Inspection on 21/04/09 for The Old Rectory Nursing Home

This inspection was carried out on 21st April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Rectory Nursing Home 26/03/10

The Old Rectory Nursing Home 04/06/07

The Old Rectory Nursing Home 19/07/06

The Old Rectory Nursing Home 27/01/06

The Old Rectory Nursing Home 12/10/05

The Old Rectory Nursing Home 07/03/05

The Old Rectory Nursing Home 17/05/04

The Old Rectory Nursing Home 30/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 21/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Rectory Nursing Home 45 Old Tiverton Road Exeter Devon EX4 6NG     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: Teresa Anderson     Date: 2 1 0 4 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 Nursing Home 45 Old Tiverton Road Exeter Devon EX4 6NG 01392431839 01392436216 enquiries@southernhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Healthcare (Wessex) Limited care home 44 Number of places (if applicable): Under 65 Over 65 44 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who may be accommodated is 44. The registered person may provide the following category of service: Care home with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category- Code OP Date of last inspection Brief description of the care home This service was last inspected on 4th June 2007. The Old Rectory Nursing Home is registered to provide care for up to 44 people over retirement age with general nursing needs. It is owned by Southern Healthcare (Wessex) Limited. The home is on the eastern side of the city of Exeter, in a residential area approximately one mile from the centre. The former Rectory - which dates back to 1875 - has been converted and extended for its present use but retains some original Care Homes for Older People Page 4 of 30 Brief description of the care home features. A health centre, Anglican church, pub and local shops are relatively close, with a bus stop opposite the home. Accommodation is on three floors, with two shaft lifts and a platform lift providing level access within the home. However, some wheelchair users may experience difficulty using one of the shaft lifts because of size limits; they would therefore benefit from being accommodated within the home where use of this lift is not necessary. There are two conservatory areas overlooking well-tended gardens to the rear, which include a pond and enclosed courtyard garden. There is a car parking area at the front of the home, with time-limited roadside parking available in the area. Mature trees screen the front of the building from the road below. Weekly fees at the time of the inspection range between 485 and 800 pounds. Fees do not include the cost of items such as hairdressing, private chiropody, aromatherapy, newspapers and toiletries (which are charged at cost price). 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: This unannounced inspection was undertaken by two inspectors over one day. It started at 10.00am and finished at 5.30pm. We bought this inspection forward by two months because there had been a safeguarding issue raised and we wanted to check on progress made to address the issues identified by the safeguarding team. During the inspection we spoke with approximately 15 people living here, with 4 members of staff and with 4 visitors. We also spoke with the manager and with the owner. We saw all of the communal and service areas of the home and the majority of bedrooms. We looked closely at records relating to six peoples care needs assessment, care planning, medication and care delivery. This is called case tracking and is the method used by the commission to evaluate peoples experience of living in a home. Care Homes for Older People Page 6 of 30 We also looked at records relating to training, recruitment, personal allowances and safety. Prior to the visit to the home, the home provided us with information about this service in the Annual Quality Assurance Assessment (AQAA). In addition questionnaires, asking for feedback and comments about the home were sent to 10 people living at home and none were returned. We sent some 10 staff and 5 were returned. We also received feedback from health and social care professionals. Feedback has been included in this report. What the care home does well: What has improved since the last inspection? Since the last inspection the home has continued with the maintenance, redecoration and refurbishment programme. In addition more pressure relieving equipment has been purchased to help ensure people do not develop pressure sores. The recruitment procedures have improved and risk assessments have been used to determine and Care Homes for Older People Page 8 of 30 manage risks around the home. 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. The home has systems in place to ensure that people who want to come and live or stay here for short periods have their needs fully assessed. Evidence: We looked at the assessments of three people who had recently been admitted to this home, one of whom was here for a short stay whilst receiving respite care. Records show, and people told us, that each person is visited by the manager who gains information from them, their family and/or carer and, where appropriate, the placing authority (local authority or health trust). In this way their personal and health care needs are identified. The assessments are comprehensive, covering important areas of care, and each assessment forms the basis for a plan of care as to how these needs should be met. Care Homes for Older People Page 11 of 30 Evidence: Staff told us that feedback about each newly admitted person is given to them during the start of the shift handover and that the pre admission written assessment information is available for them to look at. The homes AQAA states The pre-admission assessment has been improved to ensure that all needs can be met and any alterations or services needed can be actioned prior to admission, also noting the gender preference of the Resident. 