Inspection on 14/10/08 for The Meadows Care Home

This inspection was carried out on 14th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Meadows Care Home 11/03/10

The Meadows Care Home 14/04/09

The Meadows Care Home 17/12/08

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 30/01/2009.

Inspecting for better lives 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:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Trainor     Date: 1 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 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): Name of registered manager (if applicable) Mrs Wendy Jean Fitzgerald Type of registration: Number of places registered: Downing (Meadows) Limited 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. 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 Care Homes for Older People Page 4 of 31 Over 65 34 0 Brief description of the care home 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 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Commission for Social Care Inspections(CSCI) policy and methodologies which require review of key standards for the provision of a care home for older people, that takes account of the service users views and information received about the service since the last inspection. Evidence used and judgements made withing the main body of the report include information from this visit. This was the first Key inspection for this service this year. It was carried out by Regulatory Inspectors Louise Trainor and Sally Snelson on the 14th & 16th of October 2008. Care Homes for Older People Page 6 of 31 The home manager, Wendy Fitzgerald, was present for most of this inspection to assist as required, and verbal feedback was given periodically throughout the inspection and at the end of the visit. We also met the Provider, on the first day of the inspection, and had the opportunity to discuss some of the issues which were in need of address. During this inspection we tracked the care of three people who use this service. This involved reading their records and comparing what was documented to the care that was being provided. We also talked to them wherever possible to obtain their views on the service. Documentation relating to staff recruitment, training and supervision, medication administration, complaints and health and safety were also examined. We spent time in the communal areas observing care practices, including the service of the midday meal on the second day of the inspection. We also had the opportunity to talk to all the staff that were on duty on the second day of the inspection, and two of the residents family members who were visiting their loved ones. The current weekly fees range from 475.00 to 590.00 pounds, additional charges are required to pay for hairdressing and chiropody, information on the cost of these services can be obtained from the home. We would like to thank everyone involved for their support and assistance throughout this inspection process, and apologise for the delay in this report, which has been due to technical problems. What the care home does well: What has improved since the last inspection? What they could do better: There are care plans in place for these residents, however there are gaps in records and information, and the review process is not being followed. MAR sheets indicate that medication stocks are not monitored closely by the process of reconcilliation so that residents may not always be recieving medication as prescribed. Fluid balance charts were inconsistent, and indicated that there were some long periods when fluids were not administered. Prior to our visit, it did not appear that staff recorded when they offered fluid that were subsequently refused. There is presently no activity organiser in post in this home. The manager advised us that this post had become vacant in July this year, and unfortunately, to date they had been unable to appoint into this role. The food in the home is of a satisfactory quality, however evidence indicated that personal choices were limited in relation to food and activities. There were safeguarding concerns relating to financial matters, that were brought to our notice via sources from inside and outside the home. The main concern was that, food suppliers, nursing supply contractors and waste disposal services were not being Care Homes for Older People Page 8 of 31 paid on time. Although at present this is not affecting the residents, it is a potential safeguarding issue, which has been reported and is being monitored. This home provides a clean, comfortable and homely environment for the residents who live here, however some areas are in need of redecoration. There are gaps in training due to the absence of a training budget. The manager is competent and understands the core principles of running this home. She is aware of the need to continuously develope systems of practice improvement, however without the full support, including financial, of the Provider, she will not be able to achieve this. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home understands the importance of having sufficient information when choosing a care home, and new and prospective residents are provided with a Statement of Purpose and a Service User Guide. No admissions take place in this home until a full assessment of needs has been carried out by a suitably qualified member of staff. Evidence: This home has detailed information documents that are issued to prospective residents and kept on display in the home so are easily accessible to residents and visitors at any time. The document is kept under review so that reflects accurately the owners / management of the home. It includes information relating to fees, fascilities available in the home as well as those locally in the village, and other useful information, such Care Homes for Older People Page 11 of 31 Evidence: as how to identify different grades of staff by their uniforms. We looked at the files of three residents in the home, and these contained documentation to support how admissions had progressed from refferal to point of admission. For example on the 19.5.06 a family had phoned and enquired about a placement in the home. On the same day the family had visited the home to view facilities. On 20.5.08 the manager had visited and assessed the prospective resident and only then was the admission arranged. In the event of an emergency admission being necessary, the home utilises assessments and information from the referring sources, so that they still have sufficient and appropriate information prior to admission. Residents in this home all have a contract of terms and conditions that is clearly signed and dated by a representative from the home, and the resident or nominated advocate. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are care plans in place for these residents, however there are gaps in records and information, and the review process is not being followed. MAR sheets indicate that medication stocks are not monitored closely by the process of reconcilliation so that residents may not always be recieving medication as prescribed. Evidence: We case tracked the care of three individuals with different levels of need during this inspection. Care plans were in place for them all, however they were not written for all activities of daily living, and many were not being regularly reviewed to reflect individuals changing needs accurately. When we questionned a plan for catheter care that suggested a catheter should be changed every four weeks, we were told that the plan was incorrect and that it should state every three months. As the plan had been written in August 2007, and reviewed six times, we were concerned that this error had not been identified sooner. We also saw a plan that related to a daily dressing. It appeared that on the date the dressing had been changed, it had been written on the care plan page, however once the page was full, no further entries were recorded. We Care Homes for Older People Page 13 of 31 Evidence: asked the nurse where she recorded when the dressing was changed, and she told us that she would not have time to write this down every time she did she did it. When asked how a member of staff coming on duty in the afternoon would know if a dressing had been done in the morning she said We have good handovers. We were concerned that a qualified nurse showed such a lack of understanding as to why care needs must be documented. We also identified a resident whose care plan stated that she had a leg bag in situ at night. This resident was confined to bed during the day, however the need for a leg bag was not documented, and there was no leg bag attached at the time of our visit. On day two of the inspection we observed a resident in a wheel chair, without footplates. Her legs were dangling and clearly uncomfrotable. We asked a carer why there were no footrests on this chair and we were told. Its in her care plan she doesnt have them. However when we looked at this residents careplan, it had not been reviewed for several months, and actually identified that this person should have the left footplate in situ. We were also concerned that Do Not Resusitate (DNR) forms were not being completed by the appropriate authority and were not being reviewed. One such form had been completed by a family member in May of this year and not reviewed since. There are strict guidelines that should be followed relating to these issues. Fluid balance charts were inconsistent, and indicated that there were some long periods when fluids were not administered. Prior to our visit, it did not appear that staff recorded when they offered fluid that were subsequently refused. Tubs of Thick and Easy were found in bedrooms that did not correspond with the name of the resident that was identified on the label. Observations of care identified some good moving and handling practices using specialist equipment, staff communicated well with the residents throughout these procedures and the residents looked comfortable and relaxed. While case tracking we noted that the home had good relationships with the local GP who would visit as required. We looked at the Medication Administration Record (MAR) sheets. Medications were signed into the home accurately, but not carried forward, so it was not possible to reconcile stocks. The inspector and a nurse attempted to reconcile some liquid medication. They counted at least 18 signatures, indicating a 10 ml dose had been given, totalling 180mls, however there was still at least 30 mls left in the 150ml bottle, Care Homes for Older People Page 14 of 31 Evidence: instead of it being finished three doses earlier. The Manager advised us that she checks the blisters when auditing medications. Omission codes were being recorded, however it was apparent that the codes were not being used consistently, and the reason for not giving or refusing a medication was not always documented on the reverse of the MAR chart. For example, there was one code that indicated a drug had been not offered or was not required, however the code for medication being refused and destroyed was used. This medication was still in the blister pack. Some of the MAR sheets were difficult to deciffer where staff had recorded the time PRN doses of medication were given, in the small signature space. It would have been better to record these details on the reverse of the MAR chart. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The food in the home is of a satisfactory quality, however evidence indicated that personal choices were limited in relation to food and activities. Evidence: There is presently no activity organiser in post in this home. The manager advised us that this post had become vacant in July this year, and unfortunately, to date they had been unable to appoint into this role. During this inspection, on day one, the 14/10/08, there was no evidence of any activities in the home, with the exception of the hairdresser, who is clearly a regular and very welcome visitor. The hairdresser took over the front lounge as a waiting room, and those who were due to have their hair done, waited in the lounge and all gossipped together. This was a comfortable and relaxed environment. However in the back lounge people sat in chairs just gazing out of the window. There were a number of board games and jig-saw puzzles in the lounge but these were not being used. We were informed that there had been a death in the home earlier that day, that had impacted on many of the residents, accounting for the somewhat somber mood. However on the second day of this inspection, activities were still very limited. We spoke with one resident in the lounge who informed us, there was Care Homes for Older People Page 16 of 31 Evidence: nothing to do except watch the television. We even noticed that the orientation board had not been updated and still displayed information relating to the 12th of the month. Today was the 16th. There were numerous visitors in the home during both days of this inspection. The home promotes an open visiting policy. We looked at the menus on both days of this inspection. On the 14th we were told that lunch had been steak and kidney pie with potatos, carrots and runner beans followed by fruit pie and custard. One resident said to us, I think the cook must have made too much pastry. When asked if there was a choice we were told sometimes. On day two, we observed the mealtime experience. Residents were invited to the tables about an hour before the meal was served. At one point a small group of residents started singing Why are we waiting. The meal of roast gammon with saute potatoes and vegetables, looked and smelt very appetising, however one or two residents were having some difficulty chewing the meat. There were alternatives available, so we were unsure why these had not been offered to these particular residents. Residents were offered a choice of wine or sherry with their meals, however comments from staff, residents and visitors indicated that this was not the norm and had perhaps been done for the benefit of our visit. We also wondered why resident were given sherry in plastic beakers when they were perfectly able to hold a sherry or wine glass. We looked around the kitchen facilities, and the fridges and freezers were well stocked at the time of our visit. Fridge and food temperatures were being recorded appropriately. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are clearly recorded and investigations documented. The staff are trained and knowledgeable in safeguarding matters, however delays in financial settlements with suppliers to the home is presenting potential risks for residents. Evidence: There is a complaints policy in place for this home, which details the process people must follow in the event of raising concerns, and the expected timescales for responses. It also gives contact information for organisations such as the Commission for Social Care Inspection,(CSCI) that might be required if complainants are not satisfied with complaint outcomes following investigations within the home. We looked at the complaints and compliments file. There was only evidence of one complaint, which was from a neighbour and was not care related. Letters of thanks, reflected that families are generally happy with the care in the home. One letter read. While mum was in your care we felt reassured to know she was in good hands. The manager and staff in this home are knowledgeable about safeguarding procedures, and are aware of when they need to involve the safeguarding team in concerns. Staff files indicate that staff attend training in this matter appropriately. There were however concerns relating to financial matters, that were brought to our notice via sources from inside and outside the home. The main concern was that, food Care Homes for Older People Page 18 of 31 Evidence: suppliers, nursing supply contractors and waste disposal services were not being paid on time. Although at present this is not affecting the residents, it is a potential safeguarding issue, which has been reported and is being monitored. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home provides a clean, comfortable and homely environment for the residents who live here, however some areas are in need of redecoration. Evidence: During this inspection we undertook a full tour of the premises. The home was clean and homely throughout. We visited several bedrooms. These were furnished individually, and residents had their own furniture, photographs and personal trinkets around them. These were generally clean and comfortable, however we did visit two residents that were being nurses in bed, and we found the room to be rather cold. We brought this to the attention of the manager and this matter was rectified immediately. Some areas of the home, particularly upstairs are in need of redecoration. Where bedrooms were shared by two residents, there were screens in place so that individuals privacy could still be fully addressed. The communal areas were bright and spacious, with the rear lounge/ dining area overlooking well tendered gardens and miles of fields and countryside. A beautiful backdrop by anyones standards. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager understands the importance of training in this home, and staff are keen to progress their knowledge, however there are gaps in training due to the absence of a training budget. Evidence: During this inspection looked at three staff files in order to assess the recruitment process in this home. All had fully completed application forms, including a full employment history, various forms of identification and residency/work permits where appropriate. All had Criminal Record Bureau (CRB) checks, although one person had commenced work prior to the date on the certificate, and all had references which had been submitted from an appropriate source. We did however have to suggest, that a new qualified nurse who was due to take charge of the home on an imminent shift, was postponed until an induction period had been completed. We believe this had been arranged to avoid costs implicated by the use of agency nurses. We were informed by the manager that the shifts are staffed with four care staff,plus a qualified nurse during the day, plus the manager and administrator, plus ancillary staff. When we looked at the rota for the week commencing the 13/10/08, this only identified three care staff per shift. The manager informed us this was sometimes adjusted to need. We feel four staff would have been more beneficial to support the social activities in the home during this period where there is no activity organiser in post. Care Homes for Older People Page 21 of 31 Evidence: During this visit we spoke to all the staff on duty at the time. All were competent in their roles, however spoke about the need for more training. Very few had any dementia training despite there being seven residents with dementia, everyone was due to do a refresher course in moving and handling and there were gaps in other mandatory training, however most staff had done safeguarding training, and were able to demonstrate their knowledge in conversation. We discussed the training issue with the manager and the provider. He assured us that he would allocate a training budget for the manager so she could arrange the necessary training immediately. There were mixed feelings about the level of support staff received, and everyone commented on how they would like to see more activities, and be able to offer more choices to residents especially with food. Comments suggested that choices had become less available over recent months and what we had witnessed at lunchtime on the day of the inspection was not normal practice / service, and it had been enhanced for our benefit. Staff were committed to these residents and concerns were expressed about the supplies orders being delayed because of unpaid bills. Care Homes for Older People Page 22 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is competent and understands the core principles of running this home. She is aware of the need to continuously develop systems