Inspection on 06/08/09 for Sweetcroft Residential Care Home

This inspection was carried out on 6th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 32 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sweetcroft Residential Care Home 19/10/09

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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: Sweetcroft Residential Care Home 53 Sweetcroft Lane Uxbridge Middx UB109LE     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: Jane Collisson     Date: 1 2 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 46 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 46 Information about the care home Name of care home: Address: Sweetcroft Residential Care Home 53 Sweetcroft Lane Uxbridge Middx UB109LE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ilford Homes Ltd Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is:- 20 The registered person may provide the following categories of service only Care home only - Code PC to service users of the following gender Either whose primary care needs on admission to the home are within the following categories: old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Sweetcroft is a residential home for twenty older people. It is located in a large detached house on a quiet residential road. It is within a mile of the local shops and Hillingdon underground station. The A40 and public transport links are close by. Sweetcroft was an existing home, taken over by new providers in February 2009. There had been an Acting Manager in post and a new Manager Designate had been Care Homes for Older People Page 4 of 46 Over 65 20 20 0 0 Brief description of the care home appointed in August 2009. There are twenty single rooms, on two floors, of which thirteen have an en-suite toilet and two have en suite bathrooms. There are two additional bathrooms and a number of toilets. There is a passenger lift to the first floor. The lounge and separate dining room are on the ground floor. There are pleasant gardens, including a patio to the rear of the building, and parking to the front. There is a kitchen, laundry room and a small office. In the entrance hall, there are CCTV cameras for security. The fees range from £409 to £550 per week. The respite fee is £575. Care Homes for Older People Page 5 of 46 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 was the first inspection of Sweetcroft under the new ownership. It was an unannounced inspection to look at all of the key National Minimum Standards and was carried out on the 6 August 2009 from 10.10am to 3.15pm. The former Acting Manager was present, together with two members of the care staff. The newly appointed Manager had commenced that day and was on an induction period. The previous Registered Provider/Manager was initially registered as the Manager under the new ownership but left in February 2009. We will refer to the new Manager Designate as the Manager for the purposes if this report. The home had seventeen people resident, all of whom were met in the course of the inspection. There were three vacancies. Changes were being made and one room, previously used as a double, was becoming a single room. The former hairdressing room was becoming a new bedroom with en-suite toilet. A hairdressing room was being created in another area and this was seen to be used on the last visit. Care Homes for Older People Page 6 of 46 A further visit was made on the 12 August 2009 to meet with the Registered Providers to discuss the issues found on the first inspection. These included the quality of the care plans, risk assessments, and the lack of evidence of monthly visits by the Registered Providers, or the submission of notices under Regulation 37 to the Care Quality Commission. At this visit, we found serious shortfalls in the medication administration and in other areas. An Immediate Requirement was issued in respect of an audit of the medication, to be carried out by the Manager, within 48 hours. She was also required to contact the nurse who monitors the anti-coagulant medication for the three residents whose medication stock was incorrect. The Manager undertook an audit of the medication and provided us with the results by the 14 August. She found a number of additional errors on the audit. She had made contact with the general practitioners, as required, taken steps to supervise the staff, and arrange retraining. Where the residents had been placed by Social Services the Manager was asked to inform them if there had been any errors in their medication procedures. The Commission is taking enforcement action to secure compliance and achieve better outcomes for the service users. We visited for the final time on 19 August, with the Care Quality Commissions Pharmacy Inspector. She undertook a check of all of the medication. She found further errors on this occasion and a summary of her findings is included in this report. The Registered Providers were present on this occasion to meet with the staff team. Between our second and third visits, the London Borough of Hillingdon undertook two visits to carry out their own inspection. This is an annual planned inspection. They provided with the home with their report on the 19 August and made requirements for the home to complete. During the inspection most people were in the lounge but we saw a small number who prefer to stay in their bedrooms during the day going to the dining room for meals. We observed the lunch time meal at two visits. The tables were nicely laid with menus. People said that they found the food to be good and there was always a choice. There is no Activities Organiser in the home but the former Acting Manager said that the staff organise bingo, crafts and other activities between them. However, those people who were able to comment said that there were few activities now and there had been no outings unless with their families. We did see a game of bingo being played during our last visit. Three people attend a luncheon club each week and are collected by the club. We saw visitors on the last visit and spoke to two who were satisfied with the support provided to their relatives. Staff said that they ask visitors to avoid mealtimes. A variety of records were examined including staff records, care plans, maintenance and medication records. The Registered Provider completed the Care Quality Commissions Annual Quality Assurance Assessment with information about the home its services and how the home intends to develop in the future. The information we found during the inspection did not always verify what was written in Annual Quality Assurance Assessment in a number of areas such as activities, supervision and record keeping. As this was the first inspection under the new ownership, there were no previous requirements to be met. Care Homes for Older People Page 7 of 46 What the care home does well: What has improved since the last inspection? What they could do better: To ensure people have current information about the home and its services, the Service Users Guide and Statement of Purpose must be brought up to date and available to everyone. There needs to be an admission procedure which ensures that people being assessed have all of their needs taken into account. Attention must be paid to those with special needs because of their dementia. There is a lack of evidence of a good induction procedure and ongoing training. The