the service. The manager must inform the Care Quality Commission of all incidents that affect the health and welfare of people using the service. This enables the Commission to monitor any issues in order to ensure that they are being managed correctly. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough admission procedure ensured the health and personal care needs of people using the service were identified and met. Evidence: A copy of the statement of purpose and service user guide is available to people who are considering using the service and their relatives on request. These supply information about the care and facilities provided at the home. The manager explained that two senior members of staff visited people who were considering using the service in hospital or their own home before admission. The purpose of this visit is to assess the persons health and personal care needs to ensure these can be met at the home. We looked at the care records of a person recently admitted to the home and found Care Homes for Older People Page 11 of 31 Evidence: that they included a pre-admission assessment. This assessment provided important information for the development of their care plan. People considering using the service or their relatives received a letter confirming that their needs could be met at the home. Three people using the service completed the survey and all stated that they had received enough information about the home to help them to decide if Sunnyside was the right place for them. Care Homes for Older People Page 12 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 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 were cared for in a manner which promoted their privacy and dignity. Deficiencies in care planning and the management of medication could affect the wellbeing of some people. Evidence: We looked at the care plans of three people who use the service. These plans identified some health and personal care needs and provided directions for staff to follow to ensure their individual needs were met. One care plan explained what staff needed to do to help one person settle back to sleep if they woke up during the night. Another care plan advised staff that one person preferred to have a shower and enjoyed having their hair washed. However, it was clear from one of these care plans that the person was at risk of falling and had fallen several times since admission to the home. Moreover, a care plan explaining exactly what staff needed to do in order to manage this problem and help prevent falls was not in place. Although risk assessments for falls were included in the Care Homes for Older People Page 13 of 31 Evidence: three files we inspected only one of them was reviewed monthly and one had not been reviewed for more than six months. Reviewing risk assessments relating to falls every month ensures all members of staff have up to date information about the risk each person using the service has of falling so that this problem can be managed effectively. There was no evidence to suggest that care plans were routinely reviewed every month to check that they were up to date. In fact some of the care plans had not been reviewed since they written more than six months ago. Moreover, the care plan for one person had not been updated following a stay in hospital. This meant staff might not know what to do if this person experienced further problems which required urgent treatment. Risk assessments for nutrition were available in only two of the care plans we inspected and one of these was undated making it impossible to determine if the information was up to date. A risk assessment relating to the development of pressure sores was seen in only one of these files. Carrying out risk assessments enables the risks of the development of pressure sores and poor nutrition to be identified. Measures can then be put in place to make sure any identified risks are managed correctly to help prevent pressure sore formation and malnutrition. Despite these shortfalls with care planning discussion with people using the service and their relatives confirmed that they were happy with the care provided. One person said, Its a wonderful place. Another person said, Im very happy and wouldnt like to be anywhere else. The three people using the service who completed the survey indicated that they always received the care and support they needed. There was very little evidence to suggest that the person using the service or their relatives were involved in care planning. One person using the service had signed their falls risk assessment to indicate their agreement with it. However, the relative of one person said, I can see the care plan anytime I want but I dont need to see it, I trust them. A report about the care given to each person using the service was written during each shift. This ensured that all staff had up to date information about the condition of each person in order to ensure continuity of their care. There were records of the involvement of GPs and other healthcare professionals including the chiropodist and district nurse in the care of people who use the service. Medication was stored correctly and administered by members of staff who had been Care Homes for Older People Page 14 of 31 Evidence: trained in the management of medication. To ensure medication was managed correctly and to prevent mishandling appropriate records were in place. These included a record of all the medication received into the home and a record of medication returned to the pharmacist for disposal. We checked a sample of medication records and stock but found it difficult to account for some medication. This was because when a variable dose of medication was prescribed, for example one or two tablets, the amount actually given to the person was not recorded. Keeping detailed and accurate records help prevent the mishandling of medication. Some packets of medication were not dated when they were opened. This also enables medication to be accurately checked to ensure it is being given correctly to people using the service. One person was prescribed a tranquiliser to be given at night and when required. However, there were no written instructions for staff to follow about the signs of agitation this person might display when they needed this medication. Having clear written instructions for the administration of when required medication ensures people are given their medication only when they need it. It is of concern that only one member of staff who worked night shifts was qualified to administer medication. The manager explained that night staff are not responsible for the administration of medication. However, we were told that one person had got up earlier than usual on the day of this visit and had been given breakfast by the night staff. This meant they had not received their medication until after breakfast when someone qualified to administer medication was on duty. The medication administration record stated that this medication should be taken half an hour before food. Giving medication at the wrong time in relation to food can seriously affect their health and wellbeing. Another person was prescribed medication to be taken once a week half an hour before breakfast. This person liked to get up before 8am. The manager explained that for two out of three weeks the member the night staff qualified to administer medication was on duty. This meant that every third week this person had to wait until the day staff came on duty for their medication and then a further thirty minutes to have breakfast. Action should be taken to ensure that a member of staff qualified to administer medication is always on duty so that people using the service do not have to wait until the day staff come on duty before they can have their medication. There was no evidence to suggest that the manager or a senior member of staff checked the medication to ensure this was being managed correctly. The manager was advised to develop a system for regularly auditing all aspects of the management of Care Homes for Older People Page 15 of 31 Evidence: medication including staff competence. Personal care was carried out in the privacy of the persons own room or the bathroom. Members of staff were observed attending to people in a polite and friendly manner. One visitor said, They treat mum as a proper person. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples choices were respected and they were supported by members of staff to have a fulfilling lifestyle. Meals were wholesome and appetising and people enjoyed them. Evidence: People using the service were encouraged to continue with their own interests and hobbies. One person liked to stay in their room and listen to music or watch television, one person liked doing puzzles and another person enjoyed reading. One person said she went to Church every Sunday and also attended some of the Church weekday activities. Two people regularly went to the adjoining day care centre to join in the activities they organised. One person said she enjoyed the craft activities and the sing alongs they had at the day centre. Discussion with people using the service and members of staff confirmed that a variety of activities were also organised in the home. One member of staff was responsible for organising activities which included, quizzes, reminiscence, bingo, crafts and movement to music every fortnight. Several people said they were looking forward to the trip out to Hollingworth Lake. A Church group visited the home every month for a prayer meeting. A local Vicar also visited monthly and offered communion to people who wished to practice their faith in that way. Two of the three people who completed the survey stated that there were always Care Homes for Older People Page 17 of 31 Evidence: activities they could take part in. People using the service and members of staff said that visitors were welcomed into the home at any time and offered refreshments. One visitor said, Its a lovely family home and we can visit anytime. The daily routine was flexible in order to meet the needs and preferences of people using the service. All the people asked said they could choose when to get up and go to bed. One person said, I just say when I want to go to bed and I can get up when I want as well. The meal served at lunchtime looked wholesome and appetising. Although a choice of meal was not offered we were told that alternatives were readily available to cater for peoples individual likes and dislikes. Lunch was unhurried allowing people to chat and enjoy their meal. All the people asked said the meals were good. One person said, The foods worth being here for. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were taken seriously and investigated. Members of staff had the training necessary to ensure people who use the service were protected from abuse. Evidence: A copy of the complaints procedure was included in the statement of purpose and service user guide. The three members of staff who completed the survey indicated that they knew what to do if a person using the service or their relatives expressed any concerns to them. The manager has investigated two complaints since the last inspection neither of these was upheld. One anonymous complaint was made to the Commission within the last few weeks. The issues raised related to the National Minimum Standards we looked at during this visit and have been included in this report as part of the inspection. Although policies and procedures for safeguarding vulnerable adults were in place these did not clearly state the action to be taken if allegations of abuse were made. The manager was advised to amend this procedure to ensure all members of knew the correct action to take if allegations of abuse were made to them. Discussion with two members of staff confirmed that they had received training in safeguarding vulnerable adults. They both said they would report any concerns to the manager immediately. Care Homes for Older People Page 19 of 31 Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises provided a comfortable and homely environment for people who use the service. Evidence: A tour of the premises confirmed that the home was clean, tidy and well maintained. This provided a homely and comfortable environment for people using the service. Two of the people who completed the survey stated that the home was always clean and fresh. People using the service were encouraged to bring personal items for their bedrooms to make them more homely. These included, ornaments, photographs and pictures for the walls. To improve the premises for people using the service new laminate flooring has been fitted in the corridor and bedrooms. One of the bathrooms has been converted into a wet room so that people can choose to have a shower if they want. Three new adjustable electric beds have been purchased to make people more comfortable if they need to spend time resting in bed. The grounds and gardens were well kept and accessible to people using the service if Care Homes for Older People Page 21 of 31 Evidence: they wished to sit outside when the weather permitted. All the laundry was done at the home. Laundry facilities have improved with the purchase of a new washing machine and dryer. This ensures clothes are washed promptly and returned to people using the service. Gloves and plastic aprons were available throughout the home for members of staff to use in order to protect themselves and people using the service from infection. However, paper towels were not available in the staff toilet and a terry hand towel had been put in this room. Using a communal towel increases the risk of spreading infection from one person to another. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Members of staff are encouraged to acquire the skills and knowledge necessary in order to meet the needs of people using the service. Evidence: The duty rota provided details about the grades and number of staff on duty for each shift. Three members of staff completed the survey and in answer to the question are there enough staff on duty to meet the individual needs of people who use the service two stated always and one usually. The three people using the service who completed the survey all indicated that there was always staff available when needed. One person wrote on the survey, Staff are always willing, ready and able to help. We looked at the files of three members of staff appointed since the last inspection. These files indicated that all the required information had been obtained before these members of staff had started working at the home. These included two written references and a Criminal Records Bureau check. Although the references were not dated the manager said they were received before the applicant had started working at the home. The manager was advised to amend the reference request form to include the date on which the reference was written, the signature of person writing the reference and their relationship to the applicant. Care Homes for Older People Page 23 of 31 Evidence: Discussion with the manager and members of staff confirmed that training for all members of staff was encouraged. This included induction training for new employees, moving and handling, basic food hygiene, first aid, safeguarding vulnerable adults and fire awareness. In addition to this half of the care workers had National Vocational Qualifications (NVQ) at level 2 or above in health and social care. Five care workers were doing NVQ level 2, two level 3, two level 4 and one senior care worker was doing the team leaders training. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people using the service are considered when decisions about the care and facilities provided at the home are made. A lack of thorough management procedures in some areas could put people using the service at risk. Evidence: The manager has several years experience of caring for older people. She keeps up to date with current practice by attending relevant training, reading care journals and using the internet. According to the Annual Quality Assurance Assessment a number of people using the service have been treated in the accident and emergency department at the local hospital. However, the Care Quality Commission has not been notified of any incidents which necessitated such treatment. It is the managers responsibility to ensure we are informed of all incidents that affect the health and welfare of people using the service so that we know these issues are being managed correctly. It is also the managers Care Homes for Older People Page 25 of 31 Evidence: responsibility to make sure that appropriate risk assessments are in place, care plans identify and address the health and personal care needs of people using the service and are up dated when the needs of a person change. The manager explained that it was difficult for her to complete all the management responsibilities when for almost all of her shifts she is providing hands on care for people using the service. It is strongly recommended that the manager is allowed additional supernumerary time to allow her to fully meet the requirements of her role as registered manager. This would ensure the manager had time for checking that care plans were kept up to date and medication was managed correctly. Discussion with the manager confirmed that she was committed to running the home in the best interests of the people living there and had achieved the nationally accredited Investors in People Award. The people using the service and their relatives were asked to give their views about the home by regularly completing anonymous satisfaction questionnaires. The manager said she had an open door policy and welcomed feedback from people using the service and their relatives at anytime. A newsletter, which provided information about the home and details of forthcoming events was produced every three months for people using the service and their relatives. The Annual Quality Assurance Assessment stated that as a result of listening to the views of people using the service they had included a wider choice of food for the evening meal. A member of staff had also been assigned to organise leisure activities within the home. Several people using the service had a small amount of money kept at the home to pay for hairdressing, chiropody and other personal needs. To ensure this was managed safely records of all transactions were kept. We checked one of these during the visit and found the records to be up to date and accurate. Policies and procedures for safe working practices were in place. These help to make sure the home is a safe place to live and work. Fire alarms and emergency lighting were tested regularly. An up to date fire risk assessment was in place and fire drills took place regularly. We looked at the records of routine servicing of equipment. These included up to date gas safety and electrical installation certificates and evidence that the testing of small electrical appliances was carried out annually. Care Homes for Older People Page 26 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(1) To ensure the care needs of 29/08/2008 residents are met. Care plans must accurately identify and address all the care needs of each resident. 24/06/05, 30/12/05, 01/09/06 and 26/10/07 not met. 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 7 15 Care plans must accurately identify and address all the care needs of each person using the service. Care plans must also be updated when the needs of the needs of a person using the service change. This will ensure that all the nurses and care workers will know what they need to do in order to meet the needs of each person using the service. 25/09/2009 2 8 13 Risk assessments for falls, 25/09/2009 nutrition and the development of pressure sores must be completed for each person using the service. This will ensure that risks are identified and effectively managed. 3 9 13 Medicines must be given to people at the right time in relation to food. 07/08/2009 Care Homes for Older People Page 28 of 31 Receiving medicines at the wrong time can affect the health and wellbeing of people using the service. 4 9 24 A system must be put in place to regularly audit all aspects of the management of medication including staff competence. This will ensure medication is managed safely. 5 38 37 The registered manager must ensure that the Commission is notified of all occurrences listed under regulation 37 of the Care Homes Regulations 2001. This will enable the Commission to monitor any issues in order to ensure that they are being managed correctly. 14/08/2009 25/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 All care plans and risk assessments should be reviewed monthly in order to ensure the information they contain is up to date. To ensure people using the service can be given their medication when they need it and at the correct time in relation to breakfast a member of staff qualified to administer medication should always be on duty. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. When a variable dose of medication is prescribed the actual Page 29 of 31 2 8 3 9 4 9 Care Homes for Older People amount given should be recorded on the medication administration record. All containers of medication should be dated when they are opened. This will ensure medication is managed correctly and enable accurate checks to be made. 5 18 The procedure for safeguarding vulnerable adults should be amended to clearly state the correct action that staff must take if allegations of abuse are made.` Paper towels should be made available in communal toilets. This will help to prevent the spread of infection from one person to another. The registered manager should make sure robust systems are in place so that people using the service are not put at risk. It is strongly recommended that the manager is allocated supernumerary time in order to effectively fulfill all managerial responsibilities. 6 26 7 31 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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