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. People living here are treated with respect. Improvements to the way that care is planned and reviewed are ongoing and are having a positive effect on the care that people receive. The way that medicines are managed ensure that the system is safe and that people get the medicines they need. Evidence: We looked at six care plans. These show that doctors are asked to see people if they feel unwell or if staff are concerned. Records also show that people are supported to see other healthcare professionals such as Speech and Language Therapists, chiropodists, dentists and specialist nurses, which helps people to remain well. We spoke to people about the care they receive and they told us that they usually get the care they need when they need it. One person said I think my relatives healthcare needs are well met. Care plans show that nurses working here carry out assessments of peoples needs Care Homes for Older People Page 13 of 30 Evidence: and write a plan of care as to how these needs are to be met. Records show that clear instructions are not always given as to how needs are to be met. We spoke with staff about care plans and their knowledge of them. They told us that the care planning format has recently been altered and that they are still becoming familiar with this. Staff spoken with say they believe the care plans are becoming more detailed and that this will result in improved individualised care. They say they get additional information about how to meet needs during the handover of shifts. We saw in care plans that these are developed from detailed risk assessments, of which there are eleven for staff to use. We found that staff are tending to complete all these risk assessments even when the risk does not apply. However, we also found that other risk assessments are used appropriately and identify risks relating to, for example, pressure sore development, dehydration and malnourishment. Where risks are identified plans are put into place to address these risks. We did note that some people have been identified as being at risk of developing pressure sores and that it is not clear how the actions to be taken had been decided upon. For example, one person has been assessed of developing pressure sores using a tool called Waterlow. This person had a high score indicating a high risk of developing a pressure sore. Waterlow recommends the use of an alternating airwaves mattress when the person is in bed. We looked at this persons bed and found they sleep on an overlay mattress which is usually used for people who have a lower risk of developing pressure sores. We asked a nurse why this was and they said it was because there was not an airwaves mattress free, but that two had been ordered. We spoke to this person and they told us they can feel sore when in bed. This person has not developed a pressure sore. Two people living here have pressure sores and one of these people already had a pressure sore when they were admitted. Both these people are cared for on airwaves mattresses as recommended by the assessment and records show that their pressure sores are improving. The owner told us that they had already identified the need to improve this area of care. A Registered Nurse has been appointed to be the link nurse between the home and the Tissue Viability team from the Primary Care Trust and training has been arranged to update staff skills. The manager confirmed after the site visit that two additional airwaves mattresses have been received into the home and put to use. People who are identified as being at risk of dehydration and malnutrition are supported to eat and drink. We saw staff offering people regular drinks throughout the day. People who are cared for in their rooms have all their fluid intake and food intake recorded so the nurses can see that each person is getting what they need. We did however notice that carers are not given written instructions by the nurses about how much each of these people should eat and drink each day. We also noted that the Care Homes for Older People Page 14 of 30 Evidence: amount of fluid these people drink is not always added up at the end of the day as it should be. We spoke with staff about these people and they told us that they eat and drink well. One person has been assessed as being at high risk of choking. The care plans says that only a Registered Nurse should support this person to eat. The family told us that this always happens. We saw in care plans that each person is assessed to determine their moving and handling needs, and that staff are given written instructions on how to meet these needs safely. Staff told us that they have plenty of equipment to help them with less mobile, more dependent people. This includes hoists, bath hoists and adjustable beds. We saw staff using this equipment appropriately. People told us that staff are gentle when helping them to move. We did notice that some people who use wheelchairs (not specially designed for them) spend a long time sitting in these. This