Inspection on 17/11/09 for The Beeches

This inspection was carried out on 17th November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Beeches 15/09/09

The Beeches 10/07/09

The Beeches 02/06/09

The Beeches 26/11/08

The Beeches 29/05/07

The Beeches 06/06/06

The Beeches 01/10/05

The Beeches 24/05/05

The Beeches 04/11/04

The Beeches 18/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for older people Name: Address: The Beeches West Harling Road East Harling Norwich Norfolk NR16 2NP     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: Lella Hudson     Date: 1 7 1 1 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 28 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 28 Information about the care home Name of care home: Address: The Beeches West Harling Road East Harling Norwich Norfolk NR16 2NP 01953717584 01953717886 beeches03@aol.com www.beeches-residential.co.uk The Beeches (East Harling) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 44 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: Dementia - Code DE Date of last inspection Brief description of the care home The Beeches is a care home providing personal care and accommodation for 44 older people who have dementia. The home is owned by The Beeches (East Harling) Limited and is located in the village of East Harling and close to local amenities such as shops and pubs. Care Homes for Older People Page 4 of 28 Over 65 0 44 0 2 0 6 2 0 0 9 Brief description of the care home The home consists of a two-storey, converted house that is set in its own grounds. There are four shared rooms, the remainder being single rooms. All rooms have ensuite toilets, washbasins and showers or baths. The majority of rooms are on the ground floor. There are enclosed courtyards and a private garden to the rear and side of the Home. The fees are currently between £425 - £500 per week. Please contact the Home for more up to date information about fees. Care Homes for Older People Page 5 of 28 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 Key Inspection was carried out by two Inspectors on the 17th November 2009. The last Key Inspection took place on the 2nd June 2009 and there have been three Random inspections at the Home since then to monitor compliance with requirements made at the Key Inspection. During this Inspection one of the Inspectors spent two hours observing interactions with specific residents and a summary of the results of this are included within this report. We also spoke to the acting manager and the Proprietor, staff and residents. We looked around the Home and also looked at a selection of records. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Although there have been several improvements at the Home there are still many areas in need of further improvement. The changes in management at the Home only Care Homes for Older People Page 7 of 28 took place six weeks prior to this visit. The acting manager has already made some changes and is in the process of carrying out a full audit of the Home to see where further improvements need to be made. The provision of staffing is still not adequate to meet the residents needs in a consistent way. Staff have very little time to spend with residents on an individual basis and very few activities are provided. Additional comments on the residents/relatives surveys are as follows: staff are very busy there is not always someone available to help The residents are not offered a choice at mealtimes although the cook does have knowledge about what residents like and dislike and will make an alternative. Mealtimes are not an enjoyable experience for residents and is rather chaotic. The dignity of some residents has been compromised by the poor state of some of the beds that we looked at during our visit. These had been remade even though the sheets and mattresses were dirty and stained. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 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. The Home has not had any admissions recently. There is an appropriate admissions procedure which would include carrying out a full pre admission assessment. Evidence: At the time of the last Key Inspection (June 2009) the quality rating of the Home was considered to be POOR. Following this Norfolk County Council and Suffolk County Council suspended placements at the Home. The proprietor also agreed to voluntarily suspend placements of private fee paying residents. Therefore there have been new no admissions to the Home since that time which means that it has not been possible to assess whether pre admission assessments are carried out adequately. However, the Manager has an appropriate procedure with regard to this and would carry this out himself. Care Homes for Older People Page 10 of 28 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. The care plans do not provide clear guidance to enable staff to meet the residents needs in a consistent way. The dignity of the residents is compromised at times. Evidence: During the last Key Inspection it was found that the care plans were of a poor quality with little, or no, up to date information available to staff about how to meet residents needs. During the Random inspections in July and September we could see that improvements have been made but that the quality was still not sufficient to ensure that the residents needs are met in a consistent way. During this visit we looked at four of the care plans and daily notes. The acting manager has introduced a new format for the care records. The new format is detailed and when fully in use will direct staff to regularly review the care plans and daily information. However, currently these have not been fully completed and do not actually contain the care plans or risk assessments. The old care plans are locked in the office and so actually the staff do not have easy access to guidance of any kind Care Homes for Older People Page 11 of 28 Evidence: with regard to providing care to some residents and for others the information is in two places. For example, for one resident the most recent information about falls and healthcare professional visits the information is recorded in the new care plan format which the staff have easy access to. Information relating to managing difficult behaviours and other aspects of the residents care is still in the old care plan which is locked in the office. For the same resident we were told by staff that there had been a suggestion about the use of bed rails due to the resident falling. We could see that bed rails were not in place in the residents bedroom and when we asked the acting manager about this