Inspection on 05/07/09 for The Gables

This inspection was carried out on 5th July 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Gables 14/12/09

The Gables 07/05/09

The Gables 02/11/07

The Gables 06/06/07

The Gables 13/06/06

The Gables 19/12/05

The Gables 06/04/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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: The Gables 1 East Park Street Chatteris Cambridgeshire PE16 6LA     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: Lesley Richardson     Date: 0 5 0 7 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 Gables 1 East Park Street Chatteris Cambridgeshire PE16 6LA 01354693858 01354696400 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Stargate Partnership Ltd care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home The Gables is an old largely Georgian house in the centre of the small Cambridgeshire town of Chatteris, which has been updated and extended to provide accommodation for up to 41 older people. The accommodation is split over two floors. On the ground floor, there are bedrooms and communal areas, which provide secure accommodation for 17 older people with dementia, and on the first floor facilities for up to 24 older service users without dementia. There are bathroom and toilet facilities on both floors, and a large enclosed rear garden. On the day of the inspection the manager said that the fees ranged from 347 to 530 pounds. Copies of CSCI inspection reports are in the entrance hall. 3 1 1 0 2 0 0 8 0 0 0 Over 65 17 23 1 Care Homes for Older People Page 4 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: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a key inspection of this service and it took place over 5 hours and 5 minutes as an unannounced visit to the premises. There were 2 inspectors at this inspection. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. There have been 7 requirements and 2 recommendations made as a result of this inspection. Information obtained from the Annual Quality Assurance Assessment (AQAA) and from returned surveys was used in this report. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We gave Care Homes for Older People Page 5 of 28 surveys to the manager for all of the people now living at the home, their relatives and staff during the inspection. We have not received any of these surveys back. 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 the amount of personal detail in some care plans has improved, this needs to happen for all care plans. When new plans are written all the relevant information must be included from the previous care plan. Information about social needs and what people do during the day should also be written in more detail. One word information, such as outings or cooking is not enough to show where the person went or exactly what they did, and it also doesnt give a good idea of whether the person enjoyed the experience. All plans must be reviewed and changed when peoples care needs change. They should be reviewed every month. Risk assessments are completed, but they do not all contain enough information to show what the risk is or the actions that could be taken to reduce the risk. Medication records are completed and show clearly whether people have been given their medication or not. Handwritten additions to prescriptions arent signed or dated and this was also found at the last key inspection in October 2008. We have made a requirement as no action was taken to improve this area. Storage temperatures must Care Homes for Older People Page 7 of 28 also be kept to make sure that medication is not kept in an area that is too hot. There are no details in the home of any complaints made, or whether no complaints have been made in the last 12 months. Staff members have a satisfactory knowledge of abuse and reporting procedure, but this doesnt always happen. There are currently 2 safeguarding investigations about the home. During one investigation we were told that staff had not referred incidents of possible abuse, even though they were aware of the procedure. The homes environment is not ideal for people with dementia; the corridors in the dementia unit are narrow and too dark, which makes it difficult to see. Although the ground floor is being redecorated there are few orientation aids for people and peoples room doors dont have their names on. People cannot get to the garden without help, one person said, I would love to get out to the garden but Im not allowed out without a carer. One of the bathrooms has chipped bath panelling, sink unit doors and the floor was badly stained. The bath hoist is broken and needs repairing. Not all recruitment checks are obtained before new staff start working at the home. This must be improved to make sure people are safe to work at the home. Staff members are not receiving supervision, which means they do not have the opportunity to talk in private about practice issues and training needs. They have not been receiving enough support to do their jobs properly. Training records show that not all staff have received mandatory training, such as moving and handling. The Fire Safety Officer visited in June 2009 and made a requirement that staff receive adequate fire safety training. The Fire Safety Officer also made requirements for there to be more fire drills, for checks on the emergency lighting and alarms to be completed at required intervals and for changes to 2 fire doors. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before care starts, which means the home knows whether staff can care for the person properly. Evidence: Assessments are completed before people move into the home and assessments by health and social care teams are also obtained to provide more information. We were not able to look at assessments that had been completed before people had been admitted to the home. There are very few people living at the home now and all but one has lived there for a number of years. We saw Service User Guides in peoples rooms, which were also available in large print during our inspection visit. Because this outcome group was rated good at the last inspection we have few concerns that peoples needs are not assessed before they move to the home. The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes. 