Inspection on 02/03/09 for The Old Rectory

This inspection was carried out on 2nd March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

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Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Rectory The Old Rectory Fradswell Stafford Staffordshire ST18 0EY     The quality rating for this care home is:   two star good 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: Peter Dawson     Date: 0 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Old Rectory The Old Rectory Fradswell Stafford Staffordshire ST18 0EY 01889270236 01889270936 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Old Rectory Fradswell Ltd Name of registered manager (if applicable) Sheila Ann Prentice Type of registration: Number of places registered: 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 to be accommodated is 27. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 27 Dementia (DE) 27 Date of last inspection Brief description of the care home The Old Rectory Care Home at Fradswell is situated in a quite rural location in its own landscaped gardens of 3 acres. The original building has considerable character and charm and has been extended over the years to provide residential care for 27 older people. Accommodation is on 2 floors with staft lift and stairlift access to the first floor. There are 9 en-suite bedrooms and 5 shared bedrooms. There are adequate numbers Care Homes for Older People Page 4 of 30 care home 27 Over 65 0 27 27 0 Brief description of the care home of bathroom/toilet areas located throughout the building. Long-tern and respite care services are provided on a funded or private basis. The home provides a service for people who have dementia care needs. There is a high standard environment, with large and small lounges and a conservatory overlooking the extensive grounds and surrounding countryside. The separate dining room is in pleasant surrounding overlooking the drive approach to the property. A programme of individual and small group activities is available, there is an accent upon people accessing the community where possible. The home is remote, located in a small village, but transport is readily available in the form of a 7 seater person carrier to meet the transport needs of all people in the home. The weekly fees at the Old Rectory are 377 - 459 pounds per week. Care Homes for Older People Page 5 of 30 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: two star good 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 last key inspection of this service was on 1st February 2007. An Annual Service Review of the service was carried out on 15th August 2008. Changes to the registration of the service were made on 20th August 2008 when the Registered Manager, who was also a Director was approved as the Responsible Individual. The Deputy Manager was approved as the new Registered Manager from that date. This change to registration effectively meant that the ownership and management of the home remained the same. Although a new registration, the service is treated as an existing service. This unannounced key inspection was carried out by one inspector on one day from Care Homes for Older People Page 6 of 30 8.30 am - 6.pm. The inspection was carried out with assistance from the Registered Manager. The Director (Responsible Individual) was involved on an ad hoc basis and also involved in the feedback at the end the inspection. An AQAA (Annual Quality Assurance Assessment was completed by the service prior to the inspection. It is a legal requirement for all services to complete an AQAA, annually. This is a self-assessment of the service outlining the standards of care provided. The AQAA gave detailed and relevant information about the service and some of that information is included in this report. The National Minimum Standards for Older People were used as the basis of the inspection. We were not able to obtain written feedback from people using the service and other visitors and professionals prior to the inspection. However the majority of people were seen and many spoken with, both together and separately and also with and without staff present. People told us that they were satisfied with the care provided at The Old Rectory, that staff were excellent, treated them with respect and one person said we cannot speak highly enough of the carers, they are wonderful. People spoke with enthusiasm about the changes made to the environment and to the routines in the home. One person said We are really lucky to have such a good home and good staff to look after us. A visitor asked to see us during the inspection to tell us how pleased she was with the progress and care that her mother had received in the weeks prior to the inspection. She had been very ill and was unsure whether she would recover. There was an inspection of the environment including most of the communal areas and a sample of bedrooms were seen on both floors of the home. Records relating to the inspection were seen and readily available, they included care plans, risk assessments, medication records, staff records and other documents relevant to the inspection process. Staff on duty were spoken with and keen to make a contribution to the inspection. There was a very relaxed atmosphere throughout, people engaging well with each other and with us throughout the inspection. What the care home does well: What has improved since the last inspection? A new care planning format has been successfully introduced. The format is person centred and encompasses all aspects of health, social and emotional support needs. The system focuses on what people can do rather than what they cannot. Staff training continues and has been extended to include service and person specific training, including dementia care, mental health needs, colostomy care, wound care, end of life care, mental capacity and stress management. The objective being to continue to raise awareness of peoples health care needs. A requirement of the last report to keep a count of all medication given to people who self-medicate has been actioned. It is now possible to audit the medication held by people in their own bedrooms. Data sheets have been obtained for all COSHH items used as recommended in the last report. The summerhouse and garden areas have been improved and their use extended to maximise the benefit for all people in the home. There has also been continued investment into the fabric of the home. The large lounge area has been changed to provide a small separate area for people allowing opportunities for personal space and choice. A wider range of activities is provided. Care Homes for Older People Page 8 of 30 The service is updating and adopting change in relation to equality and diversity. This was exampled in the facilities provided for a recently admitted person without hearing. