Inspection on 09/12/09 for The Manor House

This inspection was carried out on 9th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Manor House 14/03/07

The Manor House 23/02/06

The Manor House 16/06/05

The Manor House 10/02/05

The Manor House 24/06/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: The Manor House 135 Loosleigh Lane Derriford Plymouth Devon PL6 5JE     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: Megan Walker     Date: 0 9 1 2 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 44 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 44 Information about the care home Name of care home: Address: The Manor House 135 Loosleigh Lane Derriford Plymouth Devon PL6 5JE 01752777572 01572776628 kathy@man-house.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: South West Care Homes Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 30 The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs are within the following categories: Old age, not falling within any other catetgory (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home The Manor House is registered with the Care Quality Commission to provide residential accommodation and personal care, for up to 30 persons for reasons of age and who may also have a dementia. The home does not provide intermediate care and it is not registered to provide nursing care. South West Care Homes Limited owns The Manor House. It is one of eleven care homes owned by the company across Plymouth, Cornwall and Somerset. The Manor House is located in the Derriford area of Plymouth, close to the hospital, Care Homes for Older People Page 4 of 44 30 0 Over 65 0 30 Brief description of the care home transport routes and other amenities. The home consists of a detached two-storey house with a two-storey extension and has been modified with ramps and a shaft lift. Thee are twenty-eight single bedrooms - sixteen on the ground floor and twelve on the first floor. There is one shared room on the first floor. Seventeen bedrooms have ensuite toilets. Bathing, showering and toilet facilities are available on each floor, close to bedrooms and communal rooms. There are lounge and dining rooms on the ground floor, as well as a smaller lounge with a dining table. There is a call bell system installed throughout the home. The home has a large garden at the rear and there is car parking at the front of the home and on street parking is available nearby. Weekly fees range from £359.28 to £494.33 per week, and are according to assessment of the persons individual care needs. Additional charges include hairdressing, chiropody, toiletries, newspapers, magazines, journals etc, all charged at commercial rates, and escort for hospital and GP appointments. Written information including information about additional charges is available for people considering going to live at The Manor House and for those who are resident. A copy of the most recent inspection report is available from the home. Care Homes for Older People Page 5 of 44 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 zero stars. This means the people who use this service experience poor quality outcomes. This unannounced inspection visit took place on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector. A Pharmacy Inspector was present for part of this visit specifically to look at issues about medication. The last key inspection took place on 22nd March 2007. This report is written on behalf of the Care Quality Commission (CQC). A tour of the premises took place and records relating to care, staff and the home were inspected. We met people who live at the home in the lounges, dining room, and in their bedrooms. We looked at how medication is administered, recorded and stored. The registered manager left the Manor House in the autumn 2009. A new person has been appointed to take day to day responsibility for the home, and has been in post since November 2009. In the report this person is referred to as the person in Care Homes for Older People Page 6 of 44 charge. This person was available throughout the visit for consultation and information. The registered provider joined us for the latter part of the visit. We received an Annual Quality Assurance Assessment (AQAA). The AQAA is a selfassessment that focuses on how well outcomes are met for the people who live in the home. We sent surveys for completion by people who use this service or their relatives/advocates, staff, and health and social care professionals. None had been returned at the time of writing this report. All this information helps us to develop a picture of how the home is managed and what it is like to live at the Manor House. Care Homes for Older People Page 7 of 44 What the care home does well: What has improved since the last inspection? What they could do better: The health,safety and well being of everyone who uses this service must be the main priority of the registered provider. This can be done by ensuring all staff are fully trained in all aspects of care, including recognising and reporting abusive practice, fire safety, moving and handling, first aid, infection control, and health and safety. This will ensure that all the staff care for vulnerable people in a safe and effective way which does not place them at risk. People who use the service must be safe at all times. They must have easy access to a call bell (it is within their reach), or systems must be in place to ensure people who are unable to use or access a bell are safe. Consultation with an Occupational Therapist would provide the registered provider with an assessment and advice about how the home and gardens could be as accessible as possible for the people using the service and thereby increase their independence. Before someone comes to live at the Manor House a thorough assessment of their health and social care needs must be carried out to ensure that the home is suitable, that any required equipment is available, and that the staff team are experienced, skilled and competent to meet the persons needs. These assessments need to be documented and include all aspects of personal, health, psychological and social care needs to ensure that peoples needs are fully identified. Once a person moves into a care home, or before, a care and support plan has to be developed with the person and/or relatives and representatives. This is to agree what care the person needs and how the staff team should support them. The care plans in the home need to include all aspects of peoples care needs and how the staff should meet those needs. The plans should include risk assessments for those people deemed to be at risk of falling, night-time routines, communication needs and details of peoples social activities, interests, hobbies and aspirations. Care plans should be signed by the people who live in the home and/or relatives/representatives to show that they have been involved in drawing up the plan and are aware of the content. Care Plans must also be improved to show that care has been reviewed and reflects Care Homes for Older People Page 8 of 44 the care that is actually given. Care records