of practice improvement, however without the full support, including financial, of the Provider, she will not be able to achieve this, and to date there are problems identified in this area. Evidence: The manager for this home has worked here for many years and has a committed team of staff supporting her. The day to day management of the home is satisfactory in that it is well maintained and safety equipment and safety checks are in place and monitored. However we have concerns relating to the input of the provider, who took over this home in the early part of 2008, and the adverse effects this may have on the home if the present state of affairs continues. Our concerns are shared by staff and relatives visiting the home, and have also been brought to the attention of the Safeguarding team. These are mainly related to financial issues which are presently being addressed and therefore cannot be discussed in further detail. However the late Care Homes for Older People Page 23 of 31 Evidence: payment of bills to service suppliers is also becoming an increasing problem, and a major concern. Although invoices are being paid, they are not being paid until the final hour, and nursing supplies, such as gloves and aprons, food deliveries and waste disposal routines are being disrupted resulting in low stocks, and consequently infection control risks being increased. On the day of the inspection we visited two rooms where gloves and aprons had completely run out. It was confirmed by staff that there was nothing to restock these rooms, as the supplies delivery was overdue and existing stocks had finished. This is unacceptable both for staff and residents where these protective aids are essential for the safe delivery of personal and intimate care procedures. We also understand from sources which wish to remain anonymous that there are regular problems and mistakes made with staff wages. This is affecting staff morale, and has allegedly resulted in some staff terminating their employment in the home. This home purchase their policies and policy reviews from a specialist company, however we were advised during this inspection that non of the policy reviews had been received this year, because the payments for this service had been stopped. Although the policies are not dangerously out of date, it is unacceptable that this system has been cancelled without an alternative arrangement being made to ensure staff have up to date documents to refer to. This ultimately increases the risks to residents. This home has the facility to keep small amounts of money for the residents who live here. We looked at the records of five residents personal monetary transactions, and all were clearly recorded, signed and dated. Receipts were present to support all transactions. Staff records indicated that staff supervision is not happening on a regular basis, and some staff confirmed that they had not received any supervision for several months. We were also concerned that there is no facility for the manager to have either individual or peer supervision since this home has been taken over. It is important that this manager receives the appropriate support. Only one Provider visit has taken place on record since the current Provider took over this home. The home manager carrys out an annual quality review, by sending out stake holders surveys and doing an analysis on the returns. This was most recently done between March - May this year. We reviewed the accident / incident books in this home. Records are being completed Care Homes for Older People Page 24 of 31 Evidence: and appropriate authorities are made aware of incidents where necessary. We believe that at present the manager of this home is working hard with her staff to try to maintain the standards previously set in this home. However the star rating has dropped following this inspection, and without the appropriate financial support from the Provider, the home will fail to meet more of the Key Minimum Standards and consequently this will continue. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that each resident has an plan of care which is reviewed regularly to reflect changes in needs. Residents who live in this home must have care plans that reflect their current needs. 01/01/2009 2 9 13 The register person must 22/12/2008 ensure that the recording, handling, safekeeping, safe administration and disposal of medication in this home is accurate. Residents must be protected by safe medication processes and records. 3 12 16 The registered person provide facilities for recreation, and suitable activities. 31/12/2008 Care Homes for Older People Page 27 of 31 Residents in this home must have the opportunity to participate in a programme of suitable activities. 4 14 12 The registered person must ensure that residents are encouraged to make choices whenever possible. Residents must be encouraged and given opportunities to make choices about their care and general aspects of their lives. 5 18 13 The registered person will address all measures to ensure that the residents are protected from abuse. Residents in this home will have appropriate stores and facilities in place to ensure that there care is not compromised and they are not at risk. 6 19 23 The registered person must ensure that all parts of the home are kept reasonably well decorated. People who live in this home must have a clean and well maintained home. 7 27 18 The registered person must ensure that there are sufficient staff working in the home to meet the need of the residents. 01/01/2009 27/02/2009 22/12/2008 29/12/2008 Care Homes for Older People Page 28 of 31 The residents in this home must be cared for by sufficient staff 8 30 18 The registered person must 01/01/2009 ensure that staff are appropriately trained to care for the needs of the residents in this home. The residents in this home must be cared for by staff that are appropriately trained. 9 34 25 The registered provider shall 12/01/2009 carry on the home in such a manner as is likely to ensure that the care home will be financially viable for the purpose of achieving the aims and objectives set out in the statement of purpose. The people who live in this home must be protected by the homes state of financial viability. 10 36 18 The registered person must ensure that all staff receive appropriate supervision. Residents who live in this home must be cared for by staff that are appropriately supervised. 11 37 17 The registered person must 31/12/2008 ensure that policies and procedures are appropriately reviewed. The people who live in this home must be protected by policies and procedures. 27/02/2009 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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