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. Care and medication records are not completed accurately or in enough detail to ensure the health and welfare of people living at the home. Evidence: During the inspection people told us care staff are nice, are polite and treat them with dignity and respect. We saw this during the inspection, that staff knock on doors before entering rooms and have an easy, good natured rapport with people. We carried out a random inspection in May 2009 after we were told of concerns by the Local Authority. At that inspection we found that care plans had not been written for everyone living at the home and they had not all been reviewed or updated when there were changes. Risk assessments had not always been completed and people had not been referred to health care professionals when they should have been. Care plans for 5 people were looked at as part of this inspection. We found the care plans did not give staff members enough advice about how to meet all of peoples needs, but that the level of detail varied between different people. Two of the care Care Homes for Older People Page 11 of 28 Evidence: plans told staff some of those peoples preferences. For example, one persons plan tells staff how many pillows they like at night, what time they like to get up and go to bed, and how they behave when they dont like food thats given to them. However, this level of detail is not in all care plans. One person still had older care plans that had not been archived. These show that the person was sometimes aggressive when staff were helping them to wash and dress. This information hadnt been written in the new care plans, although staff members were able to tell us when the person is aggressive and how they manage the behaviour. Another person needs help and assistance with personal care, but the care plan doesnt give any more information than that. Of the 5 care plans we looked at, 3 had been reviewed in the month before our visit. Plans for the other 2 people had been reviewed this year (2009), but not within the last month. None of the plans were reviewed and evaluated every month. Plans for 2 people had not been reviewed for long periods of time; one persons for a period of 8 months and another persons for between 18 months (1 year and 6 months) and 21 months (1 year and 9 months). Some plans have been written recently (within the last 6 months), while other plans were written in 2007. Few of these had been changed in any way. Although plans for 3 of the 5 people whose care records we looked at have been reviewed within the last month, this has not been done often enough before the latest review. The requirement made at the previous inspection has not been met. Risk assessments are completed for identified risks to people, although some assessments dont have enough information to show what the risk is. For example, one person had 2 individual risk assessments for falls and nutrition. There was nothing to show what was wrong with the persons nutrition or why they were at risk of falling. There was, however, enough information to show how to reduce the risk of malnutrition or falls. The moving and handling risk assessment for this person indicates they might suffer pain, but doesnt say whether this is only during moving or at other times. The risk assessment also doesnt tell staff what to do about the pain to make moving the person safer. Another persons risk assessment for falls shows their risk increased from low to medium risk in June 2009. The care plan for falls had not been updated with this change or any information for staff about how to reduce the risk. A third person had a nutritional risk assessment completed in September 2008, May 2009 and July 2009. Although the risk score was highest in September 2008 and lowest in May 2009, it had increased again in July 2009. Weight records show the person is slowly losing weight and has a Body Mass Index (BMI) that is on the border of normal and underweight. This information had not been put into the care plan and there was no plan for staff to follow to make sure the person does not continue to lose weight. Care Homes for Older People Page 12 of 28 Evidence: There is information in peoples care records to show they have access to health care professionals, such as chiropodists and district nurses. However, the person mentioned in the paragraph above who has a weight loss has not been referred to a dietician or a speech and language therapist to make sure their diet and swallowing is adequate. Following the last inspection we asked the provider to complete an improvement plan. They told us staff received care plan training at the beginning of May 2009 and were to complete further training in the middle of June 2009. This would make sure that, staff understand and implement the correct documentation and act upon any changes identified and audits of the care plans and monthly reviews will ensure the residents needs are being monitored and updated when necessary. Although this process has started, the care records show that very little had been done before the beginning of July 2009 and there is no evidence that staff members had put any of this training into practice. We checked the homes medication storage area and a sample of residents medication administration records (MAR). MAR sheets were satisfactory with staff clearly recording when they had given residents their medication. However, hand written additions to these records had not been signed, dated or checked by a second person to ensure their accuracy. The date on which liquid medications in bottles had been opened had not been recorded and the temperature of the storage area was not monitored to ensure it was cool enough to store drugs in safely. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although activities are available and people can choose what they do, there is not enough guidance to show why it is important to encourage a range of experiences. Evidence: The home employs a specific activities co-ordinator for 20 hours a week who provides a range of games arts and crafts for people to enjoy. She also regularly takes residents out to the local church Chatteris Museum and to the market on a Friday. Despite this however one resident told us that there was not enough to do to keep her busy although she had greatly enjoyed last summers trip to Hunstanton. Unfortunately there is no information or posters available around the home telling residents what activities are available to them and when they are to take place. Information about what people do and time they spend with people is recorded on activity records, although this is limited to one word explanations, such as outing or cookery. This should be written in more detail to show where people go on outings and what they make. There is information written into care plans about what people used to like to do and what they like to do now. However, there isnt enough information to guide staff in how best to help people pursue activities or enable wellbeing (give people the ability to enjoy something and recognise this through their Care Homes for Older People Page 14 of 28 Evidence: body language). For example, one person used to like gardening but because of dementia doesnt express an interest in it now. There is nothing in the actions section of the care plan to tell staff that going out into the garden may be of benefit, whether