Registered Providers must provide for the training that staff need for the work they undertake. This must include the specialist training required to support people with dementia. People must be provided with contracts or terms and conditions which are up-to-date. People need to be aware of the procedures when money is held by the home on their behalf. We found care plans, although reviewed fairly regularly, had not been updated to take into account peoples changing needs. Care plans must be updated to provide a clear plan of support which is seen to have been discussed with the residents and their representatives. There was insufficient information to show that risks had been assessed. Risk assessments must be completed to protect the health and safety of the people living in the home. These must be seen to be compiled with people, and their representatives, to ensure that they have been agreed, are realistic and in accordance with peoples wishes. There was a lack of information regarding peoples health and how their needs are met. The home must put into place systems of assessment, including those for nutrition and continence, to ensure that peoples health and welfare is maintained. We found the lack of good medication administration had put people at risk. There must be regular audits and checks of staff competency to minimise any risks to the people living in the home. There was a lack of activities and outings taking place. By consulting with the people who live in the home a range of activities and outings must be provided. The home will Care Homes for Older People Page 8 of 46 also need to demonstrate that people with dementia are provided with the opportunities for suitable activities, outings and stimulation. There was a lack of information in the home regarding the safeguarding of people and not all staff have been trained. The Registered Providers must ensure that all staff understand and have the training to help protect people. The recruitment records we examined were not all complete. The application forms and references did not have the information to demonstrate that a robust procedure is in place. The Registered Providers must ensure that the procedures for recruitment are thorough and that they are checked before staff commence work. Staff who undertake recruitment must have the training and knowledge to ensure they understand the procedures. There has been a period of unsatisfactory management of the home, with staff not being sufficiently supported to ensure that they have met the Care Home Regulations 2002 and have provided safe care to the residents. Monitoring through Regulation 26 visits could have prevented some of the shortfalls found on this inspection, in particular medication, administration, poor care planning and risk assessing, and recruitment. They must be carried out in the future. Improvements are needed to all aspects of the record keeping. Some efforts had been made to commence this work but it will need to be continued and maintained. The Registered Providers needs to have clear guidance for the staff on the reporting procedures to the Care Quality Commission, under Regulation 37, and a schedule of maintenance visits and checks. Environmental risk assessments must be carried out to ensure that people living in the home, and staff, are protected. The items which require completion in the fire risk assessment must be finished. There has been no formal or informal gathering of the residents views or those of their representatives. Quality assurance needs to be carried out at regular intervals to support the development and improvement of the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 46 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 46 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with some information about the home but it is not current. Information is available about the terms and conditions but are not up-to-date. There is a basic assessment and people can visit the home to see if the home will suit their needs. People with dementia do not have their needs assessed and any specialist facilities, for people with dementia, are not in evidence. Evidence: The Service Users Guide is provided to the people living in the home and staff said copies are kept in each bedroom. It does not have information about the new owners, and refers to the previous management. There is no information relating to any changes to the running of the home. The Statement of Purpose was updated for registration purposes when the new owners took over but was not available in the home initially. It has not been incorporated into the Service Users Guide as required. The Registered Provider provided us with an updated Statement of Purpose on the second visit but it has limited information on the way in which the home is catering for Care Homes for Older People Page 11 of 46 Evidence: people with dementia. No changes have been made to the environment, activities or staffing since the dementia category was granted. We discussed this with the Registered Providers who said that their company does intend to make changes, such as the repainting of doors in contrasting colours, in due course. We were informed that staff in post for some time have attended dementia awareness training but the training records were not all available to evidence this. Staff recruited more recently did not have this on training recorded on their files. Newer staff we spoke to confirmed they did not have this training. We saw, in the four files we examined, that there were assessments from the Local Authorities placing people in the home. The care planning system in place, before the new owners took over, was still being used to assess a persons support needs. An assessment procedure will be needed which takes into account the changes to the homes category of registration. This needs to demonstrate that the needs of the person, in relation to their dementia, have been fully assessed and recorded. There was information to show that people have, in the past, spent the day in the home as part of being assessed and making a choice. Copies of the contracts/terms and conditions were seen in the files we examined, although had not been updated to include any changes. We recommended that the information on peoples finances is contained in a separate file to maintain confidentiality. The information is currently available to all staff. The home is fully accessible, with a lift to the first floor. We were told that, at the present time, no-one was requiring any assistance with manual handling by hoist, although one is available. There are two assisted baths in the home for the eighteen people who do not have an en suite bathing facilities. There is no Intermediate Care unit in this home, so this National Minimum Standard was not assessed. Care Homes for Older People Page 12 of 46 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. Each person has a care plan but they are not updated in line with changes and people are not seen to be involved in their production. The lack of risk assessments means that people are not protected. Health needs are met by community services but are not recorded in a way which helps to promote residents health and welfare. Errors found in medication administration could put people at risk. Errors in medication administration are not investigated. There is a lack of staff awareness in regard to the dignity of