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. Good pre-admission procedures and information ensure peoples needs are met and they can settle quickly into the home. Evidence: The AQAA completed by the service states Everyone is encouraged to visit the home and spend time with us. family and friends are also encouraged to be part of the moving-in process. Everyone, where possible, is visited to complete a pre admission assessment to determine whether we can meet the persons needs. There was evidence from people spoken with and records that these pre-admission procedures are in place. One person seen was unable to visit prior to admission being referred as an emergency admission from hospital, nevertheless a Care Management (multi-disciplinary) assessment was provided to the home within 24 hours and the homes own assessment commenced at the point of admission. Details of need had Care Homes for Older People Page 11 of 30 Evidence: been given verbally prior to admission. The Statement of Purpose/Service Users Guide was updated 6 months ago when changes to the homes registration details were made. There is adequate information to inform and enable people to make a judgment about the services provided and the suitability of the home for them. There is an admission feedback form given to people following admission to inform about the effectiveness of the admission procedures. One seen gave very positive feedback. People funded by the Local Authority receive written contracts from the Authority. People funding their own care have a private contract directly with the home. One seen was signed by a relative but not dated and did not state the agreement for giving notice to leave the home. This was found to be a dated contract no longer used and a new contract will be provided to include all required information. Care Homes for Older People Page 12 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people are known and met. Evidence: The AQAA states Over the past year we have implemented a more person centred plan of care. Reporting and recording documentation has improved and staff training has taken place in all areas of care The new care planning format is more person centred. A new 24 hour plan of care gives detailed information to ensure staff are able to meet the persons needs. These include a concise overview of the daily routines and preferred choices of people, including likes,dislikes, rising/retiring times and all actions required throughout the 24 hour period, to meet personal care needs. Nutritional assessments and social histories are completed for all. Each person has a Key Worker who monitors needs and progress and reviews are carried out monthly. The Manager monitors the reviews and identifies and confirms changes to care plans. Care Homes for Older People Page 13 of 30 Evidence: Two care plans were inspected in detail and generally contained all the required information. Risk assessments in relation to moving and handling and nutritional care were in place. In relation to one person with high dependency needs - very low weight and at nutritional risk, it had not been possible to weigh the person for the past 6 months. There was a conflict of information relating to weighing - one record showed 4st 7 lbs another recorded 6 stones. Weight is an important health indicator for this person and it was suggested that the District Nurse could monitor this by means of body measurement. The District Nurse was asked to do this following the inspection but unaware of the process. There is an alternating pressure relieving mattress in place and 2 hourly turns by staff are required. The recording of this was intermittent. Similarly a food/fluid intake chart had omissions and did not record all inputs as required. This person is unable to weight bear and originally moved with a hoist, she now has to be manually handled by 2 staff because of her frail condition and skin integrity. Staff are very carefully and sensitively moving the person. Moving and handling trainers have reviewed this and feel this is the safest and most appropriate way of moving this person. Many aspects of health care recording were good. Staff have had training from the Nursing Service in colostomy care for two people. The Nursing service are visiting weekly for leg wound dressings. There is no pressure damage in the home at this time. The Doctors surgery provides a good and regular service to the home with a weekly visit or on-demand as needed. Records showed that all people have regular health checks and medication reviews. A relative asked to speak with us during the inspection to record how highly satisfied she was with the care provided to her mother, who had been very ill the previous 2 weeks, but with exceptional care from staff had made a remarkable recovery. The Doctor had visited several times, she was involved and kept informed of her mothers progress. She said I cannot thank the staff enough for the care they have given to her The medication system was inspected. A requirement of the last report to record the amount of medication given to a person who self-medicates has been addressed. Records showed good recording in MAR (Medication Administration Records) charts. The receipt, storage, administration and disposal of medication was accurately recorded. There was only one exception where Conotrane cream was applied twice daily by staff but was not on the MAR sheet or recorded. This should be done. The home have a good record of supporting people with advice and support from the District Nursing Service until their death. Relatives are always involved in decision Care Homes for Older People Page 14 of 30 Evidence: making and the care provided. Staff have recently attended further training in End of Life Care Care Homes for Older People Page 15 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Chosen lifestyles are known and met with a range of activities to meet the social, cultural and recreational needs of all people using the service. Evidence: The AQAA stated We always make socialising and activities a priority and utilise the skills of the care team to encourage activities and social interaction either on a one to one or group basis. The home has extended the range of activities to meet the diverse needs of the group. There is a policy of a Breath of Fresh Air to encourage people to have at least one change of scenery daily, either internally or externally. Part of the large lounge has been structurally changed to provide a smaller quiet, or more personal space and choice for people, particularly those who prefer smaller groups. The gardens are large, pleasant, easily accessible and provide a superb setting used extensively throughout the summer months, but also where possible at other times. There is a large summerhouse and all people in the home were consulted about its potential use, this was in the form of a competition, but all views were sought. The Care Homes for Older People Page 16 of 30 Evidence: result is summarised in the AQAA Held in-house competition to find wider use for the summerhouse. We have had it re-roofed, insulated, plastered, decorated and heating and lighting installed. Purchased new furniture and the space will have many purposes to encourage people to leave the main house and walk to the library, cafe or shop. It has already been used for staff training. Apart from a range of group activities 1:1 activities are considered as important. Some less dependent people assist with practical tasks such as laying/clearing tables, feeding the cats, folding laundry - as a means of occupation and maintaining practical and social skills. All activities are recorded in a daily diary. One member of staff has completed a training course in Activities but all staff are involved and engage with people in activities throughout the day. The home has a 7 people transporter for external visits with many trips to local venues. People spoken with told us that they enjoyed life at the Old Rectory, they were able to join in activities as they wished and staff did not put pressure upon them. All said that the quantity and quality of food were excellent. There was good choice and they could have anything we want to eat. There was evidence in recording and speaking with people that their preferred lifestyles were known and were being met by the staff. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be reassured that their safety is paramount and that any concerns they may have are listened to and acted upon. Evidence: The complaints procedure is concise and clear. A copy is available in the home for visitors and all people have an individual copy with their copy of the Service Users Guide. Staff spoken with had knowledge of protection issues and have had training in Safeguarding. Five people have received updated training in Safeguarding in the past year. It is important that pre-employment checks are robust. This will ensure people using the service are protected. Staff have had training in the management of challenging behaviours and understand the need to de-escalate any challenging behaviours presented. The home is constantly seeking ways for people to make suggestions about the service or to express any concerns. Care Homes for Older People Page 18 of 30 Evidence: No complaints have been received by the home or by us since the last inspection, in fact there have been no complaints about this service over recent years. There are very clear instructions for making complaints and there have been consistently positive comments made about the high standards of care at The Old Rectory. Care Homes for Older People Page 19 of 30 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. A high standard environment with good facilities that provides a comfortable, homely place for people to live. Evidence: The home has been in the same family ownership for over 20 years and has been extended and improved over that period. The result is a very high standard environment, the re-investment into the home over a long period continues and is evident in the exceptional presentation of the home both internally and externally. The AQAA states We have a rolling programme of redecoration and refurbishment. We consult people on a group and individual basis regarding decor. We ensure everywhere is clean and free from odour and all maintenance jobs are documented and reported to the director. The gardens are well maintained and accessible with seating provided to encourage use. Bathing and toilet facilities are to a high standard and equipment provided to encourage independence. - This statement was evidenced when inspecting the environment during this inspection. There is an annual plan for improvements and refurbishments with a schedule of work for specific bedrooms having partial or full refurbishment. A sample of bedrooms seen supported this. A new stair-lift has been recently installed so that people can access Care Homes for Older People Page 20 of 30 Evidence: three bedrooms in the extended part of the home, after planning permission refusal for a shaft lift. There are presently 4 shared bedrooms. Portable screens are provided in two of them but not the others. The Manager said that 2 people in 1 bedroom had made a written declaration that they did not wish to have screening. It is important to ensure the protection of privacy and dignity for bedrooms to have suitable screening. The existing screeens are traditional metal framed ones which could be perceived to be a potential hazard for people who are mobile. It is a matter for providers to decide what type of screens are used, but they must be in place to ensure privacy. A suggestion to consider the use of curtains was made. Bedrooms seen were well personalised reflecting peoples individuality. During an inspection of the environment the heating was off in 3 bedrooms. This was midmorning and one person was spending the morning in her bedroom. It later transpired that the heating in the lounge had been turned down as it was too hot, but the 3 bedrooms are on the same hot feed. There are apparently no thermostatic controls on the lounge heaters. The Manager will take steps to resolve this problem. There are high standards of hygiene throughout the home that evidenced good cleaning routines. There are adequate assisted bathing facilities located on both floors of the home, with plans to convert one bathroom on the ground floor into a wet room (walk-in