the person is able to say they would like to do that or not. An entry in the daily notes shows that the person has recently been out into the garden, but there is nothing to show whether they enjoyed the experience. People are able to make everyday choices about when to get up and go to bed, and what to wear, if they are able to make this choice. We saw and listened to how staff members interact with people and found they ask what people would like and how they would like it rather than telling people or giving limited options. Staff members we spoke to know the people they care for and were able to tell us some of their preferences and how they like to be cared for. The home has an open visiting policy and people can have visitors at any time of the day. The main meal is served at lunchtime and there is usually a choice of two hot meals every day. The manager told us that this isnt happening at present because of the low number of people living at the home, the home needs to use its present stock of food. We saw lunch being served in both of the main dining rooms. Food was served appropriately in a relaxed and unhurried way and drinks were offered throughout the meal. Everyone we spoke to said they like the meals and the food is good. However, all 3 people at one table left food on their plates. One person who is slowly losing weight left approximately half of their meal, but staff did not offer anything else. One resident told us that sometimes the food served wasnt very hot. Care Homes for Older People Page 15 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information for people about how to make complaints, but people cannot be sure they are safe or their concerns will be dealt with. Evidence: Details of how to complain are contained in the homes statement of purpose and service user guide, copies of which are available in every bedroom. There is also a poster in the entranceway to the home giving information about how to raise their concerns. We asked for information about complaints in the Annual Quality Assurance Assessment (AQAA), but no information was provided. We were not able to find any information about the number of complaints received by the home during our inspection. Information about complaints received by the service in the previous 12 months must be provided to the Commission when we ask for it. The Care Quality Commission and previously the Commission for Social Care Inspection have received no complaints about the home. Staff we spoke to told us they had received training in how to protect vulnerable adults and showed a satisfactory knowledge of the different types of abuse a person can face and reporting procedures. However, we attended a meeting with the local safeguarding team the day after the inspection, which showed that incidents of abuse were occurring at the home, but were not being reported. There are 2 safeguarding investigations currently in progress about care provided and the safety of people at the home. Care Homes for Older People Page 16 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 is generally clean, but does not always provide a safe or pleasant environment for people to live. Evidence: The downstairs bathroom bath hoist was out of order and staff could not tell us how long it had been broken and if it was going to be replaced. The side panelling on the bath was chipped, scuffed and unsightly, the bathroom floor was badly stained and sink unit doors badly chipped and broken making it a very unpleasant environment for people to use. The downstairs corridors in the home are long narrow and dark making it difficult to manoeuvre wheelchairs and hoists and for residents to see where they are going. There are very few orientation aids and signs around the home to help residents find their way about. The manager told us they had been removed whilst the area is being redecorated. None of the bedroom doors had peoples names on them or anything significant on them to help them know where their bedroom might be. This is particularly important for those people with dementia who can frequently get lost. The home has a garden but it is not easily accessible and there are no signs around telling residents how to get there making them very dependent on staff if they want access to fresh air and sunlight. One person told us I would love to get out to the Care Homes for Older People Page 17 of 28 Evidence: garden more but Im not allowed out without a carer. Although the offensive smell in the ground floor lounge has reduced, there was a strong smell of stale urine outside the bedrooms near the kitchen door. The manager told us the carpet in the lounge area is going to be replaced. The Fire Safety Officer for the area visited the home in June 2009 and found that one fire door needs to be fitted with strips and seals and another fire door needs to have a fire closure device that would close the door properly. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are enough staff members most of the time, they do not all have the training and skills to be able to care for people properly and required checks are not always obtained before they start work, which puts people at risk. Evidence: There are 4 staff on duty in the morning, 3 staff on in the afternoon and two staff on at night to meet the needs of 12 people currently. This ratio of staff to people is unusually high only because many of the residents are moving out of the home. People we spoke to told us that staff were available when they are needed and they only sometimes waited a long time for help. One person said, I just ring the bell and usually the girls come quick enough. Staff told us they can be busy but currently have enough time to fully meet peoples needs. We checked the personnel files for 3 members of staff. Two of these staff had started working at the home before a POVA first check and full CRB had been received. This is a serious breach of the regulations and puts residents at unnecessary risk to their health, safety and welfare. There was no evidence that another member of staff had received any induction to her new job. There were also a number of shortfalls in staff training; one member of staff had not received any training in moving and handling, health and safety, food Care Homes for Older People Page 19 of 28 Evidence: hygiene, safeguarding adults or dementia care despite working at the home for over a year. Another member of staff had not received any training in how to move people safely since October 2007. The Fire Safety Officer for the area visited the home in June 2009 and made a requirement for staff to receive adequate training in fire safety. This training has been arranged. However, information in the Annual Quality Assurance Assessment shows almost three quarters (73 ) of staff have a National Vocational Qualification in care at level 2 or above. Care Homes