the residents. Records are poorly maintained and do not support continuity of care. Evidence: We examined four of the care planning files. Each had care plan but, although some review meetings were seen to have taken place, the care plans were not seen to be updated and one was dated from 2007. There were limited risk assessments in place, including those for manual handling. There were no assessments or risk assessments for nutrition, continence, medication, falls, going out of the home or any other identified risks. We did not find any information relating to anyones dementia and how they might be protected and supported. Care Homes for Older People Page 13 of 46 Evidence: No care planning systems have been introduced by the new owners. However, the new Manager had updated one of the care planning files by the second visit, with the assistance of the staff team, to provide a model file. We were informed that the remainder of the files would be updated in due course. The file appeared to have the information required, produced on the computer and presented in an easy to read format. The previous Acting Manager said that the residents have a choice of four general practitioner practices. Because the care plans had not been routinely updated, it was not possible to see if the health and medical needs of the residents had changed. In the daily notes examined, we saw some information recording the visits of general practitioners and other health visitors, such as chiropodists. It was not possible to check that these were in accordance with the needs of the residents. We were informed that, while staff maintain the daily records records, they do not generally have access to the care plans, which would inform them if routine visits are required or if any procedures need to be followed up. The home must have in place sufficient information, for each person, to show how their health needs are being met. There must be robust procedures to ensure that all of the appointments and visits are recorded and monitored. At the second visit we looked at the medication administration. The Manager, being on induction, and in the home for only a few days, had not checked the medication. We found a number of errors in the administration of Warfarin for three people. On one of the records, staff had been signing every day when the additional dose was only to be given at weekends. A check of the stock showed that the medication had probably been given correctly. One of the staff said that, as it has been signed on the first day of the Medication Administration Record (MAR) sheet, staff had followed suit. This indicates that staff were not checking the instructions, following the persons blood test, or following the normal process of checking the day, time, route or dosage of medication. Had they done so, there would have been an awareness that they should not have been signing. We saw staff leaving medication on the dining tables for two residents, one of whom has dementia. The person poured fruit juice into the medication pot instead of taking it. There are a number of people with dementia in the home who could have taken the medication in error as they were not being observed. The staff member giving out the medication was not the person recording it had been taken, and she could not have observed all of this, as she was not in view of all of the residents. Care Homes for Older People Page 14 of 46 Evidence: We were informed that the night staff would not sign for medication they dispensed, so day staff were giving the medication before they left their shift but sometimes earlier than it was prescribed. There was no Returns Book for the medication going back to the pharmacy. We issued an Immediate Requirement for an audit to be undertaken of the medication. The Manager carried this out and informed us on the 16th August of a number of further errors she had found. She had also spoken to the staff who dispense medication and arranged for training to take place. None of the people living in the home self-medicate. The home uses a local pharmacist to provide a 28 day blister pack system. There appeared to have been no checks by the Registered Providers on the medication administration since they took over the home in February 2009. As there were no Regulation 26 visits reports available, and only one apparently undertaken, there was no record of any checks being carried out. An experienced home manager, from another of the Providers homes, was supposed to be supporting staff but we were informed she had been to the home only once for this purpose. We arranged for the Care Quality Commissions Pharmacy Inspector to visit the home on 19th August to carry out further checks on the homes medication. Her report is as follows: Because of the concerns raised on Day 1 of the inspection and the subsequent discrepancies in an audit reported by the manager we carried out a specialist pharmacist inspection of medication. We noted that the new manager had made great progress in clearing excess stock and starting a new medication cycle with new supplies all checked in and stored in an orderly manner.Staff had undertaken a training course on medication two days previously on 17th August. We asked to see the medication policy and were told it was on the computer. It was printed off during the inspection and we read it and suggested further procedures to expand it to cover the homes activity. We looked at the medication and medication administration records MAR. It was day 3 of the new medication cycle and we noted that the allergy section was not completed. We looked at the recording of receipts, administration and disposal and overall records were complete. We did notice that the receipts of medication were not recorded for a new resident and that the last tablet of a diuretic had been given the morning of the inspection and the empty bottle left on Care Homes for Older People Page 15 of 46 Evidence: the trolley.The manager told us that she did not know that this medication had run out. We looked at the MAR for a resident who had a dosage changed from 20mg to 10 mg and noticed that care workers were giving the 10mg dose from the monitored dosage system but were recording that they were giving 20mg. We counted a painkiller for one resident and found that 10 had been used from the box but 16 tablets had been recorded as given. For another resident the home carried forward 11 calcium tablets from the previous medication cycle and should have used two tablets yet there were 8 tablets left. We audited another painkiller and found that there were two too many tablets left. A further resident was prescribed their pain relief four times a day but staff were only recording that they were giving it twice a day. Two residents were also not receiving their lactulose as prescribed according to the records. We looked at the recording of warfarin and noticed that currently it was correct and audits showed that it was being given correctly. We confirmed the lead inspectors findings that in the previous medication cycle that the records on the MAR were not the dose prescribed. The controlled drugs were inspected together with the records.The manager is in the process of obtaining a bound register and had a temporary one in place. Balances were correct. The controlled drug cupboard was not secure enough as it was loosely bolted to the wall. We also looked at the lancets for checking