must be accurate. These improvements will mean that care staff have accurate records and will be able to provide care in a safe and consistent way. Care records should be informative and portray a positive picture of peoples daily life. Any equipment that is used in the home must be well maintained. Use of equipment such as bed rails and electronic devices to detect anyone who may be wandering, must be assessed to ensure these are safe to use and is the only method that can keep a person safe. Records must show why any equipment is in use and that good practice guidelines are being followed. Records must show that equipment that can be classed as restraint is only used in someones best interests. Mealtimes should be leisurely, at times that suit the people living in the home. They should be presented in a way that is attractive and appealing in terms of texture, flavour and appearance, in order to maintain appetite and nutrition. More social activities and outings should be provided, as well as engaging residents in activities of daily life in the home. Infection control practices must be improved in the home to reduce the spread of infection in vulnerable people. The registered provider should seek the advice of the Health Protection Agency and ensure staff receive training in the use of personal protective equipment. As well as ensuring staff are aware of how to reduce infection, the cleanliness of the home must improved for the same purpose. Staff must be aware of how to correctly report allegations of abuse to the local safeguarding team and be aware of how to report poor practice. This will protect people by making sure allegations are reported correctly and poor management does not affect any investigation that needs to take place. Staff must also be aware of what the Mental Capacity Act is and how their care practices could be seen as restraint. The use of restraint must only be used as a last resort and where the use is in the best interest of the person and not for the convenience of staff. The Provider must keep staffing levels under review to ensure that people have their care needs met in a way that respects their privacy and dignity. This review must also include the mix of staff skills and duties they are expected to achieve during each shift. The Provider must introduce changes in care practices to ensure that the people who live at the Manor House are respected as individuals by the manner in which they are addressed and treated. The training and induction programme must improve in the home. Staff must all be up to date with both mandatory training and additional training needed to care for people in a safe way. Improvements in induction and supervision programmes would also provide staff with the support and information to work in a safe and respectful way. Supervision of staff at all levels would also mean poor practice could be addressed. Staff must be made aware of how to correctly report incidents to the CQC. Accident records should be stored correctly to ensure the management of records is robust. Improvements are needed to the way medicines are handled in the home, to make sure people always receive their medicines safely as their doctor has prescribed for Care Homes for Older People Page 9 of 44 them. 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 10 of 44 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 11 of 44 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process is not thorough and comprehensive prior to admission because staff do not always have information to decide whether they are able to meet the needs of prospective residents. This means that prospective residents and their relatives cannot be confident that their all their care needs can be met. Evidence: We looked at three care files. We found that one care file had an pre-assessment of need completed by a social worker that was for provision of domiciliary care in the persons own home. Staff have not carried out their own assessment to decide whether they can meet that persons needs.There was no evidence to show why the person needed twenty-four hour care. Another care file had no assessment of need prior to admission. The third care file had a very basic pre-assessment completed on a stand alone proforma. This provided insufficient information on which to make a proactive judgement as to whether the persons needs could be met at the Manor House. Care Homes for Older People Page 12 of 44 Evidence: Since moving into the care home, only one of the three people had a written care plan. This provided minimal information for staff and showed that these preassessments were not completed in sufficient detail to show what care needs the person had. This care plan was dated February 2008. We found no evidence of any plan of care after moving into the home for the other two people. Since the last key inspection the care home has applied for and been given an additional category of DE. This means that it is now registered to provide care and accommodation for anyone who may have a dementia care need. The pre-assessment form we saw in use at the time of this inspection visit did not include pre-assessment of this. As an information gathering form it does not help the staff to make a comprehensive holistic assessment on which they can base a decision to offer someone a place at the home. Also it does not provide an opportunity for the prospective resident &/or family & friends to contribute information to ease transition from home to care. The Responsible Individual confirmed that any prospective resident would be given a brochure about the home that clearly states the fees, the homes philosophy and some information about the physical environment of the care home. There is also a website giving more information about the company, South West Care Homes, and about the Manor House. The Certificate of Registration and the Complaints Procedure were not evident or easy to read because they were both displayed in a hallway at an overhead height. The Complaints procedure needed to be updated to show people clearly how they can contact CQC. We suggested to the Responsible Individual and the person in charge that it would be beneficial if both these documents were displayed in a more prominent place, and at eye level. Care Homes for Older People Page 13 of 44 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. People are not involved in their plan of care or supported or encouraged to make decisions as part of an independent lifestyle. Peoples care needs have not been reviewed monthly or as their needs change meaning that people are not getting appropriate care. Staff do not always meet the needs of the people living at the home. There are improvements needed to the way that medicines are handled and managed in the home, to make sure that people always receive their medicines safely as their doctor has prescribed for them. Evidence: On the day of our visit there were twenty-three people living at the Manor House. One person was on a temporary placement. People are accepted via the Rapid Intervention, Treatment and Assessment (R.I.T.A.) scheme when