is not good practice as they do not offer the support that people need for long periods of time. We saw in records that peoples care plans are reviewed each month. However, the daily records did not always include information relating to the plan of care and each review we saw advised that the plan was to continue. We could not see how a complete evaluation and review had taken place without this information. Staff told us that information is also shared during the handover of shifts and that this contributes to the review of care plans. We looked at how medicines are managed. We saw excellent pain assessment documentation in the care plans. However, the care plans did not always include a plan of care as to how identified pain is to be managed and pain levels are not always reviewed. We found that there is ample and secure spaces for all medicines kept in the home. We looked at records related to medicines and found them to be up to date and accurate. We spoke with a nurse involved in ordering and returning medicines. She described a system which is safe and ensures that all medicines can be audited easily. We found that any hand written entries on medicines charts are checked by a second person as they should be and that staff always sign when they give a medicine or indicate why a medicine was not given. We also saw that staff clearly record when a medicine prescribed only to be given when needed is given, together with the reason for giving this. Medicines which are to be kept as controlled drugs are kept safely and securely. We observed staff interacting with people living here and saw them being courteous Care Homes for Older People Page 15 of 30 Evidence: and respectful. Staff told us they know how people prefer to be addressed (and this is recorded) and we heard them using preferred names. We talked to staff about how they help people to maintain their dignity and they told us they make sure people receive personal care in private, that they are discreet when discretion is needed and that each person is an individual who is different and that this should be respected. We saw examples of these during our visit to the home. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are helped to maintain links with their families and make choices in their daily lives. Planned further improvements for enhancing peoples social lives will help to further improve the quality of peoples lives. People enjoy a varied and balanced diet which they enjoy. Evidence: Care plans we looked at contain some information about peoples life history and their interests, although these lack detail. Activities offered by the home do not always seem to relate to the interests or previous hobbies of the people we casetracked. However, the home has developed the activities programme since the last inspection and this now includes more trips out, quizzes, bingo and music sessions, the owner and manager are aware activities could be more person centred. They have recently introduced a new assessment tool to help staff to plan activities in a more person centred way. In the Annual Quality Assurance Assessment (AQAA) that the owner and manager completed for the commission, they have recognised that this is an area of need which is important to peoples well being. The owner is promoting the development of Care Homes for Older People Page 17 of 30 Evidence: focusing on peoples past occupations and interests and has employed a group activities co-ordinator who he reports has experience in this area. People living here say they join in with some activities and some say they prefer to read or watch television. We observed people living here engaged in conversation about a programme they had watched on the television, chatting with their visitors, reading and sitting quietly. When we asked if they ever got bored, some said yes they did. One person said Thats life. You cant expect people to entertain you all the time. Although it would be nice to have something to look forward to. Another person told us that the local church minister visits the home and that they like this. People told us that whilst the home has routines to make sure that things run smoothly that they can do what they like. They say they can get up at a time that they prefer and go to bed when they like. We heard people being offered choices relating to what they would like to eat, where they would like to sit and if they would like to go to the toilet. Visitors to the home are free to come and go as they please. They say the are always made welcome and are kept up to date with changes. The home offers the main meal of the day at lunchtime and people say this suits them. They say the food is always nice and that there is a choice. One person said if you dont fancy what you have chosen, they are very good and will always get you something different. We saw that people who need assistance got this discreetly and in a way that suits them. Although there are a high number of people living here who need assistance with eating (27 according to the AQAA) we observed that each person got individual attention and that all food served was kept hot. In a survey the cooks says that they are given information about peoples likes and dislikes and about any special needs they might have. Care Homes for Older People Page 18 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. The complaints and protection systems used within this home have resulted in improved safety for the people living here. Appropriate actions are taken when complaints are made. Evidence: This home has received a number of complaints which they have documented and responded to. One of these complaints was also made to the safeguarding team in relation to an allegation that one person needs were not addressed satisfactorily. An investigation took place which showed that the home did not meet the needs of one person. Since then the home has made changes to try to ensure this does not happen again. People we spoke with say they have in the past had cause to complain, but that this need is decreasing. They say that changes are being made in response to complaints. For example one visitor told us that sometimes their relative did not always wear their own clothes, but that since a new system in the laundry was introduced this has been addressed satisfactorily. People told us that the new manager is easy to talk with and always listens to them. They say they feel safe and well cared for and that staff are kind. We talked to staff about safeguarding and they are familiar with what abuse is and what to do if they Care Homes for Older People Page 19 of 30 Evidence: suspect or see this. Records show that staff receive training in safeguarding adults from abuse. When we looked in care records we saw some entries which indicate that not all staff are familiar with the Mental Capacity Act. For example, one relative has been asked to make decisions on behalf of the person living here. There is no indication that this person does not have capacity to make decisions themselves. This may be because staff have not recorded this assessment, which they must do. Care Homes for Older People Page 20 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. People enjoy a pleasant, homely, clean and safe environment. Evidence: This is a care home that cares for people with very high needs and where many people have continence problems. We found it to be clean and odour free throughout. Although it is a nursing home there are very few indicators of this in communal areas. These areas are well decorated and homely with many personal touches such as flowers, plants and pictures. Staff we spoke with told us of the importance of ensuring that the service is homely, because this is the home of the people who live here. We visited many bedrooms and found them all to be personalised and clean. People told us they have been able to bring in their own furniture and bits and pieces. Each bedroom has been personalised for the person using it. They say if they want a picture hung or a shelf put up that the handy man does this easily and quickly. The handyman also carries out checks to ensure that equipment such as bed rails and wheelchairs remain in good repair and safe. Staff say any fixes needed are reported and dealt with quickly. Staff say they have plenty of handwashing facilities and gloves etc and we saw staff Care Homes for Older People Page 21 of 30 Evidence: washing their hands after giving personal care, as ways of helping to prevent the spread of infection. We looked at the laundry and found it to be clean, tidy and well organised. Staff explained there is a no touch policy for soiled linen, instead staff use dissolvable bags. The garden is particularly well kept and a real feature of this home. It is set in the middle of the home, with easy access to it from various points throughout the home. Many of the communal area windows and some of the bedroom windows look onto the garden. The home has a gardener, whose relative used to live here. He clearly takes great pride and pleasure in his work which the people living here benefit from. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here are supported by staff with appropriate skills who are employed in sufficient numbers to meet their needs. Improvements to recruitment help to ensure that people are kept safe from inappropriate staff. Evidence: People we spoke with were very complimentary about the staff working here. They say they are kind, caring, helpful and lovely. They also say that staff are kept very busy but that they remain cheerful. We asked people if the staff being busy affected them. Two people told us that sometimes when they are being cared for by a member of staff that that person is called away. They say they probably dont have to wait very long for them to come back, but that this wait makes them anxious just in case they are forgotten. The duty rota shows that there are usually 2 Registered Nurses on duty from 8am until 5pm, after which there is 1 Registered Nurse on duty. There are usually 8 carers on duty in the morning, 6 in the afternoon and evening and 3 at night. In addition the manager works office hours, there is an administrator, receptionist, cleaning, catering and laundry staff. Staff and people living here told us that a number of staff have recently left the home Care Homes for Older People Page 23 of 30 Evidence: and this has had an impact on their lives. Staff say that mostly they cover the duty rota where there are gaps and people say they prefer this to having agency staff. The AQAA tells us that there are 21 carers working at the home and that 13 of these carers hold a National Vocational Qualification (NVQ) in care to level or 2 or above. This equates to 60 of the workforce holding this qualification which is above the 50 recommended by the government. Records show that staff receive induction training. In addition, and since the last inspection, the home have promoted one senior carer to work alongside staff ensuring that the skills and ethos they learned during induction are put into practice. In