blood glucose and noticed that they were not of the professional type to prevent the risk of blood borne infections. This inspection was carried out on only Day 3 of a new medication cycle and because of the continued discrepancies in audit and the errors in recording we took copies of the MAR and issued a code B notice to discuss further action. We were concerned that the careless recording did not provide evidence that residents were receiving their medication as prescribed. The Commission is taking enforcement action to secure compliance and achieve better outcomes for the service users. In the files examined we saw basic information on the wishes of people with regard to their funeral plans. However, there is no further information on how peoples wishes with regard to end of life care may be met. We were concerned about one of the residents who was sitting in the dining room partly unclothed at our second visit. We did not find that staff were concerned and did not appreciate that the person needed assistance or it was undignified. Other residents were due in the dining room and would possibly have found this Care Homes for Older People Page 16 of 46 Evidence: embarrassing. Care Homes for Older People Page 17 of 46 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have limited opportunity for activities and outings. There is no evidence of consultation regarding life in the home. People say they like the meals and they have choice. Limited religious needs are being met. People who are able to make a decision can choose where to spend their time. Evidence: We spoke to people who were able to tell us about the activities and life in the home. They told us that there were not so many activities as there had been in the past. They had previously had a person visiting for exercises and aromatherapy, and they had enjoyed bingo and they said these no longer occur. People said that outings no longer take place unless with their families. One person told us that the residents used to have outings to the theatre, which were enjoyable, but had not been for sometime. The former Acting Manager said that she was not aware if the home was able to use community transport as it had done previously. On our third visit to the home, there was a game of bingo being played. We saw little written evidence that activities were being recorded and, in the sample of records we saw, the activities sheets were almost blank. In view of the fact that the home has a number of people with dementia, who would be unable to tell anyone Care Homes for Older People Page 18 of 46 Evidence: about the activities, it is important that there is evidence to show that there are opportunities to enjoy some stimulating activities. The majority of the people in the home spend their time in the main lounge and have their meals in the dining room. Those that wish to do so can spend their time in their bedrooms and we saw that this happens. The main lounge has a large flat screen television placed on the fireplace wall. We noted on the second visit that the television in the lounge was on a 24 hour rolling news channel, for a long period, during the afternoon. None of the residents appeared to be interested. Staff were seen to be congregating in the dining room. There were sufficient numbers of staff for activities or outings to have been provided for the residents. We observed one person in the garden, feeding the homes cat and doing some gardening in the raised flower beds. At present, only people who require Roman Catholic communion have their needs met in the home. The Manager said they had not had other services for some time as the local church was thought to be without a vicar. No-one currently goes out to a church. There were no further cultural or religious needs to be met. A small number of people go out unaccompanied and said they go to the local shops, about 10 minutes walk away. The Manager confirmed that visitors are welcomed but they do not encourage visits at mealtimes. During the course of the three visits, we saw three relatives and spoke to two. Two were taking their relatives out for the day. They said they were happy with the care the home provides. On the first day of the inspection, a meal of braised beef or sausages with vegetables, was served. We talked to the cook and she explained her four weekly menu. The people we spoke to said that they enjoyed the meals and confirmed they also had a choice. The cook says she also provides the opportunity for people to have salads. There was a fruit crumble for dessert or ice cream or yoghurt. For the evening meal there was soup, sandwiches or a hot choice. We observed staff asking people during the afternoon what they would like for their evening meal. The cook that the staff have access to the kitchen in the evenings to produce snacks should they be required. We found the kitchen to be very clean and tidy. People spoken to were complimentary about the meals. There were no cultural needs having to be met in regard to the food and one diabetic diet was being provided. The tables were nicely laid and there are menus for the day on the tables. Some of the residents told us that the menus are not just out for your benefit. However, they are Care Homes for Older People Page 19 of 46 Evidence: in small print, which would be difficult for anyone with poor eyesight to read, so we recommend a larger and bolder font is used. Sherry was served with the meal for those who wished to have it. However, although the days we attended the home were very warm, we saw a lack of drinks being provided, except at the set times. Because the Registered Providers had not carried out the monthly Regulation 26 visits, there was no information to show that residents had been asked for their views on the running of the home. There was no evidence of residents meetings. Care Homes for Older People Page 20 of 46 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems are in place for people to make a complaint. Some people say they know how to make a complaint. Policies and procedures have not been accessible to the staff on safeguarding and not all staff are trained. Peoples right to vote is not actively promoted. Evidence: There have been no complaints under the new ownership and none through the Commission for Social Care Inspection or Care Quality Commission. There were copies of the complaints procedure around the home but they need to be updated with the Care Quality Commissions current address. The former Acting Manager said that only one person had a postal vote at the recent elections. We saw a letter in one file, placing someone on the electoral roll some years ago. We recommended that, as this can be done at any time via the Local Authority, peoples names should be submitted as people are admitted so they do not lose their right to vote. We were provided with a copy of the Registered Providers policy and procedure on safeguarding at the last visit. This had not previously been available in the home. We noted it was not dated. There was no index or page numbering, for ease of use, and these should be included as it also contained information on finances and aggressive behaviour. There was no information available on the safeguarding policies of the Care Homes for Older People Page 21 of 46 Evidence: London Borough of Hillingdon. These are required to ensure that staff are fully of aware of the procedures. There has been one