there are vacancies. Also people come for respite stays. Care Homes for Older People Page 14 of 44 Evidence: Observation of the people living at the Manor House and care staff interactions throughout this visit found that the staff had routines that did not allow for choice and showed an institutional approach to caring for people. Care staff referred to people who needed assistance with eating as feeders. We heard staff talk about routines in general which suggests that the home uses a task based ethos instead of person centred care which looks at the individuals need. We looked at three care files. Only one had a plan of care and this was basic. The care plan gave information about the persons GP, their next of kin and family contact numbers. The reason for their admission however was not clear. There was minimal past medical history recorded. A risk assessment had been completed for pressure sore risk and this was rated as high risk. This risk assessment was dated 08/08/07. There was no evidence to show it had been reviewed since. There was a record of weight on admission to the home however there was no information about the persons nutritional needs or evidence to show that weight was being monitored. The assessment did not identify if the person was at risk in any way (e.g. falling, malnutrition), and the care plan did not give care staff information to guide them about how a persons care should be delivered. The persons care plan did not include a psychological needs care plan. The person did not have a social care plan provided which would have given staff information about the persons interests and what they enjoyed doing. A life history was not completed, which would have given staff an insight into the character and lifestyle of the person. Another person only had the pre-assessment form completed. There was a note that the person required bed rails however there was no risk assessment to support this. When we asked the person in charge of the home, we were told that bed rails had been discussed prior to the person coming into the home however they not been provided. There was no written information to explain this decision. Also the assessment stated the persons gender preference of any carer giving personal care. We asked the person in charge of the home if this preference could be met. We were told no. There was no written information explaining how this preference was being managed. Daily records for all the residents gave minimal information such as All care met. There were inconsistencies in recording. For example, some were completed daily varying up to four days. We discussed this with the person in charge of the home. She explained that she had introduced one file that kept all the daily records together. This meant that the care staff only had one place to record information. Previously each daily record was kept in individual files so care staff had tended to overlook writing daily records. She was aware that care staff needed to have training about writing Care Homes for Older People Page 15 of 44 Evidence: care plans and recording information so it was informative and person centred. We looked at arrangements for storing and giving medicines in the home. We checked the records that are held in the home for medicines given to people, and discussed how medicines are handled with the manager and other staff working in the home. We watched some medicines being given to people in the home and saw that they are given using a safe method. Records are kept of medicines received into the home, those given to people, and any unwanted medicines that are sent for destruction. All of these records help to show that people are given their medicines as their doctor has prescribed for them. Most medicines charts are printed by the supplying pharmacy but sometimes these need to be handwritten by the home. During our visit we recommended that two members of staff check these charts and sign them, to reduce the risks of any errors occurring. We recommended having a list of staff signatures, to be able to check who has administered medicines to people. We also recommended that for medicines where doses are frequently changed, for example after blood tests, that the surgery or clinic are asked to send or fax any changes in writing. This is to reduce the risks of errors occurring when telephone messages are taken. We were shown a list of staff in the home who are authorised to give medicines to people. These staff have all had recent training, and have been assessed as competent by the person in charge. There are some issues with regards to storage arrangements for medicines in the home. The home has a lockable trolley but the chain which attaches it to the wall is broken. Controlled drugs are stored in a locked tin inside a cupboard, but they should be stored in a cabinet that meets the Misuse of Drugs (safe storage) regulations. There is a separate refrigerator for medicines that require cold storage, but the temperatures in this refrigerator are not monitored. This means it is not possible to be sure that these medicines have been stored at the correct temperatures and are safe to use for people. We were told by the person in charge that a new controlled drugs cabinet, trolley and medicines refrigerator have been ordered. It is a requirement that these storage issues are addressed, to comply with current legislation, and to make sure medicines are stored securely for the protection of people in the home. We looked at some care plans to see what information was recorded about peoples medicines. We found that not much information is recorded in the plans we saw. One person who looks after some of their own medicines had this recorded in the care plan Care Homes for Older People Page 16 of 44 Evidence: but there is no risk assessment. The home has a medicines policy which says that people who do this should have signed documentation in their care plan. This would show that it is safe for people to look after their medicines. Care Homes for Older People Page 17 of 44 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. Routines within the home often mean that people do not have a choice and control over their lives. Improvements are needed to ensure that all people have access to varied and appropriate activities. People who use the service are provided with a wholesome appetising diet however improvements are needed to the way this is sometimes presented. Evidence: During our visit we saw people in their bedrooms or sitting in the main lounge. At lunchtime most people were in the main dining room. Two people eat their meals at a dining table in a smaller lounge. The staff interactions we observed with the people who use this service were assisting people with tasks such as personal care, guiding them to the dining room, and serving meals. During our visit two Christmas trees were put up, one in the conservatory (that we told by staff no-one uses), and one in the main lounge. This was done without any engagement or involvement of the people living in the home. The tree in the main lounge was later moved by the person in charge of the