Inspection on 05/05/09 for Swarthmore

This inspection was carried out on 5th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swarthmore 17/05/07

Swarthmore 13/02/06

Swarthmore 27/09/05

Swarthmore 02/03/05

Swarthmore 08/09/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Swarthmore Marsham Lane Gerrards Cross Bucks SL9 8HB     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: Chris Schwarz     Date: 0 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Swarthmore Marsham Lane Gerrards Cross Bucks SL9 8HB 01753885663 01753891645 carehome@swarthmore.co.uk 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) : Swarthmore Housing Society Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 40 The registered person may provide the following category of service only; Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Swarthmore is situated in Gerrards Cross, Buckinghamshire. The service was opened in 1947 and was founded by members of the Religious Society of Friends (Quakers). It was originally opened for the accommodation of members of the Society of Friends, however it happily accepts non-Quakers. Swarthmore is registered for 40 older people. Service users are accommodated in single rooms or in one of four flats for more independent people. There is a range of communal rooms including a quiet room/library. Care Homes for Older People Page 4 of 30 Brief description of the care home There are two passenger lifts which permit access to all levels of the building. There are grab rails in toilets, bathrooms and bedrooms. There is also hoisting equipment to facilitate safe moving and handling practice and a call bell system is in place. Swarthmore is situated close to all local amenities such as shops, pubs, a library and cinema. Service users are able to access such amenities on foot, by car or use of the local bus service. The service has a local doctors practice with the support of a district nurse team if needed. Service users are actively encouraged to use the services of a doctor of their choice. Other healthcare services are also available by way of a referral through the doctor; such services include physiotherapists, occupational therapists and podiatry. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day by Chris Schwarz and covered all of the key National Minimum Standards for older people. The last key inspection of the service took place on 17th May 2007. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion and surveys were sent to a selection of people living at the service, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records, Care Homes for Older People Page 6 of 30 observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. An immediate requirement was issued on the day regarding recruitment practice, which was placing vulnerable people at risk of harm through insufficient checks and clearances. The provider was written to on the 6th May 2009 to confirm the concerns. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? What they could do better: Any documentation which refers to the regulator for the service, such as the statement of purpose, brochure, complaints procedure etc needs to be updated to reflect that this function is now carried out by the Care Quality Commission and include the national contact details when these are circulated to the service. Items of value such as service users money should not be stored in medication Care Homes for Older People Page 8 of 30 cabinets as this is not an appropriate practice. A copy of the Buckinghamshire County Council inter agency safeguarding procedures needs to be obtained for the service and made available to the staff team. Recruitment practice needs to be improved through ensuring that all required checks are obtained and are satisfactory before staff start working at the service. The application form needs to be improved by asking for a full working history since leaving full time education, in order that there is a complete and accurate account of peoples backgrounds. Health and safety needs to me improved with evidence of a gas safety certificate or servicing for all gas appliances. This is to ensure that appliances are safe for use. A risk assessment of the premises needs to be conducted and action taken to reduce risks were there are issues. This needs to include the safety of uncovered radiators, to make sure that people are kept safe. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are thoroughly assessed prior to admission and are given opportunity to visit beforehand to ensure it meets their needs. They have a range of information available to them giving them an idea of what to expect of the service and outlining what it can and cannot provide. Evidence: A brochure, statement of purpose and general terms and conditions documents were available to look at during the inspection. Collectively they provided a good range of information about what people could expect from living at Swarthmore. They also set out any exclusions, such a provision of nursing care, and made clear what was included in the fees and additional costs such as toiletries and private health care services. The range of fees at the time of this visit was from £582 to £707 per week. Respite care beds, when available, were £101 per night. In feedback to the manager, it was pointed out that references to the regulator for the service would need to be Care Homes for Older People Page 11 of 30 Evidence: updated from National Care Standards Commission and Commission for Social Care Inspection to the Care Quality Commission. She was advised to wait until new national contact details are circulated to all services later in the year, to avoid unnecessary costs. A sentence in the brochure stating that the National Care Standards Commission inspects the service twice a year needs to be removed as this is inaccurate. Pre-admission assessments of some recently admitted people were looked at. Each had been completed by the Head of Care and signed and dated by her. Brief medical history was noted in each case plus areas such as an outline of the persons emotional state, their sleeping routine, personal dressing, breathing, mobility, eating and drinking, elimination, vision, hearing, communication needs, a brief personal history, orientation and maximising contentment. Their personal details such as name, date of birth, nationality, religion, previous address, doctor and known allergies were noted. People using the service said in surveys that they had enough information before they moved in and that they received a contract. One person added I spent a week here beforehand. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and religious or cultural requirements and ensuring that they receive medication in a safe and consistent manner. Evidence: Care plans were in place for each person living at the service with evidence of regular reviewing to update needs. Assessments for moving and handling, risk of malnutrition and risk of developing pressure damage were seen plus records of peoples weight and medical appointments or visits. A computerised care planning system which mirrors the existing paper system had been developed and was waiting to be considered for use by management. People using the service said in surveys that they always receive the support they needed, including medical support. Additional comments included this home is excellent in all respects and I am generally satisfied after over three years. Four Care Homes for Older People Page 13 of 30 Evidence: health care professionals returned surveys. They said the service always seeks advice and acts upon it to manage or improve peoples health care needs. They considered that the service was meeting peoples individual needs, including those arising from equality and diversity, and that there was good regard for peoples privacy and dignity. They said medication was managed well. One added at present I am fairly satisfied with the care they provide to clients. One said it makes patients feel it is their home now. Majority of patients are very happy there. In response to a question about what the service does well, a doctor said excellent care and empathy all round, treating the residents with full dignity. A community nurse said the service encourages independence and looks after them well. Respects their dignity. One person said it could improve by notifying them sooner of certain accidents or wounds that they find have been there for a while. A medication policy was in place to provide guidance to staff on safe practice. Some people were managing their own medication and risk assessments were in place for this, reviewed regularly. A monitored dose system of medication administration was being used at the service. On the day of this visit, only senior staff were seen handling the keys and giving out medicines. Storage of medicines was secure and records in good order. A photograph of each service user was contained alongside their medication records, for easy identification, and any known allergies or special instructions were noted. Samples of staff signatures (who administer medication) had been noted. The Head of Cares attention was drawn to an out of date sublingual spray which needed to be disposed of and re-ordered. The controlled drugs cabinet was checked and contents tallied with records in the register. Bags of service users money were found in the cabinet containing controlled drugs. The report from the inspection in 2007 included It was noted that the controlled drugs cupboard was being used to store residents money and the service was advised not to store money or jewellery in there to comply with the Royal Pharmaceutical Societys best practice guidelines. This advice had not been taken by the service. A recommendation is made to ensure that appropriate arrangements are made for safe storage of peoples money, separate to the controlled drugs cabinet. A requirement from the previous inspection for people who self-medicate to have a lockable storage space in which to store medication had been met. A recommendation for staff involved in the administration of medication to maintain records appropriately was being met. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences and religious or cultural requirements. Evidence: People using the service said there are always activities arranged by the service that they can take part in. A health care professional said the service provides very good entertainment. Activities included an art group, discussion group, music group, library, exercise group, literature group, film club, twice a week worship and once a month Holy Communion. A hairdresser visits twice a week and several people have newspapers delivered of their choice. Pigeon holes had been put up for peoples mail and newspapers to be delivered into. The days activities and menu were displayed in the building. The lunch time meal was chicken breasts in a creamy white wine sauce with fresh vegetables and a vegetarian choice. Pudding was Eves pudding and custard or fresh yogurt or fruit. The evening Care Homes for Older People Page 15 of 30 Evidence: meal was soup, cauliflower cheese and fruit and cream. Alternatives could be provided if people wanted something different to this. Morning coffee and afternoon tea were served in the dining room; during the morning coffee a birthday cake and gift were presented to a service user to celebrate his birthday and the cake shared amongst all of the residents. Food looked well presented and those people spoken with after lunch said they had enjoyed their meal and had plenty to eat. Service users said in surveys that they always/usually liked the meals provided for them. Additional comments included a high standard of well balanced meals, always two alternative choices, sometimes excellent, usually very good, occasionally (rare) not very good, the meals tend to be a bit monotonous, the same or similar menu week by week and there are usually alternatives. Visitors are welcome to see their relatives at any reasonable hour. Several people came to the service during the day and were made to feel welcome by staff. Posters around the building advertised an open day for June which service users said from previous experience was an enjoyable event. They had been able to invite their friends and relatives and said music was being provided. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding procedures are in place which aim to listen to the views of people who live at the service and reduce the risk of harm to them. Evidence: In the pre-inspection self-assessment the manager said there had not been any complaints in the past year, no use of restraint and no safeguarding incidents. The Commission is not aware of information to the contrary. A complaints procedure was in place. This was satisfactory apart from details of the regulator; see recommendation under Choice of Home to update this. People using the service said in surveys that they knew how to make a complaint if need be and that they knew who to speak with if there were not happy. Health care professionals said that the service usually responded appropriately if they had raised any concerns about care. A safeguarding policy was in place and staff training was being undertaken to raise awareness. The policy included the need to inform Social Services and the inspecting authority of any allegations or incidents of abuse. The manager was advised to obtain a copy of the local authority inter agency guidance on safeguarding in order that she and staff are familiar with local procedures, and a recommendation is made to address this. Care