safeguarding issue which took place at the time of the change of owners. The former Acting Manager provided us with the information. We did not have a full record of all of the training provided to staff and did not see, in the files of the staff recently recruited, that they had any safeguarding training. The Local Authority had arranged training for the staff in tissue viability, following the safeguarding issue, and said in their report that staff had attended the training. This training needs to be extended to all of the staff team. The former Acting Manager said the home deals only with finances for people for the hairdressing, newspapers and other minor expenditure. We saw some information in loose leaf pages in the daily records of expenditure. We recommend that the information is recorded only in one place, to ensure it can be recorded and audited. Care Homes for Older People Page 22 of 46 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 home provides a pleasant environment for people. The home is furnished in a homely way in all areas. Bedrooms can be personalised if people wish to bring in their own items. The gardens are pleasant but attention is needed to ensure safety for people to walk. Evidence: The lounge, though nicely furnished, has all of the armchairs against the walls so that some people who may wish to watch television are at some distance from the set. We recommend to the Manager that she might look at ways, in conjunction with the residents, to provide a better environment for those who might wish to watch the television and those who may wish to sit in a quieter area, or in groups with their friends or visitors. There are no other private spaces, other than bedrooms, but the dining room could be used for meeting with relatives, and the entrance of the home also has a small amount of seating. However, neither area would be private. Two bedrooms have full en suite facilities, one having a bath and one a shower. There are thirteen bedrooms with an en-suite toilet. There are two communal bathrooms, one on each floor, for eighteen people. Each of the communal bathrooms has a seat over the bath. One bathroom has a separate flat bedded shower but it is not in use. Care Homes for Older People Page 23 of 46 Evidence: We recommend that this could be brought back into use to give people a choice of a bath or a shower. The former Acting Manager was asked if the shower was flushed through regularly. She was not aware of any necessity to do this. We found on the second visit a report about the water system, undertaken under the former Registered Providers. The current Registered Providers were not aware of a report from November 2008, which showed that the water is now coming through the mains system. We did find that the water temperatures in the bathrooms, on the first visit, were over the safe temperature of 43 degrees Centigrade. This was remedied between the first and second visits and the water temperature adjusted to make it safe. A regular water temperature check needs to be in place. The Manager said that none of the residents required a hoist to help them to move. There is a hoist available but we could not see a label to see that it had been recently serviced. Several people have Zimmer frames to move around the home, which is accessible in all indoor areas. There is a patio garden with seating tubs and plants. To the rear of the home is a lawned area with paths and seating. We noticed that one edge of the path had a small v shaped trench to one side, several inches deep. Because the path was narrow, without rails, it could have presented a hazard should someone place their foot in it. As it is important for people to have a place to walk, we advised that the trench should be filled in so that the path and lawn are on one level. The Registered Provider said that he would extended the path to make it wider and this was being carried out on the third visit to the home. Risk assessments need to be in place for all areas of the home and garden and ensure that any hazards are removed and risks are minimised. There is a very large shed to the rear of the garden which could be used for storage. We saw all of the bedrooms on this inspection. They are all pleasantly furnished with individual furnishings and decor. A former double room is to be used as a single but, with an additional bedroom provided on the ground floor, the number of residents who can be accommodated will remain at twenty. We found the home to be clean and free from any unpleasant odours. There are two cleaning staff on three days of the week and one on each of the other four days. The Manager said that staff also clean as required and help with the laundry. Care Homes for Older People Page 24 of 46 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. There are sufficient staff on duty to meet the needs of the current residents but the lack of organisation does not help people to enjoy more activities and outings. The lack of a robust induction procedure and a training programme does not support staff to develop their skills. Evidence: There were three staff in the home on the first day of the inspection, including the Manager. The new Manager was also present but was on her induction period. There are three or more staff on each of the early and late shifts and two waking night staff. No agency staff are used. The new Manager had been recruited without a Criminal Records Bureau disclosure, but had a POVA 1st check. We discussed this with the Registered Providers, who assured us that the Manager would not work unsupervised until the CRB disclosure was received. Although we saw training certificates in the files we examined, going back several years in some cases, we did not see any records which would evidence all of the training undertaken, which was required and which was current. We spoke to one member of staff who had been in post for one year but had not attended any training courses. Another staff member had attended only moving and handling. There was no evidence of a planned programme of training and development. We noted that there are staff who need additional support to undertake training and day-to-day work. The Care Homes for Older People Page 25 of 46 Evidence: Manager needs to ensure that this support is in place to assist the staff to carry out the work required. We were informed that the staff were trying to obtain places on the free training courses provided by the London Borough of Hillingdon but these are limited. We discussed with the Registered Providers the need for the organisation to provide sufficient basic and specialist training courses for new staff, and those who require refresher training. These need to be sourced through appropriate training companies, or trainers, if there is insufficient free training available at the time. A medication course was arranged for all of the staff between the second and third visits, following the issuing of the Immediate Requirement. The Registered Providers said that they intend to arrange more training in the future. The Manager was advised that she must provide records that demonstrate the training undertaken and demonstrate how the training needs of the staff will be met. Five staff have just commenced National Vocational Qualification training and the Annual Quality Assurance Assessment recorded that eight staff have the qualification at Level 2. We could not ascertain this