home because it was placed in a position that took no account of people sitting in the room. Care Homes for Older People Page 18 of 44 Evidence: We asked the person in charge of the home about the Christmas programme. There were no posters or other information around the home to tell people about forthcoming events. We were told that a pantomime production and a Christmas party were booked for the week before Christmas. We were also shown posters about the pantomime that had arrived the day of our visit. We asked about activities and general involvement of the people who live in the home. The person in charge of the home told us that she would like to introduce either an Activities Co-ordinator or a dedicated shift for care staff to solely plan and organise activities for the people living in the home. We discussed the staffing numbers on each shift and how this would impact on the care staff team. It was evident from the task focused way in which staff worked that they were not used to engaging in a social manner with the people for whom they were caring. The person in charge suggested that staffing numbers needed to being increased, introducing different job descriptions. This would enable care staff to have time to work alongside people encouraging and enabling them with daily live skills such as washing, dressing and eating. Also they would have the time to sit and chat with people living in the home, and become more involved rather than looking after people. We spoke to one of the two cooks who works four days a week from 08:00 until 14:00. We were told that the home has a four week rolling menu however this needs revising and updating to include a choice of main courses at lunch time. It was also hoped that the new menus would be displayed on dining room tables with a copy on display in the entrance hall so that families could see what was being served each day. At the time of this visit a roast meal was served two days each week and one day was popular because it was a fry up day. Fridays was traditionally a fish meal. Salads, omelets, soup and sandwiches were offered daily as an alternative to the main dish. All the food is ordered by the cook and locally sourced as much as possible. The cook told us that all the meat, fruit and vegetables were bought fresh. At the time of this visit two people had diabetes and the cook was able to prepare suitable foods for them to eat. She also had new menus that would include fortified and build-up foods for people who had low weight or were identified as being at risk of malnutrition. The person in charge of the home told us that when she first started work at the Manor House, pureed food was served mixed together by some staff. Also there were discrepancies about soft food and pureed food as the pureed food had large pieces of meat and vegetables and was not fully blended. We found that pureed foods were served separately. The cook told us she was hoping to introduce food moulds so the pureed foods looked more presentable. The cook also Care Homes for Older People Page 19 of 44 Evidence: told us that she was hoping to attend some training courses about different diets including managing malnutrition and menu planning. People choose where they eat their meals. Staff told us that six people choose to eat their lunch in their bedrooms. We met two people who were eating in the small lounge. There was a bag with some grapes in it on this table. We asked if the person had brought them to lunch. We were told that there should have been a bowl of fresh fruit on each dining table. It was not clear why the fruit was put on the table with the main course. Our observation of the dining room and smaller lounge was two very quiet rooms. There was little interaction of any sort except between staff. Lunchtime was short with food being served and cleared away in such a manner it did not encourage the meal to be a social or pleasurable occasion. One person we noticed was sitting with their food unsupervised and not eating. This was addressed by the person in charge who spoke quietly and encouragingly to the person. We were told that at least six people eat their lunch in their bedrooms. There were two people eating in the smaller lounge. This was a matter of concern as we had earlier been told that people who needed assistance to eat were not receiving help from the care staff. Many of the people living at the Manor House have a degree of confusion and/or memory loss. This means they may not understand that the plate in front of them is food they can eat or they may have forgotten how to eat. For others, difficulties with finger and hand joints may restrict them in the use of cutlery. We saw no provision of plates with guards that would allow the person to eat independently and not feel embarrassed about food falling off the plate. We saw no provision of ergonomic cutlery designed to enhance peoples experience of eating because they can hold it more easily. We did not see any of the care staff assisting people with eating although we did hear staff refer to feeders. The person in charge told us she has been trying to raise awareness with the care staff about some peoples needs with assistance and/or encouragement with eating and drinking. Care Homes for Older People Page 20 of 44 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that complaints will be dealt with appropriately. The lack of staff training and staff knowledge regarding protection of vulnerable adults and restraint has the potential to put people at risk. Changes are needed in work practices to show that care is person centred and not institutional. Evidence: The Manor House has a complaints procedure however it is not evident or easy to read because it is displayed in a hallway at an overhead height. The complaints procedure needed to be updated to show people clearly how they can contact CQC. We suggested to the Responsible Individual and the person in charge that it would be beneficial if this document was displayed in a more prominent place, and at eye level. Observation of the staff interactions during this visit found they were providing care and support for the people living at the home. This was task focused with little involvement or interaction with the residents as individual people. A recent audit of training needs for all the staff has found that training about protecting vulnerable adults; dementia care; and dignity and equality are all a priority. Six staff were expected to attend a protecting vulnerable adults training course a week after this Care Homes for Older People Page 21 of 44 Evidence: inspection. Funding was expected to be made available in January 2010 for staff to commence distance training about caring for people with a dementia that would also include dignity and equality. Care Homes for Older People Page 22 of 44 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. Generally individual bedrooms appeared homely. The accommodation and grounds are spacious, but some areas are tired and in need of refurbishment The storage of equipment, oddments of furniture and general supplies in lounges and bathrooms made the