Homes for Older People Page 17 of 30 Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are clean, well decorated and maintained, promoting a positive environment for the people who live there and which are suitable for the needs of the people living there. Evidence: Swarthmore is located a few minutes walk from the centre of Gerrards Close and is close to shops and the usual facilities that a small town has to offer. There are transport links nearby. The building is a large detached property which has been extended over the years. The building is located along a short residential road in a quiet area and has extensive, beautifully kept grounds. There is parking for staff and visitors. The service is registered for up to forty people. There is provision for four more independent people in four flats. The main accommodation for people using the service is on two floors with passenger lift access between floors. All bedrooms are single occupancy, a programme of adding en-suite bathrooms has been in operation to improve facilities. Rooms without en-suites have a wash basin and vanity unit. There are communal adapted toilets and bathrooms. Bedrooms that were viewed were of a good size, nicely decorated and personalised and varied in layout and design. Some on the Garden wing have access direct to the gardens. Corridors had been decorated with Care Homes for Older People Page 19 of 30 Evidence: varied and interesting artwork that people using the service had created. Communal areas were pleasantly arranged and decorated and chairs were comfortable to sit in. The dining room is spacious and overlooks the garden and tables had been set attractively for mealtimes. There is a seating area at one end of the dining room and a piano and audio equipment. There is a main lounge with a wide screen television and a quiet room/library next door to it. Housekeeping staff were maintaining the premises to a high standard and managing odour control well. The kitchen was in good order and clean. The service had two sluice rooms with macerators and essential supplies. Improvements have been made at the service since the last inspection such as new summer houses, new windows, carpet, curtains and redecoration in one wing of the building and new garden furniture had been purchased. People using the service said in surveys that the building is always kept fresh and clean. Additional comments included scrupulously kept at all times and it is always beautifully clean and with lots of flowers. Clothes are washed very well. A radiator cover in a corridor and one persons bedroom were not securely fixed to the wall and will need attention. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well staffed and there are good training arrangements to make sure people have the right skills and competencies to meet needs. There was poor attention to required recruitment checks which could place people using the service at risk of harm. Evidence: People using the service said in surveys that staff listen and act on what they say and that there are staff available when they need them. Additional comments included all the staff are excellent here and all the staff here are very kind to us and we are very glad to be here. Healthcare professionals who completed surveys said that care staff usually have the right skills and experience to support peoples social and health care needs. Staff were observed to be attentive to peoples needs, gentle in their interactions and conveyed respect. There were photographs and names of the staff team on the wall outside the main lounge and library/quiet room. A sample of recruitment files was looked at. Most staff files had a photograph of the person in order that they can be readily identified. It was noticed that not all required pre-employment checks had been undertaken consistently when appointing new staff. File 1 contained two unsatisfactory references. One stated employment terminated at end of one month during probationary period. The pre-set questions on the basic Care Homes for Older People Page 21 of 30 Evidence: reference request form used by Swarthmore had not been answered by the referee. A second reference stated no under the question would you re-employ her/him and under the general remarks he had said her availability had not been suitable for the type of care his service provided. There were no records to show that the manager had pursued these references further to find out why both previous employers found her work to be of an unsatisfactory nature and to also explain why the manager went on to employ someone with references of this nature. In file 2 it was noticed that the member of staffs passport had been stamped with limited leave to remain in the country and that this member of staff was able to work as authorised by the Secretary of State. There was no copy of any supporting documentation to explain what employment she is permitted to undertake. There were also no references on her file. In file 3 there were no references. Another member of staff started working at the service very recently, according to information in her contract. She was initially described by the administration manager and senior carer/homes trainer as not working until her Criminal Records Bureau check is returned but instead undergoing training and induction. It was confirmed by the senior carer/homes trainer that she had worked supernumerary to the rota two days prior to this visit, undertaking some domestic duties and also serving teas and coffees in the dining room. Where a Criminal Records Bureau check is awaited, it is permissible for new staff to undertake restricted duties under close supervision provided that a preliminary POVAfirst check has been obtained and is satisfactory. No such check had been carried out and the manager and administration manager were not aware that this check existed separately to a full Criminal Records Bureau disclosure. A requirement was made at the previous inspection for Criminal Records Bureau checks to be undertaken of any volunteers, the hairdresser, maintenance person and occasional workers. This had been addressed except for the exercise instructor. It was noticed that the application form used at the home does not require applicants to give a full working history going back to leaving full time education. Applicants are asked to provide details of the past two employers only. For example, in one file employment details were only given back to May 2002, in a second to February 2006 and in a third 2005. This leaves considerable unknown areas of peoples backgrounds and what they have been doing since leaving full time education. The files looked at during the inspection were of concern to warrant issue of immediate Care Homes for Older People Page 22 of 30 Evidence: requirements. A letter