Inspection on 24/06/09 for The Briars

This inspection was carried out on 24th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Briars 27/06/07

The Briars 20/06/06

The Briars 23/03/06

The Briars 30/08/05

The Briars 31/03/05

The Briars 07/01/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Briars 4 Station Road Thornton Cleveleys Lancashire FY5 5HY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jennifer Hughes     Date: 2 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Briars 4 Station Road Thornton Cleveleys Lancashire FY5 5HY 01253854722 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Ellen Hewitson,Mr Martin Paul Hewitson care home 15 Number of places (if applicable): Under 65 Over 65 15 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 15 Date of last inspection Brief description of the care home The Briars is situated in Thornton Cleveleys near Blackpool. It is a detached property, with shops and amenities nearby, and there is easy parking in the roads alongside the home. The home provides personal care for up to 15 older people, and is equipped to suit the needs of the people who live there. For example, a passenger lift gives people access to the first floor, and ramps are provided for wheelchair access. Bedrooms are all single occupancy, and are on both the ground and first floors. Two of the bedrooms are ensuite. Toilets and bathrooms are conveniently located. Care Homes for Older People Page 4 of 31 Brief description of the care home There is sufficient communal space, made up of a lounge, a dining room, and a small conservatory, which is also presently used as a smoking room. A small tidy garden is available for the use of residents. The home has achieved the Investors in People Award. As at June 2009, the fees ranged from £386.50 to £435 a week. Further information can be obtained from the manager. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home, in that the owners were not aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 and a half hours. Every year the registered persons are asked to provide us (CQC) with written information about the quality of the service they provide. We use this information, in part, to focus our assessment activity. This document is called the Annual Quality Assurance Assessment (AQAA). Care Homes for Older People Page 6 of 31 Surveys were sent to residents and staff at the home. We received 4 surveys back from residents. No staff surveys were returned. During the site visit staff records and resident care records were viewed, alongside policies and procedures of the home. The manager, residents, and care staff were spoken to, along with any visitors who called during the day. Their responses are reflected in the body of this report. A tour of the home was made, viewing the lounge, dining room, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. What the care home does well: What has improved since the last inspection? What they could do better: A formal pre-admission assessment could be carried out by the home with prospective residents before they move into the home, to ensure the staff at the home are able to care for them appropriately. The care plans could be better by showing how the health and welfare needs of residents are to be met, to ensure that the residents always receive individualised care from staff. The risk assessments could show how any identified risk for residents can be minimised, so that the health and safety of residents can be protected as much as possible. Care Homes for Older People Page 8 of 31 Each resident could have an assessment of their capacity to make decisions, as stated in the Mental Capacity Act 2005. Then it would be clear when people could continue to make decisions over their own lives, whenever possible. There could be clear records available for each resident, to show the pattern of care needs and care provision during their stay at the home. The manager could make sure medication records are formally audited at least monthly to help make sure they are handled safely and staff are competent. Residents could sign medication declaration forms, showing who is taking responsibility for administering their medication. The residents interests and hobbies could be clearly recorded, and the home could provide more opportunities for stimulation through leisure and recreational activities in and outside the home. Records of any routine maintenance required, and carried out, could be kept up to date. Records held of the recruitment of all staff employed at the home could be clear and complete. Records held of staff development and training programmes could also be clear, and the content of their training could meet the changing needs of the residents. The quality monitoring system of the home could be improved, with regular and formal auditing of records, and also by actively seeking the views of family, advocates and health professionals on how the home is achieving goals for residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Formal information about each prospective residents needs is not fully gathered before they move into the home, to ensure the home is the right place for them to be looked after. Evidence: Individual records are kept for each person living at the home. At our last visit we saw evidence of the procedures in place to admit someone to the home, with pre-admission assessments being carried out. These were used by management to check that staff could give suitable care to that person, before the manager agreed that the home was the right place for them to live. At this visit there was no evidence of pre-admission assessments being carried out. The manager told us that he visited prospective residents at home or hospital, to