from the records. The former Acting Manager, in post since February, has the Registered Managers Award. We did not see that staff had an induction in accordance with the Skills for Care standards and no induction records were seen. The three files we examined initially, on recruitment, all had deficits in their recording. Some were prior to the new owners taking over but had not been checked for compliance. The files examined of staff members recruited since the new owners have been in charge did not have the required information, including those of the new manager. References did not request, or have the dates of employment, status of the referee, or proof of the company, such as a company stamp or letterhead. The application forms were incomplete and employment histories did not appear to have been checked for gaps or missing dates. The references did not appear to be from the employer in some cases, but from colleagues. The Registered Providers must ensure that all the staff they employ have the required checks. We issued a Code B notice to the Registered Providers and copied information to show that the references and employment histories were incomplete. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. Between the second and third visits, a Manager from another home had visited to get Care Homes for Older People Page 26 of 46 Evidence: the recruitment files in better order. Care Homes for Older People Page 27 of 46 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 management of the home has been unsatisfactory with little or no input from the Registered Providers. Insufficient monitoring has taken place to ensure that the requirements of the Care Home Regulations 2002 have been met. Staff are not supported with regular supervision and appraisal. There is no evidence that peoples views are sought on a regular basis. Records are kept in poor order and do not provide evidence of good management. The information in the Annual Quality Assurance Assessment cannot all be verified. People who live in the home and the staff are not protected by robust health and safety procedures. Evidence: The former Registered Provider/Manager remained in the Managers post when the home was registered in February 2009 but left shortly afterwards. The former Acting Manager had the qualifications to manage the home but lacked managerial experience. Prior to becoming the Acting Manager, she worked in the home for ten years as a care worker. She had completed her Registered Managers Award and National Vocational Qualification at Levels 2 and 3. However, she had been left in Care Homes for Older People Page 28 of 46 Evidence: charge of the home since the Registered Manager left in February 2009 and appeared to have been offered little support. We found, for instance, that the home did not have a copy of the National Minimum Standards or Care Home Regulations and the Acting Manager was not aware of them. These were obtained by the second visit to the home but were without the amendments to the Regulations. The new Manager Designate commenced on 6th August 2009. The new Manager is a qualified nurse and has experience of working in a hospital, nursing home and in domiciliary care. She is part way through her Registered Managers Award. We were informed that she would be submitting her application to the Care Quality Commission for registration. There were no Regulation 26 visit reports to show that the Registered Providers representative had made the monthly visits to check the home was being managed efficiently and to check on the residents and staff views. Regular checks would have highlighted the areas where the former Acting Manager required support to fulfil her role. We were informed that the Manager of another home owned by the Registered Providers was visiting the Sweetcroft regularly to provide support. However, we were informed that the person had been only once in the five months, prior to our visits. There are surveys in place for people who visit the home to complete but the former Acting Manager did not know of any residents surveys or other quality assurance measures which had been undertaken recently. We saw one report from 2007 compiled under the previous management. No meetings have been held with the residents families, which would have provided some advocacy for people not be able to speak for themselves. Since the new owners took over there have been no Regulation 37 notices sent to the Commission for Social Care Inspection or Care Quality Commission. The former Acting Manager was unsure of the circumstances in which they need to be sent, except when residents died. Accidents had been recorded in an accident book. We looked at the finance records which are maintained on behalf of the residents. Peoples families supply a sum of money for hairdressing, newspapers, chiropody or other small items. When the money is low, people are asked to top up the sum. The system has been changed and, prior to the new owners taking over, people or their relatives were invoiced for money spent on their behalf. The arrangements for managing peoples finances is not included in the Service Users Guide or the Statement of Purpose, and the policy of the Company should be explained. Care Homes for Older People Page 29 of 46 Evidence: The former Acting Manager confirmed that they do not hold larger sums for people or bank accounts. No monitoring of the finances was apparent. We saw some evidence that the former Acting Manager has undertaken some supervision but this has been limited and the National Minimum Standards of six a year was not being met, although the Annual Quality Assurance Assessment (AQAA) stated that it had. The home has very limited office space and we found that it was difficult to look at files in the office, as there is no desk space. On the first visit, heavy files were being stored on a top shelf that made retrieving them difficult and potentially dangerous. This was pointed out to the Manager, who took action to move them by the second visit. The Registered Providers need to undertake a health and safety risk assessment to ensure that staff have the right equipment to undertake their work and any hazards can be removed or minimised. We did not see environment risk assessments completed for the home or gardens. We discussed this at the meeting on 12th August and the Providers said they would look at providing a desk in the office. Records were not easy to access and it was difficult to find the information required for inspection. We found that records were not kept in a confidential manner, as the key to the care planning files also opened the staff files cupboard, meaning files were accessible to all of the staff team at times. The records, such as the daily record sheets and health records, were not being maintained in an orderly fashion, or in a way where the information could be used to support people or provide evidence of support. We recommended that the information on peoples personal finances are removed from their care planing files so that they are kept in a confidential manner. The former Acting Manager was unsure which of the files were current, so had not moved those left by the previous Registered Providers. Many were out of date or needed to be archived. It was recommended to her, and to the new Manager, that they reorganise the files in line with the documentation required by the Care Home Regulations to make