home feel cluttered and uncared for. Carpets throughout the home are in need of replacement. Evidence: The Manor House is a detached two-storey house with a two-storey extension and has been modified with ramps and a shaft lift. There are twenty-eight single bedrooms, sixteen on the ground floor and twelve on the first floor. There is one shared room on the first floor. Seventeen bedrooms have en-suite toilets. There are two call bell systems fitted in the home. One system is no longer in use however it has not been removed. The newer system enables the bell cords to reach anywhere in the bedroom. We found that the staff have to be reminded to be pro-active about ensuring people can reach their bell. All the bedrooms we saw were personalised and individual. Bathing, showering and toilet facilities are available on each floor, close to bedrooms Care Homes for Older People Page 23 of 44 Evidence: and communal rooms. These are domestic in style. Only one has equipment to assist bathing. We found these bathrooms were cluttered and were more use as storage areas than as a pleasant facility that people may enjoy using. There were also toiletries that we suspected were used by the staff for everyone rather than people using their personal toiletries. We were told about plans to convert one of the bathrooms into a wet room because it is too small. There are a lounge, a dining rooms as well as a smaller lounge with a dining table on the ground floor. The dining chairs do not have arm rests. This makes it difficult for people to sit down or stand up from the chair without supplementary support such as the dining table. It also makes it more difficult for people to move their chair nearer or further away from the table. As we toured the premises the home appeared cluttered and uncared for. Pieces of furniture, for example, left by previous residents, had been moved out of bedrooms then left. The linen rooms had clean bedding on the floor where it had not been properly folded and placed on the shelf. Other bedding was jumbled and looked like it had been thrown into the cupboard without any care for where it landed. The main linen room itself was not clean with sweet wrappers on the floor and dust balls gathering around the skirting boards and behind the door. The laundry had a large shelving area covered by a curtain. Again it was cluttered with all sorts of items pushed in anywhere. Fire door signs were peeling and fraying at the edges. Paint was chipped on skirting boards and doors. One bedroom door had a hole in it where the en-suite door handle knocked into it each time it was opened. The carpets look tired and in places are worn with tape stuck to hold the carpet together presenting a trip hazard. The floor of the care home is uneven in places with small slopes that are not readily visible due to the pattern of the carpet. These also present trip hazards. The front garden is overgrown with weeds and dead plants. There were many seemingly insignificant areas that needed attention. These overall created a home that looks shabby and tired that no-one respects or cares about. We discussed with the Responsible Individual our concerns that a tour of the premises inside and outside showed little evidence of routine care and management or respect for the upkeep of the home. We were told that the home employs a maintenance person and a gardener as well as care staff. It is understood there is an annual environmental audit undertaken by the responsible individual. It was unclear if there is a plan for the ongoing regular maintenance of the home to make sure that the condition of the home does not deteriorate further. Also it was unclear who oversees the maintenance person or the gardener. It was suggested during this visit that this should be reviewed as well as providing more structured expectations for all staff with Care Homes for Older People Page 24 of 44 Evidence: regard to reporting areas needing attention and designating responsibility so ensuring things are done. Storage is an issue at the care home. For example, the larder for the kitchen is on the first floor. This larder is next to three bedrooms, at the end of a corridor, out of sight. On the day of our visit the door was marked to be kept locked at all times, however we found it open. We were told by staff that it is not convenient when they are preparing food or when there is a food delivery. The person in charge has started a review of all the storage in the care home. Bedrooms are redecorated when they become empty. Although curtains and bedding are provided we were told that people can choose to bring in their own soft furnishings and bedding subject to fire compliance and other health and safety measures. Care Homes for Older People Page 25 of 44 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. Staffing levels and skill mixes on each shift need to be reviewed to ensure that people are always cared for in a safe way. Not all staff are adequately trained to meet the needs of the people living at the home. Recruitment systems used at the home are not robust and have the potential to place people at risk. Evidence: On the day of our visit there were twenty-three people living at the Manor House. Noone was on a respite stay at this time although this is possible. The R.I.T.A. team also make short stay placements at the Manor House when there are vacancies. During the morning as we walked around the building, we saw four carers, the cook, the maintenance person and the person in charge. There was also a volunteer who was working with the maintenance person and also assisted in the kitchen clearing up after lunch. In the afternoon there were three carers and the person in charge. We were told that two cleaners are employed to work five hours each day, Monday to Friday, and one cleaner works five hours on Saturdays. The care staff are responsible for cleaning the home on Sundays. The care staff are also responsible for all the laundry. The dishevelled state of the laundry and linen cupboards showed no-one took Care Homes for Older People Page 26 of 44 Evidence: any responsibility or care about maintaining them clean and tidy. There are two carers on duty overnight from 20:00 to 08:00. There were signs that staff were not providing the level of care people deserved. People were left for long periods of time with no interaction by staff. During our visit we observed one person who stays in their room all day. The staff were seen giving medication. We saw that lunch had been taken in and later cleared away. We did not see any interaction or encouragement offered by the staff. They were focused on achieving tasks. As we observed the staff around the home, some staff appeared to forget that they were working with individuals in their home. One example was during the morning a few people were sitting in the lounge. A Christmas tree was being put up in the conservatory (this leads off the lounge, and later a second tree was put up in the lounge. The staff did not engage with or involve the people who live in the home with this activity. One tree had to be moved because it was placed in such a