Care Homes for Older People Page 11 of 31 Evidence: discuss their needs, and decide whether they could be appropriately cared for at the home. He said that on admission the manager or senior staff would then carry out a formal assessment of need and start developing a care plan, and during the initial four week trial period both the resident and the home could decide whether it was the right place for them. On examining the residents files it was not clear what the assessment had been on admission, as many records had been archived and were difficult to find and put in order. The manager must ensure the procedures followed always include a formal preadmission assessment, as stated in regulation 14 of the Care Homes Regulations 2001, and standard 3 of the National Minimum Standards for Care Homes for Older People. These should be signed by the prospective resident or their family to show their participation and agreement in the decision. Any emergency admissions may only have assessments carried out on admission. A visiting relative told us that the manager visited her mother before she moved into the home, when he assessed her care needs and gave them information about the home. She confirmed people are able to visit the home and stay for meals or drinks to try and help them make a decision on staying there. Staff we spoke to were able to discuss the needs of the residents they cared for, and said that information was always passed on to them about any new or changing needs. A new senior staff member in post was in the process of structuring the files to show a clear path through each persons assessments and reviews, to the up to date care plan. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a basic care planning system in place that does not provide enough detailed information for staff to provide person centred support. Residents benefit from the support of healthcare professionals. Evidence: At the last visit the manager had been developing and improving the individual care plans of residents, which gave staff better information and so helped them provide better care. At this visit we found each persons file held only the latest information, and it was not clear on how often reviews of the care provided had been carried out since the person had been admitted to the home. This was due to past information being archived and being difficult to find, so there was no clear history available of the needs and care provided to the residents. The care plan used was in a generic tick list format, and we advised that this needs to Care Homes for Older People Page 13 of 31 Evidence: made more person centred and individual for each person. For example, one care plan indicated the person needed assistance with evening bathing, but gave no detail on what help they needed or how it should be given. Another stated likes a drink now and then, with no information on what sort of drink, or when they prefer to have it. Another care plan stated vision not brilliant, which does not explain to staff what this means for the person, or what the best way is to address the situation. We saw that any changes in need are noted in the care plans where we could find the reviews, although on occasion the changes did not link to previous records. For example, for one resident their care plan had stated needs assistance to wash and change, and their new care plan gave no indication this was needed, with no record that their health had improved to enable them to now manage this. Another care plan had informed that the person needs wheelchair when going out, when the most recent care plan did not mention this, or any improvement in mobility. There needs to be a clear overview of the care needs and the care provision of each person during their stay at the care home. The records should show evidence of regular reviews, with care plan updates if needed. Archived records should be structured and easily accessible. Care plans need to be person centred and inform staff on the specific care needed by each resident. We noted that a new senior staff member was in the process of making all of the care information up to date and correct, and she discussed plans to ensure regular reviews and updates were formally carried out. There was no recent evidence on the files we viewed that the residents had participated in the decisions made on the care required, and the manager needs to ensure agreements are clear with signatures from the resident or their family on the care plans. There was no clear evidence that an assessment had been made of an individuals capacity to make decisions, and the manager needs to ensure this is carried out. We saw that staff made records for each person at least three times a day, informing on how they were and any events in their day. There was evidence of visits from healthcare professionals and liaison with social services. Day to day care is very good said a resident. A visiting relative commented, We looked at a few homes and this seemed the best. Little things count - like my mums skirts seemed too tight and a carer tried all of them on with her to check so I knew what to buy for her. She is very happy here. Care Homes for Older People Page 14 of 31 Evidence: A staff member told us, This is a nice place to work. The senior always passes information on about new residents or changes and I always feel that I have enough knowledge to be able to provide the right care. Staff we spoke to were able to tell us about the care people living at the home needed. The problems seemed to be linked to the recording of the care needed and given rather than the provision of it. We viewed the Medication Administration Records (MAR) and found them to be generally up to date and