them easier to find and maintain. They would then have them to hand to use on a regular basis and for inspection. The Manager had made some progress, at the visit on the 12th August, to address these issues and streamline the files. The bedrooms all have battery operated devices to hold open doors. The Fire Officers had advised putting one on the laundry but this had not been done. The Fire Risk Assessment completed recently had a photograph to show that the laundry door was being propped open when the Fire Risk Assessment was compiled. There were a Care Homes for Older People Page 30 of 46 Evidence: number of other photographs of items which needed attention but it was not clear if they had been completed. We discussed this with the Registered Providers initially but they were not aware if the work had been completed. A walk around the home showed that some work, such as new signage, was obviously not completed. The Registered Providers said, at our third visit, that they were arranging for the work to be done on Friday 21st August. The fire alarms were seen to be checked weekly. We did not see evidence of the remaining checks but the AQAA records that the lift was checked in May 2009, the fire equipment in April 2009 and the emergency lighting in May 2009. Although we were informed the hoist is not in use, it was recorded as being checked in July 2008 but we did not see a label to this effect. The Registered Providers need to ensure that they have carried out all of the required maintenance checks and that the information is readily accessible. We tested the bath water on the first visit and found it to be just over 45 degrees Centigrade The staff do not regularly check the water temperatures. The Acting Manager had these checked between out two visits and they were adjusted to be around 43 degrees. We could not find information relating to any water testing but these were found on the second visit and had been carried out in the last year by the previous Provider. The policies and procedures being displayed were still those of the previous Registered Providers. The Registered Provider said that the policies and procedures are available on the computer but had not made been available to the staff team. We were provided with the medication policy on the third visit but there were additions to be made. The new Registered Providers must ensure that staff have their policies and procedures and show that they are fully aware of them. We saw that the home had its insurance certificate displayed, which was valid to February 2010. On our first visit, an electrician was present to carry out the five year electrical installation test, although the AQAA stated this had been done in April 2009. In the list of small electrical appliance testing (PAT) it did not appear that the person undertaking this has checked items in the residents rooms. This will need to be done. Care Homes for Older People Page 31 of 46 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 32 of 46 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 The Registered Providers 14/08/2009 must ensure that the medication is being correctly administered. The stock must be checked. Regular audits must take place. To ensure that people have the correct medication as it is required. 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 1 4 The Registered Providers must ensure that the Statement of Purpose is completed to reflect the needs of the people the home is able to accommodate. The home can demonstrate that the needs of people with dementia can be met by the homes staffing, environment and activities. 31/10/2009 2 1 5 The Registered Providers must ensure that an up-todate version of the Service Users Guide is completed and distributed. 31/10/2009 Care Homes for Older People Page 33 of 46 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 people living in the home and their representatives have current information. 3 2 5 The Registered Providers 31/10/2009 must ensure that an up-todate terms and conditions or a contract are supplied to the people living in the home. To ensure that people have the information on fees and facilities. 4 3 14 The Registered Providers must ensure that a procedure is in place which demonstates that all of the needs of the people considered for admission have been assessed for all areas of support, including dementia. To ensure that the needs of the person being admitted are fully assessed and there is evidence to show that their needs can be met. 5 4 18 The Registered Providers must ensure that staff have the required training and expertise to meet the needs of the people being admitted. 31/10/2009 31/10/2009 Care Homes for Older People Page 34 of 46 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 able to support people with dementia and any other specialist needs. 6 7 13 The Registered Providers 30/09/2009 must ensure that all potential risks are assessed and action taken to minimise any risks to the person or to the staff. These must be updated as and when the persons support needs change. To ensure that people and staff are protected and risks to their health and safety are reduced. 7 7 15 The Registered Providers 31/10/2009 must ensure that a care planning system is in place which contains up-to-date plans for each person, showing how their needs will be met. These must be seen to have been produced in conjunction with the person or their representative. To ensure that peoples needs are known and appropriate action is in place to meet their needs. 8 8 12 The Registered Providers must ensure that the heath needs of the people living in 30/09/2009 Care Homes for Older People Page 35 of 46 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 the home are assessed and recorded, together with the action taken to meet those needs. To ensure that people have their health needs met appropriately. 9 9 13 Make arrangements to ensure that all medication is adminstered as directed by the prescriber to the service user it was prescribed, labeled and supplied for. THIS IS A STATUTORY REQUIREMENT NOTICE. To ensure that peoples health and welfare is protected. 10 9 13 Make arrangements to 05/10/2009 ensure that medication records are accurately maintained; that the reasons for nonadminstration of medication are recorded by the timely entry of an appropriate code or entry on the medication adminstration record; and that the person adminstering completes the Medication Adminstration Record in respect of each individual service user at the time of administration. 05/10/2009 Care Homes for Older People Page 36 of 46 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 THIS IS A STATUTORY REQUIREMENT NOTICE. To ensure that peoples health and welfare is maintained. 11 9 13 Make arrangements for the recording, handling, safekeeping, safe adminstration and disposal of medicines received into the care home. THIS IS A STATUTORY REQUIREMENT NOTICE. To ensure that peoples health and welfare is protected. 12 10 12 The Registered Providers must ensure that staff are aware, through training and supervision, that peoples dignity is to be respected at all times. To ensure that people are treated appropriately and their privacy and dignity are maintained. 13 12 16 The Registered Provider must ensure that, in consultation with the residents and their representatives, a range of activities is provided which meet the needs of people living in the home. 31/10/2009 30/09/2009 05/10/2009 Care Homes for Older People Page 37 of 46 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 people have the opportunity for a range of activities. 