way that some people sitting in the room were blocked from the rest of the room by the tree. Drinks and meal times are rushed. Care staff are taken away from their duties of caring for the people living in the home because they are responsible for food preparation at breakfast time, teatime and supper time. The carers are preparing and serving food whilst they may also be assisting people with getting up or going to bed, and giving out medication. Our observation of lunchtime found it was chaotic. The cook is responsible for preparing, cooking and putting the food out on to individual plates ready for the care staff to take to people. We found that because the larder is on the first floor this can mean several trips up and down stairs. This adds to food preparation times. It also increases the risk of injury or harm because the cook has to leave the kitchen unattended as well as carry catering size food packets and tins from the larder back to the kitchen. All the carers assisted with serving and clearing meals at lunchtime. The kitchen was therefore dangerous at that time because all the staff were in and out, at times all together. Our observation of care staff caused us to question if they understood when it was appropriate to wear gloves. One carer was wearing gloves on every occasion we saw them: during a medication round, assisting someone with their personal hygiene, taking a resident by the hand having just exited from a bedroom carrying soiled items, and whilst serving food. We discussed our concerns with the person in charge and the cook. Both were aware of the dangers and risks of staff carrying hot food and drinks as well as cross infection. They raised their concern that the wash hand basin is on the far side of the kitchen. This means that everyone has to walk through the kitchen in order to wash their Care Homes for Older People Page 27 of 44 Evidence: hands. An Environmental Health Officer identified this as a matter of concern during their visit. The person in charge told us that care staff had been told not to wear gloves when they were preparing food as this was not necessary. One proposal they suggested was to serve lunch from a heated trolley in the dining room. There was also a proposal that a part time kitchen assistant could reduce care hours used for the preparation of food. This would also reduce the numbers of people who pass through the kitchen on a daily basis and reduce the risk of cross infection. We discussed this with the person in charge and the cook. Both were aware of the dangers and risks of staff carrying hot food and drinks as well as cross infection. We raised our concern about care staff understanding when it was appropriate to wear gloves. One carer was wearing gloves on every occasion we saw them: during a medication round, assisting someone with their personal hygiene, and whilst serving food. The same carer was also seen taking a resident by the hand having just exited from a bedroom carrying soiled items. They had not removed the gloves or disposed of the soiled items before assisting the resident. The person in charge told us that care staff had been told not to wear gloves when they were preparing food as this was not necessary. The cook and the person in charge raised their concern that the wash hand basin is on the far side of the kitchen. This means that everyone has to walk through the kitchen in order to wash their hands. An Environmental Health Officer identified this as a matter of concern during their visit. One proposal was to serve lunch from a heated trolley in the dining room. There was also a proposal that a part time kitchen assistant could reduce care hours used for the preparation of food. This would also reduce the numbers of people who pass through the kitchen on a daily basis. We looked at staff files for four staff. One of the four had a photograph of the person. Three had an application form. Two had two written references. One had a record of telephone references only, and one had a personal reference. Only two had a valid police check. One had a record of induction and supervision. Three had a contract with terms and conditions of employment. We were told that there have been two staff meetings recently to raise awareness amongst the staff about working together as a team. We were also told that future staff recruitment will include staff working on a rotational basis. Present staff are being encouraged to change shifts, especially between day and night shifts to enhance staff experience of a day and night in the life of people who live in the care home. We suggested that a review of staffing levels at particularly peak times of the day (before breakfast, teatime and twilight hours) may help the staff to work in a way that engages with the people living in the home. We also suggested that increasing the Care Homes for Older People Page 28 of 44 Evidence: staff number during the evening would give the people living in the home more choice about what time they go to bed. Some care plans we saw had a standard comment about bedtimes. This inferred that people would go to bed when they were told to do so by staff. We were unable to finding supporting evidence that people were going to bed before 20:00 because this was their choice and not because it suited the staff shifts and duties. A staff training analysis is due to be undertaken by the person in charge. Key areas of mandatory training have already been identified as lacking. Some local training has been identified and booked. The person in charge is hoping to introduce distance learning for all staff with an option for them to study at home. She plans to set up a training file that will cross reference with each staff members personnel file thereby providing a quick glance reference for each staff member. She also plans to set up a NVQ matrix and a mandatory training matrix. Care Homes for Older People Page 29 of 44 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. Lack of effective management at the home has had a negative impact on the quality of the service provided. Staff have been poorly supervised at the home meaning that poor practice has not been addressed. People are placed at risk because of some health and safety practices at the home. Evidence: The registered manager left the Manor House in the autumn of this year. Someone was appointed to replace the registered manager and has been in post since November 2009. The departure of the registered manager has brought to light a number of serious concerns that affect the health and well being of the people living at the Manor House. These include pre- assessments of prospective residents; comprehensive plans of care setting out in detail the action that needs to be taken to ensure that all aspects of health, personal and social care needs of each individual, Care Homes for Older People Page 30 of 44 Evidence: including any relevant clinical guidelines and risk assessments, are met; robust policies and procedures for dealing with medicines; variable routines of daily living and activities that involve the people using this service; regard for privacy and