complete. The staff involved with medication had received recent medication awareness training from their pharmacist. All medication was stored securely, including controlled drugs (medication open to misuse). The manager said that he audited the medications about every two months. We advised he made a formal audit of the medication records and procedures carried out at least every month. There were no medication declaration forms available on residents files. The manager should ensure each resident signs a declaration to show agreement that either the home is taking responsibility for administering their medication, or the resident is taking responsibility themselves. Self administration would also be linked to a risk assessment of the residents abilities. We saw that staff had an awareness of the need to uphold the privacy and dignity of the residents. We saw them tactfully and gently guiding residents to where they wanted to go in the home, and advising and helping those who were a little confused. One resident wished to join in with a staff meeting and discussion, and was welcomed into the group. Doors were closed when any personal care was being carried out. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals are nutritious, and residents are encouraged to enjoy food and mealtimes. There are some social activities, meaning that people are sometimes being provided with stimulation. Evidence: The individual care plans contain minimal information on each persons likes, dislikes and preferred activities. There is some social history information, but no guidance on how to motivate and stimulate each individual. In one care plan one comment under social interactions was likes hairdresser. The manager told us We still find it difficult to motivate the residents with activities, they do seem to prefer chats with the staff. Weve purchased games and quizzes and try those, and a pianist calls for a sing-along. A staff member agreed, and said we try to do activities - Ive just done their nails so we had 1:1 chats. An activities record shows a small amount of activities such as board games and singing. We spoke to some residents in the lounge, where one lady was busy knitting. Another said she didnt want to do any activities, or sit outside in the good weather. Care Homes for Older People Page 16 of 31 Evidence: Others said they were happy to sit and not do anything, and they wanted to rest. The manager said they try not to have the television on all the time so as to encourage some conversation. One resident said Its really good here. They make me feel part of everything and that Im useful. I enjoy watching what goes on. Staff listen to me if I want to say something. The manager needs to continue to try and develop the activity programme so as to provide some stimulation to suit the interests and needs of the residents. There are sometimes activities we can take part in, was a comment on a residents survey. Visitors are able to call when they wish, and we saw relatives popping in through the day. The residents confirmed that church ministers call. The menu has been improved, as previously the meals were devised on a day to day basis. The menu is now planned for the week, with meals that residents have chosen, and said they enjoy. We saw the fresh fruit and vegetables store in the kitchen, with good stocks of other produce. We spoke to staff who helped prepare meals, and they were aware of residents likes and dislikes, and any special diets. We advised that a daily menu board should be on view to inform residents what the meal of the day was. Residents surveys were positive about the meals at the home, all agreeing they always liked the food and one stating The food is fresh and prepared in their own kitchen Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident their concerns will be listened to and acted upon. Staff have an understanding of safeguarding issues, which protect residents from abuse. Evidence: There is a complaints procedure in place, and it is available for residents and visitors in the Service User Guide, and in the entrance hall to the home. A complaints book records any complaints that have been made. There have been none since the last inspection. We discussed the benefits of recording minor dissatisfactions, and using them as a quality assurance tool, noting areas the home could possibly improve in. Residents told us that staff always listened to them, and that they knew who to speak to if they were unhappy. We noted that all of the residents were very relaxed with the staff and manager, and were comfortable saying what they did and did not like. All homes are required to have written procedures in place to be followed if it is suspected that a resident has been the victim of abuse. These are generally referred to as safeguarding procedures. We found that staff had been trained in the procedures to follow, and they confirmed that the issues were also addressed in their National Vocational Qualification (NVQ) training. Care Homes for Older People Page 18 of 31 Evidence: Staff told us that they were aware of the Whistleblowing policy of the home, and knew they could report any concerns in confidence to the manager. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a generally well maintained environment, which provides aids and equipment to meet the care needs of the residents. Some areas of risk are not always addressed which may affect the safety of residents. Evidence: There is a small lawned area at the rear of the home that is usually kept tidy, with patio furniture so that residents can sit outside in the better weather. We viewed a selection of rooms in the home, and found them to all be nicely decorated and clean. We saw that they held a variety of personal possessions of the residents, including pictures, ornaments and small pieces of furniture. Its nice to have your own things around you commented a resident. We noted that the lounge and dining room and some bedrooms had been decorated, and new carpet had been laid in large areas of the home. We noted that some of the divan beds were lacking valances, and the manager agreed that staff had omitted to replace the clean ones. We saw one bathroom contained a stock of communal toiletries on show, such as shampoo and talcum powder, which the manager explained were for the use of those residents who had none of their own. We advised these should be locked away securely to ensure the safety of residents. We also saw a tub of skin cream in the Care Homes for Older People Page 20 of 31 Evidence: bathroom. The senior agreed that should not have been left there, and immediately removed it to store with the medication. An instruction list was on the wall in the bathroom, outlining bathing procedures for staff with residents. We advised that this should be removed, as it created a clinical and impersonal environment in the residents home. We saw that a small stair gate had been placed at the top of the stairs, and were informed it was for the safety of one short term resident, when they were upstairs. We advised that this could be restricting other residents and could also be a risk to people, who could fall over it. We advised that this should be removed, and senior staff took action to make sure this was done. We confirmed that a risk assessment should be carried out on the use of a first floor room, if use of the stairs was a risk to someone. Grab rails, assisted bath, raised toilet seats and a lift all go towards helping the mobility of people around the home. There is a dedicated cleaner and handyman, who keep the home clean and up to date with any maintenance. Any work needing to be done is usually recorded and signed off when completed. The manager needs to ensure this record is up to date in order to be able to monitor the outcomes as part of the homes quality assurance audit. The manager told us there is a rolling programme of maintenance and decoration. There is a dedicated smoking area for residents in the sun lounge at the rear of the home. The manager confirmed that the room had been checked by Wyre Borough Council who were satisfied it complied with legislation. The residents told us that the home is usually fresh and clean. The laundry area was clean and tidy, with an organised procedure to ensure no laundry went missing. The manager told us that there is an infection control procedure in place in the home, and so far three staff members have received training in the prevention and control of infection. A relative said Its a homely, caring atmosphere Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported by sufficient numbers of staff. Incomplete recruitment and training records do not always show that staff have the appropriate skills to provide the right care. Evidence: There is a standard recruitment procedure in place at the home, which it was not always possible to evidence when viewing staff files. The manager needs to ensure there is a clear path through the recruitment process, showing date of application, references and Criminal Records Bureau (CRB) checks, date of the start of employment, both under supervision and without, and induction training. There was no clear start date on any of the three files viewed, and one of the files held verbal references only. We confirmed that written references must be obtained. Protection of Vulnerable Adults list (POVA 1st) and CRB disclosures had been obtained for all three staff members shortly after the application form had been completed. We saw that induction training started for staff at the time the POVA 1st check was received, although one file held little information regarding ongoing training and Care Homes for Older People Page 22 of 31 Evidence: appraisals. All staff are provided with in-house training supplied by an external trainer, which consists of written information and DVDs to study. We saw the training matrix, which showed courses had included health and safety, first aid, moving and handling, food hygiene, and fire safety. These hold good information, and we discussed with the manager the need for more direct training for staff from a training provider, which would include more participation and two way communication. The manager confirmed he had changed to a new training organisation who would provide personal in- house training, and the results from this will be viewed at our next visit. National Vocational Qualifications (NVQ), are attended by staff, and the manager confirmed that 64 of staff hold NVQ qualifications. A relative commented The carers make every effort to get to know the residents individual needs and act upon them Residents surveys commented that staff were always available when they were needed. We spoke to some residents who said they were happy with how they were looked after, and one said the staff will do anything for you, and another said They make you feel part of it all. The rota showed appropriate staff on duty, with usually three care staff working before lunch, and two after lunch. There is one waking watch overnight, and one staff member sleeps in. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and staff are working to improve services to protect the health and safety of residents. Evidence: The manager of the home has six years experience, and has achieved his Registered Managers Award (RMA). The home holds the Investors In People award, showing a commitment to the development of staff, and is on the local authoritys Preferred Provider list. A visitor to the home told us Im always made very welcome, and the manager and staff are there to speak to if I need. Surveys received by us stated , My mother is very happy at The Briars and we are satisfied with the excellent care she receives, and It creates a homely caring atmosphere. The manager told us that he sends surveys out to residents and their families about Care Homes for Older People Page 24 of 31 Evidence: twice a year. We viewed some recently returned surveys which were all positive about the home. The manager said that there were no residents and relatives meetings, as they said meetings were not needed as they spoke to the staff all of the time. We advised that any decisions made about the care provided at these informal discussions should be recorded. Staff meetings have recently resumed after none taking place for a while. An agenda is provided for each one, and we advised that minutes should be taken to evidence for all staff what discussions and decisions have been made. We saw that some staff one to one supervisions had taken place. The manager needs to ensure that these address any training needs that are linked to the specific needs of the residents, outside of the mandatory courses, such as dementia awareness. This would enable staff to develop relevant skills in the provision of care to all residents. As mentioned previously in this report, the manager needs to ensure that residents records are well maintained, contain enough detailed information so staff can provide the right care, and are up to date. Staff records also need to be structured so that there is a clear path through the recruitment and training records for all staff. This will help to identify staff competancies and training requirements, and so enable staff to meet the health and welfare needs of the residents. The manager has no financial responsibility for any of the residents money, and any small amounts left by relatives for the residents are securely held and recorded. We advised obtaining the signature of the person leaving the money to confirm the amount and the balance on the record. The senior staff on duty immediately actioned this advice on the day of our visit. The manager told us he audits all records every couple of months to have a picture of what is happening in the home. There was no evidence that these audits were carried out, and we advised they should be done more often, particularly the medication records, with some indication, such as a signature, that the audit had occurred. The health and safety audits also need to be regularly reviewed to ensure procedures being used in the home are appropriate, such as leaving products freely available in bathrooms, and the use of a stair-gate. We viewed accident records, and saw that any accidents are recorded, and also noted in the daily notes of the resident involved, with a risk assessment carried out if needed. Care Homes for Older People Page 25 of 31 Evidence: We viewed some maintenance and service certificates for equipment in the home and found them to be up to date. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 A formal pre-admission assessment must be carried out with the prospective resident before they move into the home To ensure the staff at the home are able to care for them appropriately. 31/07/2009 2 7 13 The risk assessments must show how any identified risk for residents can be minimised So that the health and safety of residents can be protected as much as possible. 31/07/2009 3 7 14 There must be evidence of resident participation in the decisions made on the care to be provided To show that the resident has been involved and agrees with the plan of care. 31/07/2009 Care Homes for Older People Page 28 of 31 4 7 15 The care plans must clearly show how the health and welfare needs of residents are to be met. So that the residents receive person centred, individualised care from staff. 31/07/2009 5 37 17 Records for staff and residents must be kept well maintained and up to date, as specified in schedules 3 and 4 of the Care Homes Regulations 2001. So as to enable constant monitoring that residents needs are met by suitable staff. 14/08/2009 6 38 4 Unnecessary risks to the health and safety of residents must be identified and as far as possible eliminated. So as to provide residents with a safe place to live 14/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 An assessment should be made of each residents capacity to make decisions, as stated in the Mental Capacity Act 2005. This is so that it is clear when people can continue to make decisions over their own lives whenever possible. Records should be available for each resident to show the pattern of care needs and care provision during their stay at the home. There should be medication declaration forms, signed by Page 29 of 31 2 7 3 9 Care Homes for Older People the resident, regarding who is taking responsibility for administering their medication. 4 9 Medication records should be formally audited at least monthly to help make sure they are handled safely and staff are competent. The residents interests and hobbies should be clearly recorded, and they should be given opportunities for stimulation through leisure and recreational activities in and outside the home. All parts of the home residents have access to should be free from hazards. Records of routine maintenance required, and carried out, should be kept up to date. The quality monitoring system should be developed with regular formal auditing of records, and by actively seeking the views of family, advocates and health professionals on how the home is achieving goals for residents. 5 12 6 7 8 19 19 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!