Inspection on 11/03/10 for The Meadows Care Home

This inspection was carried out on 11th March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Meadows Care Home 14/04/09

The Meadows Care Home 17/12/08

The Meadows Care Home 14/10/08

The Meadows Care Home 21/12/05

The Meadows Care Home 04/08/05

The Meadows Care Home 05/10/04

The Meadows Care Home 22/06/04

The Meadows Care Home 19/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for older people Name: Address: The Meadows Care Home 48 Moorend Road Yardley Gobion Towcester Northants NN12 7UF     The quality rating for this care home is:   one star adequate 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: Judith Roan     Date: 1 5 0 3 2 0 1 0 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Meadows Care Home 48 Moorend Road Yardley Gobion Towcester Northants NN12 7UF 01908543251 01908543234 meadowscarehome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rising Meadows Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: That the home continues to be registered to accommodate 34 service users in the category of OP, for either Personal or Nursing Care Date of last inspection Brief description of the care home The Meadows is situated in Yardley Gobion a village location midway between Northampton and Milton Keynes. There are local shops and amenities and the home has good links with the community. The home is an extended original building set in its own grounds with extensive views of the local countryside from the rear of the property. It is registered for up to 30 service users with nursing needs and up to 10 service users requiring personal care, with a total of 34 service users accommodated. Care Homes for Older People Page 4 of 32 Over 65 34 0 1 4 0 4 2 0 0 9 Brief description of the care home Accommodation is over two floors with a passenger lift and staircase for access to the first floor. There are a range of communal areas including two lounges and service users are able to enjoy the garden areas. Bedrooms are located on both floors and there are 21 single rooms with ensuite facilities, a further 2 single rooms with was hand basins and 5 double rooms available. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is adequate 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Quality Care Commission (CQC) is upon outcomes for people who use the service and their views of the service provided. This process considers the services capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was case tracking which involved selecting four people who use the service and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. This inspection was undertaken as the the inspection undertaken in December could not be reported on due to long term illness of the inspector who undertook the site visit. This report however does include the views of the expert by experience who Care Homes for Older People Page 6 of 32 visited the home on 12th December 2009.An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The views and experiences of people who use services are central to helping us make a judgement about the quality of a service so they should be fully involved in the inspection process. We use information from experts by experience to help us triangulate evidence and verify any issues.central to helping us make a judgement about the quality of a service so they should be fully involved in the inspection process. We use information from experts by experience to help us triangulate evidence and verify any issues. Some of the issues raised have been addressed since the visit in December. The homes owner also completed an Annual Quality Assurance Assessment (AQAA) a questionnaire required to be completed by CQC. The inspection was unannounced and was undertaken during the morning and afternoon lasting 7.5 Hours. The service presently has no registered manager. An appointment to the vacancy has been made and they are due to commence in April 2010. People using the service said:- They received enough information to help them decide if the home was the right place for them We know how to make a complaint That the home is usually fresh & clean They make you feel at home The food is good at times depends who is cooking Staff said;- The home provides a friendly and caring environment with a lovely setting The team needs to work together to provide better support to people living at the home We like to get to know the people that live at the home. We have some very caring team members Lack of management has caused some issues. Not all the food is prepared to a good quality It is a good place to work Good team work at nights Relatives/Advocates said:The staff are very pleasant and responsive. They try to provide a home from home atmosphere and generally do so They look after my relative and others well We are generally pleased with things and we would wish the authorities would give the owners and staff space to get on with providing the care The home is always kept clean and very nice Good Food,good activities, good care Could respond more quickly to call bells Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: 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 32 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 32 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. People admitted into the home can be assured that their needs will be fully assessed. Evidence: The AQAA states that A robust pre-assessment is carried out if a client chooses our home after they have visited. If they are not in a position of being able to view then the family/representative is encouraged to come and