dignity of the people using this service; robust policies and procedures for the recruitment of suitable, competent and experienced staff; training for all staff to ensure they are suitably qualified and competent to do their jobs, and that the people using this service are in safe hands at all times; robust policies and procedures to ensure that the health, safety and welfare of both the people using this service and the staff are promoted and protected at all times. At the time of this visit the Responsible Individual acknowledged that he had taken his eye off the ball because the home was rated three star at the last key inspection. Also he had considered the registered manager to be discharging her duties fully. The provider visits (Regualtion 26 reports), he told us, had not therefore been as in depth as they should have been. He agreed that with the person in day to day charge of the home they would draw up a plan to review all aspects of care provided at the Manor House. We discussed with the Responsible Individual the need for a review of staff numbers and skills on each shift, the duties they are expected to carrying out during their shifts so they can be held accountable for their actions, the time staff are given for these tasks, and what outcomes staff provision and delegation of tasks provides for the people who use this service. Also that staff should receive regular supervision to provide them with support and to review their work performance and training needs. At the time of this visit there was little evidence of staff awareness or training about caring for people with a dementia. We discussed with the Responsible Individual that all the staff working at the Manor House should receive training and guidance about good practice in caring for people who have a dementia. The Responsible Individual told us that the staff working in the other homes in the South West Care Homes group have had training using an Alzheimers Society programme called Yesterday, today, tomorrow. This should have been implemented at the beginning of 2009 at the Manor House by the registered manager. The departure of the registered manager brought to light this has not happened. We discussed the physical environment of the building with the person in charge. There is little signage or visual aids that could assist people find their way around, particularly the people who have a memory loss. There are unmarked ramping along the landings. There are carpet strips where carpets are worn and torn. Both are potential trip hazards. An electrical meter cupboard situated in a bathroom has no Care Homes for Older People Page 31 of 44 Evidence: warning sign or lock. The busy pattern of the carpets could be very confusing for some people who have a dementia. The building looked cluttered and uncared for generally such as fire signs peeling off doors, chipped paint on skirting boards, and a neglected front garden. We talked to the Responsible Individual and the person in charge about the furniture we had seen around the home. Some chairs for example, are not suitable for anyone who is physically frail and needs assistance with sitting down and standing up. Our observation saw people putting themselves and others at risk in the dining room because they were using the dining tables as a support for this purpose. Similarly there is a lack of equipment such as handrails in halls and landings, and only one bathroom had a hoist to assist people getting in and out of the bath. We suggested that an Occupational Therapists assessment and advice about the home and external grounds would provide the provider with clear indicators about how the home could be as accessible as possible for the people using the service. It would also enable them and increase their independence. The person in charge told us that she was reviewing storage around the home. She hoped new cupboards or alternative storage areas could be built or improvised around the home for the storage of medications and clean linen. We also suggested that alternative arrangements to relocate the larder and store food near or in the kitchen would be beneficial for the safety of both staff and the people using this service. This was in light of the larder being found open in spite of a sign stating it should be kept locked at all times, the cook having to leave the kitchen unattended during the preparation of hot food, and the moving and handling up and downstairs of commercial, catering size tins and other food packages. We reminded the person in charge that doors must not be wedged open and that staff must be made aware of this. If, as we found during our visit the linen cupboard is wedged open because beds are being changed, the wedge must be removed as soon as no-one is using the cupboard. Alternatively any doors wedged open on a regular basis must be fitted with a suitable device that links with the homes fire alarm system. We reminded the person in charge to ensure robust measures are in place to prevent the risk of cross infection. Also where and how to record accidents, and securely retain copies of accidents. We urged that all staff receive urgent training on all safe working practices to ensure that the health, safety and welfare of the people using this service are promoted and protected at all times. Care Homes for Older People Page 32 of 44 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 33 of 44 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 People must not be 22/01/2010 admitted to the home unless they have had a satisfactory assessment performed. This is to ensure staff are aware of the needs of the person and have made a decision they are able to meet those needs. This shows that staff are able to meet the needs of the person before they come to the home and to help staff prepare what equipment and training is needed. 2 7 15 Care plans and risk assessments must be accurate, are reviewed to show changes and contain accurate information to enable staff to provide care in a safe and consistent way. 22/01/2010 Care Homes for Older People Page 34 of 44 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure staff will be aware at all times what care an individual needs. 3 8 12 Systems must be in place to ensure people receive the finer details of care that allows them to make decisions about their lives. This will ensure that care staff involve people in their care. 4 9 13 Arrangements must be made to ensure that care plans include detailed information for staff about the administration of medicines to people, and risk assessments where people manage their own medicines This is to make sure people receive their medicines correctly and safely, in the way their doctor has prescribed Arrangements must be made to ensure that medication is stored securely and at the correct temperature recommended by the manufacturer. 15/02/2010 22/01/2010 5 9 13 29/01/2010 Care Homes for Older People Page 35 of 44 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to protect people in the home and to make sure that medicines are safe and effective for people. 