for Older People Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home is not strong enough to make sure required checks are completed or that monitoring systems are in place, so that people can share their views and staff are supported. Evidence: The registered manager was suspended from the position earlier this year and now no longer works for the service. We had a meeting with the owner of the home and the group manager earlier this year about this issue and how they were going to improve the situation at the home. We had asked them to complete an improvement plan to tell us how they were going to meet requirements made at a random inspection in May 2009. They told us they would send us an action plan every week to show us how improvements and changes were being made. We didnt receive any of these. We did receive the improvement plan within the timescale we set for the service. A new manager to the home has been recently appointed and has been in post for about two weeks. She has previous experience in managing a home for older people Care Homes for Older People Page 21 of 28 Evidence: and has completed her Registered Managers Award and is about to complete a National Vocational Qualification level 4 in care. Staff we spoke to told us she was approachable, was good at keeping them informed of changes and felt confident she could turn the home around. She had already identified a number of the homes shortfalls and appeared keen and committed to sorting them out. We checked a sample of staff files which showed us that they were not receiving formal supervision of their working practices. One member of staff had only received 3 supervisions since December 2007 and another only 2, which is well below the recommended minimum standard. The home does send out questionnaires to people living there to gain feedback about the service they receive. These questionnaires are good and ask for peoples comments in relation to their environment, the quality of their care and the food. Most respondents on the questionnaires we saw were very satisfied with the service. However, these surveys were completed in May 2008, over a year ago and the home should send out new ones to get feedback about its current service. We asked the home to complete and return an Annual Quality Assurance Assessment (AQAA) before the inspection. They did not do this within the time we asked for it, but the new manager returned the questionnaire after we extended the time they had to return it in. The AQAA did not give us the information we asked for because it was completed by the new manager, who did not have all the information. No other person from the home or acting in a support role during the time when there was no manager was in place completed the AQAA when we asked for it. The home holds cash for some people. We checked a sample of cash sheets which showed that written transactions of all money spent on behalf of people are recorded and appropriate receipts kept. However, the home holds over £800 for one person. This money should be transferred to the persons bank account where it can be held securely and also gain interest. It was also not clear if the home is actually insured to hold this amount of money for people. We checked a number of records in relation to health and safety, including: gas, electrical appliances, hoist and lift service records, fire and emergency lighting. This showed us that the home regularly maintains and services its equipment to make sure its safety and effectiveness. However, there was no record available that the home regularly checks the temperature of its hot water to ensure that people are not at risk of scalding themselves. Care Homes for Older People Page 22 of 28 Evidence: Following the random inspection in May 2009, we contacted the Fire Safety Officer for the area. He has visited the home and talked to them about the checks they had not been keeping and the homes risk assessment. Requirements were made by the Fire Safety Officer about completing these checks, fire drills, improving fire doors and giving staff training. Another visit will be carried out to make sure the home is complying with requirements made. The home has recently been awarded 4 stars out of a maximum of 5 by the environmental health officer ensuring that people receive food that has been stored, prepared and cooked in hygienic and safe circumstances. Care Homes for Older People Page 23 of 28 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 24 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 7 15 Care plans must be updated when there are changes to identified needs. This is so that people receive the correct care and staff have up to date guidance about how to give that care. 31/08/2009 2 8 13 Referrals must be made to 14/08/2009 health care professionals if a risk assessment shows an increased risk. This is so that people and staff have up to date guidance about how best to reduce the risk and improve the health of the person. 3 9 13 Records must be kept to show the receipt of medication, their prescriber and storage conditions. This is so that medication is prescribed in a safe way, there is an audit trail for the 14/08/2009 Care Homes for Older People Page 25 of 28 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 medication in the home and it is stored in safe conditions, making sure it remains clinically effective. 4 16 22 Records of complaints made within the last 12 months must be kept and made available. This is so that the service and the regulating body (Care Quality Commission) are able to see the level of complaints made and how they have been dealt with. 5 18 13 Incidents of abuse or possible abuse must be reported. This is so that people are kept safe and incidents can be dealt with properly. 6 29 19 Required checks and documents must be obtained before new staff members start working at the home. This is so that the service can be sure that the person they employ is safe to work at the home and people living there are not at risk. 7 36 18 Staff at the home must receive supervision. This is so that they are 07/09/2009 07/09/2009 31/08/2009 31/08/2009 Care Homes for Older People Page 26 of 28 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 supported to carry out the role they are employed to do, identify training needs and give an opportunity for private discussion about practice issues. 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 2 33 35 A survey to obtain peoples views, so that the home can develop and improve should be completed every year. Large amounts of money held on behalf of people living at the home should not be kept unless for specific reasons. This is not safe and does not give the person the opportunity to earn interest on the money. 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). 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