he explained the reasons for this and the alternative safety measures that were in place. However, there were no records of this or a risk assessment within the residents care records. The quality of the daily notes is varied with some containing good detail and others only containing limited information. For one resident the information in the daily notes was contradictory to information from staff about their behaviour. For example, according to the residents medication chart they had been given PRN (as required) medication for aggressive behaviours during the morning of three consecutive days but according to the daily notes the residents behaviour during two of those mornings was sleepy and quiet. There were no records of aggressive behaviours. Staff said that since the previous management team have left the Home they are now receiving more consistent advice about care needed by the residents and about how this should be provided. One of the senior carers has taken on more responsibility and provides consistent leadership to the other care staff. Staff told us that the Senior and the acting manager communicate with the staff team in a positive way and that they feel better supported now. We received completed surveys from two health care professionals and these said that the care staff usually/sometimes monitor and meet the residents needs adequately and that they usually/sometimes seek advice and act upon it. The response was the same with regard to whether the staff respect the privacy and dignity of the residents. Additional comments were made, such as that the care has improved since the change in management and praising the senior carer who has taken on additional responsibilities. There were also comments about the need for staff to have additional expertise and training with regard to providing care for residents with dementia, particularly those with difficult behaviours. We received 9 surveys from residents which had been completed with assistance from Care Homes for Older People Page 12 of 28 Evidence: staff or relatives. 7 stated that they always receive the care and support that they need and 2 stated usually. The responses were equally mixed between always/usually/sometimes to the question about whether staff are available when they need them. Additional comments were made about staff being very busy and not always available to help when needed. There were also more positive comments such as that there is a good atmosphere in the Home and that there is good communication between staff and residents. We received 2 surveys from staff and both state that they receive up to date information about the needs of the residents. The responses are completely contradictory to the question about whether there is enough staff with one stating always and one stating never. During this visit one of the Inspectors carried out a SOFI (Short Observational Framework for Inspectors) observation over a two hour period. This involved the Inspector spending two hours in the lounge observing interactions with five specific residents. The results of this showed that the interactions that staff did have with residents were all positive but that staff mainly interacted with residents who initiated the interaction in some way. In general the residents who did not initiate interaction did not receive any. Residents spent a considerable time with no interactions with anybody. At the time of our previous visits several of the residents had pressure sores which were being treated by the District Nurses. During this visit staff told us that there is only one resident with pressure sores and that these are healing well. There is also a resident with a skin tear following a fall which the District Nurses are attending to. Staff said that the system for obtaining healthcare input for residents has improved and that they now contact the GP and District Nurse at an earlier stage than previously. The acting manager said that the opticians visit the Home and are due to come in February. He said that the chiropodists visits the Home on a regular basis. The residents have not been supported to see a dentist for some time, this was confirmed by a relative who told us that she had been asking the staff to arrange a dentists appointment for her relative for over a year. However, the acting manager told us that they have just made contact with a local dentist and are in the process of registering residents with them. At the time of our visit there were 40 residents with dementia living at the Home. There were six staff on duty from 8am to 2pm and one staff who worked 9am to 3pm. Care Homes for Older People Page 13 of 28 Evidence: There were six staff on duty from 2pm to 9pm. One of the staff on each shift is the senior carer who is responsible for administering medication. The acting manager said that there are usually six staff on duty during the day but that they are aiming to have seven staff on duty. Staff told us that they do not have much time to spend with individual residents other than when assisting them with personal care. We observed that staff were very busy and that they spent very little time with individuals. This was confirmed through the SOFI observations. During this visit we looked at the medication system. Since the previous management team left the Home one of the senior carers has taken on the responsibility for ordering and checking in medication. Both the senior carer and the owner of the Home have attended training with regard to the use of the monitored dosage system. We could see that records are kept of medication that arrives at the Home and that which is returned to the pharmacy. There were no gaps in the medication administration records. Medication is stored appropriately. The requirement that was made at the last Key Inspection with regard to the need for PRN (as required) guidance for those residents who are prescribed medication on a PRN basis has not been met. In addition to this the daily notes do not provide evidence for the use of PRN for the resident whose medication we tracked. As mentioned earlier in this section of the report the daily notes stated that the resident was quiet and sleepy but they had been given PRN medication for aggressive behaviours. We observed the staff speaking kindly and respectfully to the residents. However, during this visit we saw examples of the residents dignity being compromised. For example, during our visit we looked around the Home. During our look around we looked in several of the bedrooms. In five of the bedrooms we found that the beds had been made but that the sheets and pillow cases were dirty. There