14 13 16 The Registered Providers must ensure that people have the opportunity for outings and to remain in contact with the local community. To ensure that all of the residents have the opportunity to go outside of the home, particularly those without families or visitors. 15 18 13 The Registered Providers must ensure that there is information available for staff on safeguarding policies and procedures. To ensure that staff are aware of the processes for reporting safeguarding incidents. 16 18 13 The Registered Providers must ensure that new staff have the training in safeguarding people to help them support and protect people. To ensure that all staff have the awareness of safeguarding and 30/09/2009 30/09/2009 31/10/2009 Care Homes for Older People Page 38 of 46 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 understand the procedures for reporting. 17 19 13 The Registered Providers 30/09/2009 must ensure that all areas of the home are safe and that risk assessments have been completed to minimise any risk to people living in the home and to staff. To ensure that all areas are maintained to a safe standard and any risks are minimised. 18 29 19 Ensure that for anyone who you employ to work at the care home, you have a full employment history, together with a satisfactory written explanation of any gaps in employment. THIS IS A STATUTORY REQUIREMENT NOTICE. To ensure that people are not put at risk. 19 29 19 Ensure that for anyone who 16/10/2009 you employ to work at the care home, you are satisfied on reasonable grounds as to the authenticity of the two written references in respect of that person, and this is recorded as such. THIS IS A STATUTORY REQUIREMENT NOTICE. 16/10/2009 Care Homes for Older People Page 39 of 46 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 people are not put at risk. 20 29 19 Ensure that for anyone who you employ to work at the care home, you have obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2 of the Care Homes Regulations 2001 and that these are made promptly available to the CQC on request. THIS IS A STATUTORY REQUIREMENT NOTICE. To ensure that people are not put at risk. 21 29 19 Ensure that for anyone who 16/10/2009 you employ to work at the care home, you have two written references for that person, including, where applicable, a reference relating to the persons last period of employment, which involved work with children or vulnerable adults, of not less than three months duration. THIS IS A STATUTORY REQUIREMENT NOTICE. 16/10/2009 Care Homes for Older People Page 40 of 46 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 people are not put at risk. 22 30 18 The Registered Providers must ensure that all staff have the required induction and training to perform the work they are employed to carry out. To ensure that staff have the skills they need to carry out their work to a good standard. 23 31 9 The Registered Providers must ensure that the home is managed by qualified, competent and experienced staff. To ensure that the Care Home Regulations are understood and are being met, to protect and support the residents. 24 33 26 The Registered Providers must ensure that the monthly visits to the home are carried out and are available for inspection. To demonstrate that the Registered Providers have satisfied themselves that the home is being run to a good standard, records are in 30/09/2009 31/10/2009 31/10/2009 Care Homes for Older People Page 41 of 46 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 order and the residents and staff views are sought. 25 33 24 The Registered Providers 31/10/2009 must ensure that the home has a system for quality assurance and monitoring that reflects the views of the people living in the home and their representatives. To ensure that people have input into the way in which the home is run. 26 35 13 The Registered Providers must ensure that the systems in place for holding peoples money are known to those concerned and regular audits are carried out. To ensure that people are aware of the systems for keeping their money and that it is checked on a regular basis. 27 36 18 The Registered Providers must ensure that staff receive regular supervision from management staff. A programme must be commenced to ensure that all staff commence regular supervision within the timescale. 31/10/2009 30/09/2009 Care Homes for Older People Page 42 of 46 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 receive support and guidance in carrying out their work. 28 37 17 The Registered Providers must ensure that the records kept in the care home are maintained in good order, and are up-todate and available for inspection. To demonstrate that the home is well managed, with good systems and monitoring procedures in place. 29 38 13 The Registered Providers 30/09/2009 must ensure that risk assessments on the environment are carried out and action taken to minimise risks to staff and residents. To ensure that any risks to staff and people living in the home are reduced and eliminated wherever possible. 30 38 13 The Registered Providers must ensure that there is a schedule of planned maintance and servicing, and staff are aware of the checks that are required to maintain good health annd safety in the home. 31/10/2009 31/10/2009 Care Homes for Older People Page 43 of 46 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 support safety in the home and protect peoples health and safety. 31 38 13 The Registered Providers 30/09/2009 must ensure that the outstanding work identified in the fire risk assessment is carried out. To protect people living in the home, staff and visitors. 32 38 37 The Registered Providers must ensure that staff are aware of the circumstances under which a notice must be made to the Care Quality Commission under Regulation 37 and must monitor to ensure this is done. To ensure that the home reports appropriately under the Care Home Regulations 2002. 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 18/09/2009 1 5 That all information on peoples finances is kept separately to their care planning information to maintain confidentiality. That an end of life plan is in place for those people, or their representatives, who wish to have one completed. Page 44 of 46 2 11 Care Homes for Older People 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 3 4 15 17 That more use if made of visual aids to help people to understand the menu and what is available. That the manager ensure that peoples names are added to the Electoral Roll, as they are admitted to the home, to ensure their right to vote is protected. That the information on residents finances in recorded in one place only to ensure that the records can be easily maintained and audited. That the Manager looks at ways in which the lounge can be arranged to ensure that people can watch the television in comfort, if they wish to do so, or have quieter spaces to talk to friends and family. That the Registered Providers consider bringing the shower back into use in one of the communal bathrooms so that people can be offered a choice of bathing facility. 5 18 6 19 7 21 Care Homes for Older People Page 45 of 46 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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