Inspection on 11/02/09 for The Old Vicarage

This inspection was carried out on 11th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Vicarage 12/02/08

The Old Vicarage 06/09/07

The Old Vicarage 20/02/07

The Old Vicarage 05/06/06

The Old Vicarage 18/10/05

The Old Vicarage 26/10/04

The Old Vicarage 11/05/04

The Old Vicarage 25/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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 Vicarage Warren Road Hopton On Sea Great Yarmouth Norfolk NR31 9BN     The quality rating for this care home is:   one star adequate 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: Judith Last     Date: 1 1 0 2 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 33 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 33 Information about the care home Name of care home: Address: The Old Vicarage Warren Road Hopton On Sea Great Yarmouth Norfolk NR31 9BN 01502731786 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Estateband Limited Name of registered manager (if applicable) Mrs Jill Chaplin 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 total number of people accommodated shall not exceed twenty (20). Twenty (20) older people of either sex may be accommodated. Two (2) older people who have dementia and are named in the Commission`s records may be accommodated. Date of last inspection Brief description of the care home The Old Vicarage is in the village of Hopton-on-sea, between the coastal towns of Great Yarmouth and Lowestoft. It is sited in the centre of a holiday caravan village that is densely populated at certain times of the year. There are local amenities and the beach within walking distance of the home and a public transport service that provides a link to the main towns. Care Homes for Older People Page 4 of 33 care home 20 Over 65 2 20 0 0 Brief description of the care home The home is a two storey detached Georgian house with a newer extension. It provides residential care and accommodation for up to twenty older people. The home stands in its own grounds of approximately two acres mostly laid to lawn, which is partially accessible to the front of the home. There is parking to the front of the home. There is a passenger lift to the first floor to make access easier for people. There are three lounges of different sizes, a dining room, two bathrooms containing adapted bath, washbasin and toilet on each floor, two toilets on the ground floor and one toilet upstairs. There are nineteen single and one double bedroom. The range of fees is from £348 to £370 per week for a single room. There are additional charges for private chiropody, hairdressing, newspapers or personal spending. There is an additional charge for some outings and for staff escorting people to the hospital or local surgery. This is all set out in the guide to the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the home we reviewed all the information that we had about it. This included the information the manager has to send us about what has been happening in the home over the last year. We also had letters from 5 relatives, three people living at the home, and one staff member. We visited the home unannounced and spent just over 7 hours there. Our main method of inspection is called case tracking. We use this to see what records say about peoples needs and then to find out from observation and discussion, Care Homes for Older People Page 6 of 33 how they are being supported in their daily lives. We used the information we gathered and the rules we have, to see what outcomes were achieved for people using the service. What the care home does well: What has improved since the last inspection? What they could do better: There are still some things that need to happen to improve the service and outcomes for people using it. Medication records (although much improved) must accurately show whether medicines have been given or withheld. We found one medicine that should be kept cool and thrown away 4 weeks after opening. This was not dated on opening and was not kept in the fridge so staff could not be sure that it was still effective to use. Care Homes for Older People Page 8 of 33 Activities do not always meet peoples needs and preferences. Comments made to us and records do not show well that people have regular opportunities to do something they enjoy. One person told us bingo happens regularly, but I cant stand it. More efforts need to be made in this area. There are concerns about safety of the grounds. This includes the outside store where freezers and some food is kept, is in poor condition, rotting and leaking. There is also a pile of rubbish (old bed heads etc) at the far end of the garden. These issues present harbours for vermin, risk of arson, and potential risk to people who wander or to young children visiting to the home. The organisation of records makes it difficult for the manager to demonstrate evidence of what she is doing on occasions. For example, she was unable to locate duty rosters to confirm that new staff were appropriately monitored pending completed checks and during their induction so they did not present a risk to vulnerable people. She also could not locate the Fire Risk Assessment showing how the risk of outbreak of fire and containment measures were set out and being monitored to promote peoples safety. More robust monitoring visits by the providers, with rigorous follow up of shortfalls or improvements required would show they are taking more responsibility with the manager for the continued improvement of the service - rather than waiting for issues to be raised at our inspections. 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would have enough information about the service to be sure that it could meet their assessed needs, before deciding whether they wish to live there. Evidence: The information available to people who are thinking about moving to the home, has been updated. It now includes information about the fees for staying there. . One person told us the manager had visited them before they moved in and provided plenty of information. This means that the manager has acted to meet the requirement we made last time for ensuring people have all the information they need and the law says they must have. People now have access to the information they need to help them decide whether they wish to move in. 100 of the people who wrote to us say that they have had a contract. We looked at Care Homes for Older People Page 11 of 33 Evidence: records for three people and saw these were on file. This means that people know what they can expect to receive from the service. The manager has improved the way she assesses peoples needs and tells us in information she sent, that she intends to improve this further to gather still more information. We did not see contradictory information on records as we had on previous visits (and which could lead to confusion among staff about actual need). One person told us that the manager had come to talk to them about their needs before they moved in. 80 of relatives who wrote to us, feel that the home always meets the needs of the person living there. 