6 9 13 Controlled drugs must be stored securely in accordance with the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973 as amended. This is to make sure controlled drugs are safely stored and to comply with current legislation. 7 10 13 The registered person must 22/01/2010 ensure staff work in a way that respects the privacy and dignity of people who use the service. This must be done by ensuring the language used to refer to people who use the service is appropriate ( not using expressions such as toileting rounds or feeders). This promotes privacy and dignity. 8 12 16 Staff must consult with people living at the home about their social interests and make arrangements to enable 29/01/2010 31/03/2010 Care Homes for Older People Page 36 of 44 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 them to engage in a range of activities according to their ability. This includes people less able and those spending considerable time in their bedrooms. This will ensure that everyone living at the home will have a good quality of life and be able to participate in things they enjoy. 9 12 18 Staff must be deployed in such a way that there is time for people living in the home to engage in meaningful and appropriate activities. This will ensure that all people are able to participate in meaningful activities and lead a more fulfilling life. 10 14 12 Staff must be deployed in 07/02/2010 such a way to have enough time to enable and encourage people living n the home to make decisions with respect to their care and so far as it is possible to ascertain take into account their wishes and their feelings. 12/02/2010 Care Homes for Older People Page 37 of 44 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This means everyone living at the home will have a good quality of life and feel valued as an individual. 11 18 13 Arrangements must be 29/01/2010 made for the training of all staff in prevention of abuse and what to do if abuse is suspected. This will ensure people living at the home are protected from abuse and abusive practice. Risk assessments must be undertaken and regularly reviewed for the premises. This is to ensure that the people living and working n the care home are not subject to undue risks. 13 19 23 The premises both inside 12/02/2010 and outside must be suitable for the purpose of achiving the aims and objectives set out in the statement of purpose, and are appropriate to the needs of the people using this service. 12/02/2010 12 19 13 Care Homes for Older People Page 38 of 44 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that people live in a well mainitained building that is appropriate to thier individual needs 14 26 23 All parts of the care home 12/02/2010 must be kept clean and reasonably decorated and suitable storage provided for the purposes of the care home. This ensures that the people live in a clean and pleasant home that is comfortable and safe. 15 27 18 Staff deployment and skill mix must be monitored to show that people who use the service are getting their needs met and not having the level of care affected. This will mean that there are sufficient staff in numbers and skill mix to meet the needs of people in the home. 16 28 18 Clear evidence of any training undertaken that will include those who have achieved a National Vocational Qualification in care must be provided. 12/02/2010 12/02/2010 Care Homes for Older People Page 39 of 44 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that people using this service are in safe ands at all times. 17 29 19 Staff recruitment practices must be robust including correlation of information and ensuring all necessary checks are in place before someone starts work at the home. This will mean that the people using this service can be confident they will be protected from harm and safe. 18 30 18 A clear and comprehensive 12/02/2010 training programme is in place for all staff and that all staff attend at least all mandatory training arranged for them. This means that people using this service can be confident they are being cared for by staff who are trained and competent to do their job. 19 31 12 The home must be managed 29/01/2010 in such a way that proper provision is made for the health, welfare and safety of the peple who use this service. 29/01/2010 Care Homes for Older People Page 40 of 44 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that anyone with managerial responsibilty knows what their role and responsibilites of what they must do and can carry out thier duties. 20 36 24 A system of staff supervsion must be put in place. This will ensure that poor practice can be addressed and monitored, and that all staff can receive support to perform their duties in a safe way for the benefit of the people using this service. 21 38 13 All staff must receive training in the protection of vulnerable adults, first aid, infection control, and moving and handling This will ensure that all staff can work in a safe way that is up to date. 22 38 17 Accidents at the home must be recorded and managed. All copies of accidents recorded must be stored safely and securely. This will ensure that accidents can be monitored for trends, and referred to if needed. 29/01/2010 12/02/2010 29/01/2010 Care Homes for Older People Page 41 of 44 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 23 38 37 The CQC must be informed of any adverse events that occur in the home. This will ensure that we can monitor events at the home. 29/01/2010 24 38 23 All fire doors must be kept shut unless held open by an approved hold-open device. This is to ensure that the people uisng this servce are protected from harm. 29/01/2010 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 9 It is recommended that any handwritten medicines charts are checked and signed by two members of trained staff, and that any dose changes are asked to be sent or faxed through in writing. It is also recommended to have a sample list of staff signatures, to be able to identify staff who have given medicines to people. These are to reduce the risk of any medicines errors occurring. The complaints procedure should be displayed in a prominent position and at a height that is easily readable by everyone. An effective quality assurance system, with a summary of any findings,should be put in place that actively involves and seeks the views of the people using this service, their friends and family, and stakeholders who have contacts with the home. A full review of the physical environment should be undertaken to ensure that signage is in place or replaced where it is worn or missing. This review should also 2 16 3 33 4 38 Care Homes for Older People Page 42 of 44 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 consider providing locks for cupboards. 5 38 An Occupational Therapists assessment and advice about the home and external grounds should be sought.This would provide clear indicators about how the home could be as accessible as possible for the people using the service and thereby increase their independence. Care Homes for Older People Page 43 of 44 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. 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