shower) to provide an alternative bathing facility. Care Homes for Older People Page 21 of 30 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 numbers, skill mix and training of staff are good, but recruitment procedures must be improved to ensure the protection of people in the home. Evidence: The home provides 504 care staffing hours each week. Additionally the Manager works supernumerary but still providing hands-on care. The Provider also has a daily presence in the home in supporting all staff. Apart from the above hours there are 195 hours per week for ancillary staff including catering, domestic, and maintenance. The staffing hours adequately support the current levels of dependency in the home. There are presently no vacancies and a small waiting list. The home generally runs at full capacity. There is a low turnover of staff in this home. At this time there are 23 care staff - 15 have achieved NVQ Level 2 or above the remainder are involved in NVQ study. There is an ongoing staff training programme with all statutory training in place and additional service or person specific training also provided. During the past year there has been training in Moving and Handling, dementia, mental health, wound care, foot care, end of life care, mental capacity Act, first aid and stress management. We saw evidence of training in individual staff files and a training matrix was recommended for easy reference. Care Homes for Older People Page 22 of 30 Evidence: A sample of 2 staff files were inspected to assess the recruitment, selection and appointment process. There were shortfalls in this area. In one instance a reference from the last employer was received after the start date and no POVA or CRB obtained prior to employment. This was disappointing and must be swiftly addressed to ensure protection of the people using the service. Managers are aware that checks are required prior to staff commencing employment, but in this instance the person had been previously employed by the home and the usual stringent checks had not taken place. Care Homes for Older People Page 23 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A well managed home with positive leadership that is people driven. Staff commitment and close monitoring of the service ensure people have high standard care and good quality of life. Evidence: There has been a change of management of the home since the last inspection. A new registration was approved in August 2008. Karen Hunter-Roberts was previously the Registered Manager and Provider, she has now been approved as Provider and the Responsible Individual. The former Deputy Sheila Prentice has now been approved as the Registered Manager. The former Team Leader has been promoted to Deputy Manager. The service is strengthened by the promotion of experienced and competent staff within the home. Karen Hunter-Roberts continues to have a daily presence in the home and monitors standards. These changes have integrated well into the daily running of the home. Many staff Care Homes for Older People Page 24 of 30 Evidence: have been employed for several years. There is a very open and relaxed atmosphere in the home, staff engage well with people and each other. Staff spoken with had a good detailed knowledge of the needs of particular people and were enthusiastic and proud of the high standards of care provided at The Old Rectory. There is constantly full-occupancy and people clearly able to discuss any issues relating to care and routines. The home is run in the interests of the people resident there. There are regular meetings, daily discussions with people about the running of the home and examples of all being involved in making choices. Some examples were people choosing colour schemes, wallpapers, furniture and use of the gardens and summerhouse. The home embed the principles of self determination and choice into daily routines. Peoples view of the service are sought in written feedback following the admission process and thereafter on an annual basis. The views of relatives, visitors and other professionals are also sought. Records seen were to a good professional standard. Some updating of information in care plans is needed and charts relating to some health care inputs could be improved. Nevertheless generally there is good and adequate information to inform practice. We discussed the adequacy of the recording by night staff and Managers will review this process and format. The area of poor practice was in staff recruitment procedures. This must be strengthened and become more robust to protect people using the service. The financial viability of the home is evident from the improvements that are constantly made and detailed financial records provided at the recent change of registration support that view. Although there has been a change of management the same people are effectively still managing the home but in different roles. The home has had a good track record of continuous improvements and excellent compliance with requirements, recommendations or suggestions made at inspection in the past. In relation to the next 12 months the AQAA states Management will continue to update our knowledge, evaluate guidance and introduce new working practices. We will remain people focused. Investigate, assess and implement new products and initiatives and continue to access training, update and refresh knowledge. Care Homes for Older People Page 25 of 30 Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 38 19 POVA or CRB checks and 2 written references must be obtained for all staff prior to employment This will ensure people using the service are protected 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Turn charts should accurately record the 2 hourly turns required in the care plan. This will support evidence of actions for good skin integrity. Food/fluid charts should be completed accurately to record and ensure people have sufficient daily intake for their well-being. All prescribed creams must be entered on the MAR sheet and recorded when applied. This will ensure the prescribers instructions are followed and people have the correct treatment. Screening should be provided in double bedrooms to ensure people will have privacy for personal care. Ensure that all bedrooms have adequate heating at all times throughout the day. Page 28 of 30 2 7 3 9 4 5 24 25 Care Homes for Older People Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!