outlining deficits in recruitment practice was sent to the provider the day following the inspection. The in-house trainer for the service was met and outlined what training opportunities are available to staff. A sample of training files was looked at. In each case there was evidence of an induction being undertaken. The majority of mandatory training was up to date; one person had missed out on an annual moving and handling update according to records, leaving a gap of twenty three months since training was undertaken. A course to refresh moving and handling was taking place shortly after this visit which may include this member of staff. Files showed that staff were receiving safeguarding training as part of the planned package of courses, plus dementia awareness. A database was being kept of staff training. Fifty seven percent of staff had achieved National Vocational Qualification level 2 or above and a further ten percent were in progress. The manager and Head of Care have the Registered Managers Award and the senior carer/homes trainer has National Vocational Qualification level 4. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the service promote continuity for people living at the service but lack of adherence to key policies and procedures places people at risk of harm. Some attention is needed to health and safety to make sure that hazards are promptly identified and remedied. Evidence: The manager is registered with the Commission and is from a nursing background. She will be retiring in June this year and advised that a new manager has been appointed. There will be a two week handover period between the out going and in coming managers. The manager is supported by a Head of Care who is also a qualified nurse. There is also an administration manager. The provider has been monitoring quality of care at the service and reports of these visits were available to see. They show that on each occasion there is discussion with people using the service and staff, the condition of the premises is taken into account Care Homes for Older People Page 24 of 30 Evidence: and records are looked at. Some peoples money was being kept for safe keeping in the controlled drugs cabinet as mentioned earlier in the report. Records and receipts were in place and a check of two peoples money tallied with records. Policies and procedures were available to staff in the duty office and covered a wide range of areas necessary for a care service. Safeguarding and recruitment policies and procedures had not been followed before appointing staff to work at the service and could have placed people at risk of harm, as outlined under the previous section of the report. Portable electrical appliances had been checked in November last year. It was pointed out to the manager that a tick had been put alongside items tested in a pass/fail column without indicating whether items had passed or failed. It would be advisable to enter a P or F in this column instead. There were electrical installation certificates for new and existing hard wiring of the premises. In the pre-inspection self-assessment no dates were given for the last review or certificate for various equipment, including gas appliances. The manager was not able to produce a gas safety certificate or service records for gas appliances during the inspection and a requirement is made to address this. The most recent inspection by the fire service took place in December 2008. The report reflected satisfactory measures in place and advised keeping the fire risk assessment under review. A risk assessment of the premises was last reviewed in June 2002. The manager confirmed that no more recent assessment had been documented. This needs to be done on at least an annual basis to make sure that all parts of the premises are safe and free of hazards. A recommendation made at the previous inspection to assess the risk from some uncovered radiators in communal areas for the home had not been done. This needs to be addressed, particularly as there are some people who have dementia (thirteen identified in the pre-inspection self-assessment) whose behaviour and actions could be unpredictable and without regard for safety. A requirement is made for a risk assessment to be undertaken of the premises, which needs to include uncovered radiators. There was evidence of hoists and baths being serviced. A requirement made at the last inspection for hazardous cleaning products to be locked away when not in use was being complied with. A recommendation regarding storage of gloves and pads seemed to have been addressed. Care Homes for Older People Page 25 of 30 Evidence: Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 All of the required Schedule 2 recruitment checks are to be obtained and satisfactory before staff start working at the service. Staff are not to be permitted to carry out care duties until a full enhanced Criminal Records Bureau check has been obtained. Staff may undertake restricted duties under close supervision following a satisfactory preliminary POVAfirst check. This is to ensure that people using the service are protected from the risk of harm. 06/05/2009 2 29 19 Full working history since 06/05/2009 leaving full time education is to be requested of applicants and gaps to their employment explained to ensure that there is a complete and accurate account of peoples backgrounds. This is to help make an informed decision about their suitability to work with vulnerable adults. 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. Care Homes for Older People Page 28 of 30 No. Standard Regulation Requirement Timescale for action 1 37 13 A risk assessment of the premises is to be conducted and action taken to reduce risks were there are issues. This is to include the safety of uncovered radiators. This is to make sure that people are kept safe. 01/08/2009 2 38 13 A gas safety certificate or 01/08/2009 evidence of servicing for gas appliances is to be obtained and made available on the premises. This is to ensure that appliances are safe for use. 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 1 Any documentation which refers to the regulator for the service, such as the statement of purpose, brochure, complaints procedure etc needs to be updated to reflect that this function is now carried out by the Care Quality Commission and include the national contact details when these are circulated to the service. Items of value such as service users money are not to be stored in medication cabinets as this is not an appropriate practice. A copy of the Buckinghamshire County Council inter agency safeguarding procedures is to be obtained for the service and made available to the staff team. 2 9 3 18 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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