surveys staff told us that they are given training relevant to their role and that induction covered everything they needed to know about their job when they started work. We looked at the recruitment files for 2 members of staff who have recently been recruited. We found that robust recruitment procedures are undertaken. Each member of staff had not been permitted to work in the home until a POVA 1st had been undertaken and then worked under supervision until an enhanced police check was obtained. We also found that written references are obtained for staff prior to them starting work and that proof of identity is provided. However, gaps in employment are not always fully checked as they should be. As this home sometimes uses agency nurses, we also looked at the evidence the agencies provide saying they have carried out full recruitment checks on their staff before allowing them to work. We found these to be in order. Care Homes for Older People Page 24 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. The management arrangements for this service ensure that it is a safe place to live and that increasingly it is run in the best interests of the people living here. Evidence: Although this service no longer has a Registered Manager, the person who is currently managing the home has worked at the home for many years and has made an application to register with the commission as the manager. Staff say the manager is approachable and understands both management and care issues. Each month the home is inspected unannounced by the Director of Nursing for the company who own this home. She uses the outcome areas of the National Minimum Standards for care homes as the format for the inspection. The reports that she writes show that the management style of this company is an open and transparent one. Any shortcomings identified are reported and acted upon. In addition, since the home was involved in a safeguarding issue, the owner of the home has invested in more training, Care Homes for Older People Page 25 of 30 Evidence: more staff, improved assessments and improved staff supervision for this home. Regular meetings are held with the people who live here and with relatives as well as with staff. There are a number of formats and forums in which these meetings take place, and the minutes show that these meetings seek suggestions for improving the service offered. Regular satisfaction surveys are undertaken, the results of which are easily available for people to see. The most recent survey resulted in menu planning suggestions which the manager reports have already been implemented. Staff spoken with say they have good training and that this includes mandatory training including moving and handling, infection control and fire safety. The AQAA records that maintenance and servicing contracts are in place and up to date. People confirm that fire alarms are tested regularly and records show this is happening weekly. Checks are made to detect Legionella, window restrictors are checked weekly and bath water temperatures are tested to help prevent scalding. When we checked the hot water in one bathroom, we recorded a temperature of 45C. Bath water should be delivered at no more than 44C to prevent scalding. The kitchen was clean and tidy. Fridge and freezer temperatures are checked and show that these are running at the required temperatures. Fresh foods stored in the fridge are covered and dated. We checked the personal accounts of some people living here. Accounts are easy to understand and easily auditable. All receipts are kept for monies spent on behalf of the people living here. 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 7 15 The work started to improve 31/07/2009 care planning and reviews should continue. This will help to ensure that people get the care they need and that reviews of the care delivered are based on feedback from those delivering the care. This Will help to ensure that reviews are based on factual information and that changes to care are made accordingly. 2 8 12 Measures must be taken to ensure that where risks are identified that appropriate actions are always taken to minimise or manage these risks. In particular this relates to people who are identified as being at risk of developing pressure sores. 31/07/2009 Care Homes for Older People Page 28 of 30 This will help to ensure that people do not develop pressures sores and they are helped to remain healthy. 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 8 If it is identified that people experience pain then a plan as to how the pain is to be managed should be put in place and a review should take place to determine if the plan is working to relieve the pain. People should not sit in wheelchairs for long periods of time as these do not provide sufficient support or comfort, unless the wheelchair is specifically designed for that person. The type and amount of activities offered should be kept under review to ensure that they meet individuals preferences, interests and abilities. Any decisions made on behalf of people must be done so, and recorded as such, in line with the Mental Capacity Act guidance. Routine and regular checks of the bath temperature regulator should be made to ensure this is working to help ensure that hot water is delivered to baths at a temperature of 44C. The manager should continue with her application to become registered with the commission. 2 8 3 12 4 18 5 38 6 38 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. 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