view. The home manager will travel and conduct the pre assessment to clarify the clients needs and expectations. Family are encouraged to be present and be involved. If there is no family then a friend/advocate or social worker are asked to attend. In viewing the files it was clear that assessments are completed prior to admission and carers were aware of the needs of people living at the home as described in their assessments and care plans. Most staff confirmed in the questionnaires that there is adequate information available to them when someone is newly admitted. No new admission had been undertaken for some time as the Northamptonshire Social Services and the Primary Care trust had made a decision not to admit to the home as they had concerns about the level of Care Homes for Older People Page 10 of 32 Evidence: care provided. We found that outcomes of care for people at the home were good. People who use the service are given a choice of rooms available when they are admitted. Relatives are aware they are able to visit at any reasonable time to view the home and service provided. People using the service mainly confirmed that they had a contract with one person saying that they did not know and another no. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual personal and health care needs are met. Evidence: Care plans viewed showed that all required information to meet the needs of people who use the service was recorded but not easily accessible. Care plans are not consistently updated. Reviews that have taken place are not recorded in full. We found that people who required residential care had been reviewed and had updated care plans. There were shortfalls for those people requiring nursing care. It was the responsibility of the Nursing staff to maintain their care plans The AQAA states that we have encouraged our service users and their representatives to participate in compiling there care plans. All assessments i.e. nutritional, manual handling & waterlow are completed on the day of admission. All care plans are now up to date and reviewed monthly, a copy of reviews and comments is kept for auditing purposes. Care plans had risk assessments in place to support areas of identified need but these were not completed in full and lacked a care plan on how risks were to be minimised. However in discussion with care staff they were knowledgeable about the needs of the Care Homes for Older People Page 12 of 32 Evidence: individuals that were case tracked and knew how to ensure risks needed to be supported. It was observed that staff knew how to use the hoist equipment and manual-handling training was being undertaken on the day of the inspection. Manual handling assessments do need to be fully completed and in use for those people assessed as requiring support.Assessments do need to identify appropriate slings for each person. We did however note that a separate sling was in use for one person with MRSA infection. Good laundry routines ensure that infection control systems are in place. Nutritional and fall assessments again need to be descriptive in how individual needs are to be met. However the assessment for a person with Diabetes was clear on how their needs to maintain their sugar levels was in place and working. The resident confirmed that the staff were very watchful and provided the support as required. There was good information for carers on how to monitor the persons needs. There had been a reduction in hypoglycemic episodes since their admission. The Expert by Experience observed that: Nearly all the residents were in wheelchairs. This causes its own problems as a few of them had to be hoisted in and out of their wheelchairs. This takes time and could account for some of the comments concerning waiting for meals. During the inspection the inspector observed in the main nurses/carers to be respectful and responsive to the needs of residents in the home. However it was necessary to report the actions and attitude of one member of the staff on duty that day to the safeguarding team. This is presently still under investigation. The Expert by Experience noted that The residents on the whole were very appreciative of the staff, the staff do a good job and are very helpful. This statement was quite often qualified by the except for waiting for cup of tea or meal. I was told that one member of staff, no name given, could be very short with the residents. When one resident had pulled the emergency pull in the lounge on behalf of a resident who was desperate to go to the toilet she was told that is only for emergencies. She has never pulled it again. other comments made to the expert by experience were There is not enough staff. On the day of the inspection there were adequate staff on until the training began. This left two staff plus the Nurse for three hours which did place them under pressure in meeting the needs of residents. One comment made by a visitor to the expert by experience was that I was informed by a visitor that she had been in the lounge several times when the District Nurse had been treating a resident. I thought this was not giving the resident dignity. Administration of medication within the home is safe. However people at the home said that their are times when the morning medication is very late. In observation of this task this fact was confirmed. Morning medication was still being administered at 11.00am. In discussion with the owner they confirmed that they were aware of issue Care Homes for Older People Page 13 of 32 Evidence: and it was addressed within supervision. Supervision records were however not substantive. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are person centred to achieve good outcomes for people using the service. Evidence: There is a range of activities at the home which are arranged by the dedicated activity coordinator. The staff member works each weekday and provides various activities that people can choose to participate in. There are two lounge areas One where activities take place and there is a TV and the quieter lounge where individuals can listen to music, read or spend quiet time. All communal areas are clean and well maintained. Most residents said that they were assisted to make choices during their day and felt that their preferences were respected. The menu has choices and individuals are consulted each day as to their choice from the menu. We observed the catering staff undertake this early morning. On the day of the inspection there was a choice of lamb hotpot and fresh vegetables or quiche with salad. A lentil soup had been made earlier for tea to accompany a range of sandwiches/cakes. People who had difficulty with eating were supported individually. Those individuals that needed a soft diet had the meal specially prepared. All the food Care Homes for Older People Page 15 of 32 Evidence: looked appetising and freshly cooked. Snacks are available throughout the day to accompany drinks. There were adequate supplies of fluids. Feedback varied about the standard of food depending on who was on catering duty. The owner is aware of these comments and they are addressing it with the person identified. Individuals can choose to eat in the dining room that set up with table clothes and fresh flowers or eat in the privacy of their room. many of the complaints raised by residents to the expert by experience were in relation to food, The residents seemed very happy with most of their treatment but there were complaints. I get up early in the morning and would like a cup of tea. Most days I do not have it until breakfast, staff say they will bring me a cup but I do not get it. The food is not very good. We have too many frozen vegetables. The meat was so tough the other week we could not eat it We sit and wait and wait at the table for a meal and quite often it is very late. the expert by experience states that I was not offered coffee as there was none available; there was no coffee in the home. As I am sure some residents would like coffee I thought this was unacceptable. The reason I was told was different people do the orderingSome residents think that it to do with cost but lack of communication in actually clarifying the issues with ordering supplies at the home. In participating at lunchtime with residents the expert by experience made the following comments The tables for lunch were set out very nicely with serviettes. There were also mugs on the table but I was not sure why they were there as I did not see any tea served although I was given a glass of water. I was offered a baked potato and either cheese or tuna with a salad. This was very well cooked. The menu for the day was either fish or a pasty and some residents had soup. The fish was well cooked and the resident I sat with enjoyed it very much. I noticed five people who had to be fed and four of the staff helped with this. These residents were sat on two different tables with other residents. There was general chatter on these tables and the staff in a kind and friendly way encouraged the residents to eat. During the meal a member of staff visited all the tables to check that all everything was going well and encouraging some to eat and having a little chat with the residents. The expert by experience noted the following about activities,In the lounge attached to the dining room the Activity Lady on the visit was running a game of bingo and she being helped by a visitor who assisted quite often. The Activity Lady was very engaging and the residents certainly looked as thought they were enjoying themselves. She always asked the residents who usually sat in the other lounge if they wished to join in and they would be brought along if necessary. There was a four week programme of activities and these were on the notice board with a large star to show which was the relevant week. All the residents I spoke to were very pleased with the activities even if they did not wish to participate. I was told she takes an interest Care Homes for Older People Page 16 of 32 Evidence: in you and tries to do something you like. Many had enjoyed the Christmas Party that had taken place the week before. Many residents knit and it has been organised that they knit squares and a lady in the village crochets them together to make blankets which are given away. The wool is donated by visitors. Families are made to feel welcome at the home and are kept up to date with changes in needs of their family member. There are no restrictions on times that families/friends can visit. Care Homes for Older People Page 17 of 32 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 using the service are in the main protected by the practices at the home. Evidence: Most residents and their relatives are fully aware of how to have their concerns and complaints addressed. Relatives completing the surveys confirmed that they would be confident that concerns would be addressed. CQC has not received any complaint about the service relating to the service since the inspection in May of 2009. Some carers have undertaken safeguarding training and knew the whistle blowing procedures if a person using the service was at risk or being harmed. Comments made to the expert by experience supported this