were brown stains on the sheets and in one room we found brown stains on the mattress and in another there were similar stains on the box of gloves in the ensuite bathroom. We also saw examples of how residents dignity is compromised during the main mealtime. The Home only has one dining room and this is not big enough to accommodate all of the residents. There are large tables with heavy chairs which residents find difficult to move. There is a lack of space for residents to move around the room. Residents were taken to the dining room from 11.50am but lunch did not arrive until 12.20pm. We observed two residents hitting out. We observed a resident Care Homes for Older People Page 14 of 28 Evidence: drink other residents drinks. One resident was shouting out continually and this was causing upset to other residents. Residents were asked to sit down and were constantly told by staff that dinner was coming but for some residents the wait was 30 minutes and they clearly did not understand why they were being asked to sit down. When the meal arrived there was no choice offered to residents and several residents were given a plate of dinner with no explanation of what it was or offers of help to cut up food. The dining experience was chaotic with some residents clearly quite distressed. Care Homes for Older People Page 15 of 28 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of meaningful activities provided to the residents. Residents nutritional needs are assessed but there is a lack of choice and the dining experience is not a positive one. Evidence: Two comments were made within the residents surveys about the need for activities to be provided on a regular basis. One of the care staff currently spends a couple of hours a day, four days a week, providing activities for residents. This is not adequate and the requirement for residents to be able to take part in meaningful activities has not been met. The majority of the residents spend their time in the large lounge, with some in the conservatory. The Home has another, smaller lounge but there are currently not enough staff to support residents to use this room.. As stated earlier in this report the mealtime experience was not a positive one for the residents. The dining room is too small for the amount of residents who are using it and the tables and chairs are not easy for the residents to use. Residents were not given a choice about the meal they were given as this was already on the plates. They Care Homes for Older People Page 16 of 28 Evidence: were also not given a choice about drinks as these were already poured into the plastic glasses on the table. We spoke to the cook and she said that only one main meal is prepared and that when sandwiches are made there is only one choice. However, she said that the staff know the residents likes and dislikes and if someone does not like what is on offer then an alternative is provided. The residents who need their food liquidized have everything liquidized together rather than seperately. Residents did say that the food is tasty and that they enjoy their meals. Care Homes for Older People Page 17 of 28 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. Staff are aware of the whistleblowing policy and are confident that concerns will be dealt with appropriately. Complaints are responded to appropriately. Evidence: The acting manager and proprietor of the Home have worked co-operatively with the Commission and Social Services during recent safeguarding investigations. At the time of the previous Inspection care staff were not confident in raising concerns due to problems within the management team but during this visit they said that they feel more confident now about raising concerns. Both of the returned staff surveys stated that they know what to do if someone wants to raise a concern. The responses within the residents surveys are mixed with some stating that they know about the formal complaints procedure and others saying that they are not aware of it. We looked at the complaints record and could see that the acting manager had responded appropriately to the one complaint recorded there. We looked at the Safeguarding procedure and this needs to be linked to the local authorities safeguarding procedure to ensure that staff know how to refer any concerns or allegations appropriately. Since the last Key Inspection nearly all of the staff have all received updated Safeguarding training. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides comfortable accommodation for the residents. Some areas of the Home are not kept clean and hygienic. Evidence: There have been several improvements to the accommodation since the last Key Inspection. An additional bathroom has been refurbished and has an appropriate bath for those who need an assisted bath. One of the toilet areas has also been refurbished and the missing call bells have been replaced. The raised covers in the floors in the corridors have been lowered and are no longer such a trip hazard. A new chair lift has been fitted to the main staircase. Window restrictors have been fitted to the ground floor windows. The fence around part of the garden has been replaced to provide additional height. We ran the hot taps in the ensuites in the bedrooms and found that the hot water appeared to be extremely hot. The proprietor arranged for a plumber to visit the Home on the day of our visit to fit temperature regulators to the taps. As previously mentioned in this report we looked at a selection of bedrooms and found that they were dirty and unhygienic. Beds had been remade despite the fact that the sheets and pillowcases were stained. In one of the ensuites there were brown stains, Care Homes for Older People Page 19 of 28 Evidence: possibly faeces, on the box of gloves. The bedrooms are personalised and some have had new furniture and been decorated. Care Homes for Older People Page 20 of 28 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. The staffing levels are not adequate to meet the needs of the residents in a consistent way. Staff training has improved and further training is planned. Staff are kind and positive about the working at the Home since improvements have been made there. Evidence: The current staffing levels are for there to be six staff during the morning with an additional member of staff on duty from 9am to 3pm. There are also six staff on duty in the afternoon. There are three staff on duty over night. In addition to this there are catering and domestic staff. Since the last Key Inspection the catering staff have been increased so that care staff do not have to prepare tea which is an improvement. The current staffing levels do not enable staff to have much time to spend with residents on an individual basis and there are very few activities available. The staffing levels mean that the second lounge is not able to be used as there are not enough staff to support residents there. At the time of our visit we noted that a member of staff was on the rota to work an afternoon shift followed by a night shift which would mean that they were on duty for approximately 16 hours. We issued an Immediate Requirement that this situation does not occur again. The acting manager told us before we left that he had arranged for Care Homes for Older People Page 21 of 28 Evidence: another member of staff to work during the afternoon and that staff would no longer work those long hours. At the time of the last Key Inspection there was little training provided to staff. Since then, additional training has been provided in mandatory subjects such as moving and handling and safeguarding. The acting manager is auditing the training records that are available and planning further training. There is a real need for staff to have training about working with older people with dementia. The induction for new staff also needs to be reviewed to ensure that it meets the necessary standards. The staff surveys that were returned to us contained additional comments such as: since the changes in management it has been much better here there is better communication we have more courses Additional comments on the residents/relatives surveys are as follows: staff are very busy there is not always someone available to help If I have any worries I never hesitate to ask staff staff are kind there is a good atmosphere staff are lovely We spoke to staff and observed them supporting the residents. Staff were kind and respectful when speaking to residents. Staff said that they enjoy working at the Home since the change in management and other improvements have been made. We looked at a selection of recruitment files and these contain the necessary information and show that appropriate checks are carried out prior to staff starting work. Care Homes for Older People Page 22 of 28 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 of the Home has improved and there is better communication and leadership provided to the staff team. Some of the health and safety issues have been addressed. A formal quality assurance system needs to be in place to be able to monitor the care provided. Evidence: At the Key Inspection in June 2009 it was identified that the management of the Home was poor and that there was a lack of leadership being provided to the staff team. The proprietor has taken steps to address this, and as a result, the previous management team no longer work at the Home. An acting manager was appointed to manage the Home six weeks prior to this visit. He has relevant previous experience and has already made some improvements and is in the process of identifying where further improvements are needed. The proprietor has also been much more involved in the running of the Home and continues to be actively involved. Care Homes for Older People Page 23 of 28 Evidence: One of the senior carers has taken on additional responsibilties and another experienced senior started work at the Home on the day of our visit. The senior staff would benefit from some form of management/leadership training. Staff told us that they feel much more positive about working at the Home since the previous management team have left. The acting manager has recently started to carry out formal supervision for staff. The acting manager said that they do not look after money for any of the residents. We looked at a selection of health and safety records and can see that regular maintenance and servicing of equipment is carried out. Previous requirements with regard to health and safety issues have been addressed, for example, the raised covers have been lowered and a new chair lift has been fitted. However, the temperature of the hot water presents a risk to the residents and needs to be addressed. There is currently no formal quality assurance system in place but the acting manager has started to carry out his own audit in order to prioritise the improvements that need to be made. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 It is required that the care 30/06/2009 plans contain detailed guidance about how to meet the residents needs To ensure that the residents needs are met in a consistent manner 2 9 13 It is required that there is 31/08/2009 clear guidance about the use of PRN (as required) medication To ensure that residents receive medication at appropriate times and in a consistent way 3 10 12 It is required that the privacy 30/06/2009 and dignity of the residents is respected To ensure that the residents are cared for respectfully 4 12 16 It is required that the residents are able to take part in meaningful activities To ensure that residents have a choice about taking part in meaningful occupation 30/09/2009 5 15 12 It is required that the dignity 30/06/2009 of residents is respected at mealtimes Page 25 of 28 Care Homes for Older People 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 To ensure that the needs of the residents are met in a respectful and dignified manner 6 18 13 It is required that the Safeguarding procedure is updated to reflect the local procedures To ensure that staff have clear guidance in the event of a concern being raised. 7 27 18 It is required that staff are 31/07/2009 provided in adequate numbers and with the right skills and experience to meet the needs of the residents To ensure that the needs of the residents are met 8 30 18 It is required that staff receive appropriate training in both mandatory subjects and areas relevant to the residents needs To ensure that staff have appropriate training to enable them to carry out their roles effectively 9 33 24 It is required that an effective quality assurance system is in place To ensure that issues are identified and action taken to make improvements 30/09/2009 31/12/2009 30/06/2009 Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 13 It is required that the hot 15/01/2010 water temperatures are regulated in the ensuite baths and that a risk assessment is carried out for all other hot water outlets. To reduce the risks to the residents of scalding 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 Care Homes for Older People Page 27 of 28 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. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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