view. The recruitment practices at the home in the main ensure that people using the service are protected. We found that all staff have a valid Criminal Records Bureau (CRB) check except for one person who is new. They have had a Protection of Vulnerable Adults check and they are awaiting a full CRB disclosure. Staffing levels at the home ensure that this member of staff is fully supported whilst they are on duty. The policy on gaining references needs to ensure that one is taken up from the persons previous employer especially if they had worked in a hospital/nursing or residential care setting. The environment mainly provides a safe and secure setting for older people. There is a Care Homes for Older People Page 18 of 32 Evidence: need to change the pressure area mattress for one person to ensure it is of a higher level and does not place the person at risk of infection due to wear of the mattress covering. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that safety is maintained to an acceptable standard. Evidence: The home was found to be clean tidy and rooms seen were decorated well and provided personal space where individuals could have their own belongings around them. Cleaning routines ensure that home is kept free of odours and cross infections. The expert by experience made the following observations about the environment, There was no smell in the home. The corridors were clean and many had had a recent coat of paint. There were some pictures on the walls but certainly upstairs could be improved by more pictures probably of the residents and their activities or local areas of interest to the residents. All the residents rooms had their name on the door in a very neat plaque. The doors were also numbered except for one I noted upstairs and I was told was number 16a. The rooms visited had been individualised by the resident with many family photographs, books and televisions. One toilet area was out of action at the visit in December and had been for two months, this has now been rectified. A handyman is employed full time to ensure that maintenance issues are completed in a timely manner. They also assist with gardening and they told me that it was their intention to use some of the area to grow fresh vegetable with their partner who was Care Homes for Older People Page 20 of 32 Evidence: one of the catering staff. Care Homes for Older People Page 21 of 32 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. A committed staff team support people using the service. Evidence: Staff files were reviewed and demonstrated that recruitment procedures are in place and that most required checks have been completed to protect people using the service. Files contained application forms with employment histories, references and criminal record bureau (CRB) disclosures. Protection of Vulnerable adults confirmation is included within the CRB process. A new member of staff still required a CRB but was being fully supervised by others on the same shift. It is important that the rota indicates which member of staff that they will be working with to provide the supervision. Mandatory staff training is not being fully maintained and staff files reviewed contained limited evidence about what course that they had completed. New members of staff did not have their induction programme signed off after each session to confirm that they has understood the information. This work is essential to demonstrate compliance. Manual handling refresher training was being held at the home on the day of the inspection attended by twelve staff. Staff spoken with indicated that induction and basic training was being completed but records failed to confirm this fact. There has been significant staff upheaval over the past few months since the previous manager left with many staff following them to another home. Care Homes for Older People Page 22 of 32 Evidence: However the owner has been recruiting to replace staff. Some agency staff are still being used. We found the agency nurse on duty on one day of the inspection to be competent and fully aware of the needs of individuals. Staff surveys in the main confirmed that training is undertaken and that they are supported. Supervision records were however not substantive. Staff handover is undertaken via a diary and note pad, some nurses stay on to give a verbal handover, however no time is scheduled for this activity. The handover information on loose leaf paper was poorly recorded and leaves the potential for information to go missing. The AQAA confirms that of a care team of twenty one care staff seven have completed NVQ two or above. This figure does not include Nursing staff. Staff surveys were in the main positive. They all however felt that there is a need for a manager but did however feel supported. They also confirmed that as a team they felt that they had good practice experience and had the skills and knowledge to meet the different needs of people who live at the home. In discussion with staff we found that they had good knowledge about the needs of the residents overall and when questioned about the three people case tracked could tell the inspector the important issues relating to their care. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not being managed to ensure that evidence demonstrates how the service is run in the best interests of people living at the home. Evidence: There has been a manager vacancy for several months which has caused a lack of clinical management and support to the staff working at the home. Best practice has not always been demonstrated. The present owners are very dedicated to the future development of the service and do seek to ensure that people receiving the service are well looked after. They are attentive to what people have to say and endeavour to have good outcomes for them. However with lack of experience within the care sector they are struggling to produce the recorded evidence that supports the actual good outcomes of care at the service. there is a lack of recording system in relation to care planning and risk assessments along with poor training records for staff. Governance of management systems is also lacking. Policies and procedures are in place but without management guidance the records do not support what is actually happening within the home. There are few monitoring systems that have produced good analysis Care Homes for Older People Page 24 of 32 Evidence: of data to show to those that inspect the service . This is having a direct consequences on admissions to the home. The owner has asked people who use the service and their relatives to complete surveys but the information is not freely available as part of a quality assurance system. An external consultant has been supporting the home but to date the owner has not requested that they provide an overview on how well the service is functioning. Surveys received at CQC as part of the inspection process have been analysed and indicate the following outcomes for people living at the home. Relatives mainly support the people who use the service with their finances. In a few situation the homes administrator keeps valuables. Health and safety checks are maintained but again records are not at a standard required to meet all of the health and safety legislation. Financial records that would have confirmed services for electrical, gas and lifting equipment maintenance are not routinely kept at the home, which should be under the Care Standards 2000 Regulations. Care Homes for Older People Page 25 of 32 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 26 of 32 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 clear, updated with changes and supported by risk assessments that are complete. This is to ensure that carers have all the written information required to provide the care to people using the service. 31/05/2010 2 9 13 Medication must be delivered at the time indicated by the prescriber. This is to ensure that people using the service receive their medication in a timely manner to meet their health care needs. e.g. pain relief when required. 30/04/2010 3 10 13 The rights of people to choose where and how they receive their support must be respected. 30/04/2010 Care Homes for Older People Page 27 of 32 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 individuals rights to choose are protected. 4 18 19 Recruitment procedures must ensure that two references are taken up for applicants with one being from their previous employer where applicable. This is to ensure that people using the service are protected. 5 22 13 Pressure relief equipment used for individuals living at the home must be monitored and kept in good condition. This is to ensure that people at risk of pressure sores have the correct level of pressure relief and infection is minimised. 6 29 19 Recruitment policies and procedures must adhere to the Care Standards regulations. This is to ensure that staff are recruited using a robust system and protects people using the service. 30/04/2010 30/04/2010 30/04/2010 Care Homes for Older People Page 28 of 32 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 7 30 18 All staff must receive 30/06/2010 mandatory training as set by the Skills for Care workforce model. This is to ensure that staff have the necessary skills to support the people using the service. 8 30 18 All staff must receive training in Mental capacity and deprivation of liberty. This is to ensure that people using the service are supported in choosing how they live their life. 30/06/2010 9 30 17 Evidence of training must be 31/05/2010 available at the home. This is to ensure that detailed records are maintained and demonstrate that staff are trained to meet the needs of people using the service. 10 31 8 The service must be managed by a qualified and competent person. This is to ensure that the service is managed in the best interests of people living at the home. 30/04/2010 11 36 18 All staff must receive formal supervision 30/06/2010 Care Homes for Older People Page 29 of 32 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 staff are developed and supported to undertake their role. 12 37 17 Records required by 30/06/2010 regulation must be maintained at the home. Care plans, risk assessments reviewed, updated and legible. Health & Safety records updated. Invoices to confirm health checks have been completed This is to ensure that evidence is available to demonstrate that needs are being met, safety checks are completed and that the home is compliant with the regulations. 13 38 13 The provider must 30/04/2010 demonstrate that health and safety checks at the home are being fully undertaken. This is to ensure that the home is a safe environment for people using the service. 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 15 It is recommended that the provider puts in place quality Page 30 of 32 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations monitoring of the food served at the home. This is to ensure that the food is prepared to a good standard, nutritious and enjoyed by the people using the service. Care Homes for Older People Page 31 of 32 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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