20 feel that it usually does. Care Homes for Older People Page 12 of 33 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 feel that their personal and health care needs are met and that they are well supported by staff. Medication management is now more consistent and safe than it has been previously. Staff are aware of the principles of privacy and dignity but jovial interactions or banter may be misconstrued by visitors to the home. Evidence: We looked at care plans for three people to see what they said about their needs. We talked to people about whether they felt these were being met. Some records were not well organised and it was difficult to locate information and to cross-reference it with information about how staff were to keep people safe and well. However, the information was available in various locations in the records. We received comments from people living at the home such as Im very happy with the care I receive. The girls help me with my personal care and getting dressed in the morning. There is always a member of staff available when I call out or press the bell especially when I fall or feel unwell. They are very kind and very caring. 100 of Care Homes for Older People Page 13 of 33 Evidence: people living at the home who wrote to us, say that they always receive the care and support they need. Another person told us that I cant fault them [the staff]. They are very good. If I want anything I just ask. Its got much better. The person is able to attend to much of their day to day care independently but says they can have help when they need it. Records show support plans are more regularly reviewed than they were the last time we visited. One relative wrote to us, where the person supported found this difficult. They told us that things here are always under review by the manager and she likes to get residents and relatives involved. Another commented on behalf of a resident that the care is as good as [name of person] could get and also I would need for [name of person] Records of visits from the doctor or other health professionals (like the district nurse) show that people are referred appropriately for support with their health care. Some records are in different locations and have not been added to the files for each individual. Some are undated and in one case unnamed. However, daily notes help to show that concerns about peoples health have been followed up appropriately. One person was unwell when we visited and staff were taking additional precautions to minimise the risk of infection spreading. Discussion with staff showed they were clear about what was expected and were monitoring fluid and food intake so they would know if the person needed medical referral. We saw a nutritional assessment on file for one person, representing an improvement since the last time we met, and checks are made on peoples weights so that they can be referred for additional advice if this is needed. In the past, medication has been poorly managed at the home, leading to enforcement action by the Commission. The manager had improved systems at our last visit and this one. We looked at medication administration record charts for the period from 19th January onward. These are more accurately maintained than we have seen previously. There were very few omissions of signatures where the chart did not show whether the medicine had been given as prescribed. One bottle of eye drops received has instructions that it is to be stored in the fridge. This was not refrigerated and not dated upon opening so staff cannot be sure that it remains both effective and safe in use. Other records showed that medication in variable doses and with more complex regimes, such as Warfarin, were being managed appropriately, with clear guidance Care Homes for Older People Page 14 of 33 Evidence: about the amount to be given. Balances remaining tallied with records of doses given showing these are accurate. A check on controlled drugs showed these are stored and recorded accurately. This shows that these medicines are managed safely. Information has come to us about the way that the home is supporting someone to manage their own medication. Staff have asked for advice about the risk and management of it, having regard to the persons wishes for independence in this area. The manager carries out audits of medication and of peoples competence to administer it, as required. She says that the Primary Care Trust is due to look at medicines in detail in the near future. They will provide a report to her about any other improvements she needs to make. People told us that they feel their privacy is respected and we heard staff knocking on peoples bedroom doors before they entered peoples rooms. We heard interactions showing that there was a good rapport between one person and the staff on duty. We spoke to the person concerned who said she got on well with staff and enjoyed a laugh and a joke with them. She did not feel that staff overstepped the mark or showed a lack of respect. We spoke to the manager however, about how the interaction we heard might be perceived if overheard by a visitor who was not in a position to discuss it with the person concerned. Care Homes for Older People Page 15 of 33 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. People are able to make some choices about their daily lives and their experience of mealtimes is positive. However, social and recreational activities to not yet meet the expectations and needs of people living in the home. Evidence: None of the people who responded to us in writing and who we spoke to, were able to confirm that activities always met their needs and preferences. The home can more easily show this for people who are relatively independent and able. for example one person told us that it was their preference to spend time in their room reading, listening to the radio or watching television, and they like to read the daily newspaper. They told us that there may be bingo once a week and sometimes people dont want to do it. They told us that sometimes there are only two [staff] on and one of thems got to be on the floor. The told us that the mobile library comes and they are able to borrow books if they wish. Care Homes for Older People Page 16 of 33 Evidence: A second person told us that they would like to see more spiritual things. They said there is bingo but I cant stand it. They told us there was scrabble the other day and I thought that was good but they had declined to join in. They suggested it would be nice to have occasional manicures in the afternoon. The hairdresser was visiting on the day we carried out our fieldwork. It was clear from the laughter and conversation between people, that they enjoyed this activity. Two relatives commented to us specifically that they felt there could be more activities and one felt these had declined, although others recognised that the home did well in celebrating particular big events like birthdays. One commented that the homes staff make a big effort with holiday activities like bonfire night etc. Daily records do not show clearly whether people have joined in an activity where they would need encouragement and support to do so. They also do not clearly and consistently show where people have been offered opportunities and declined. The manager recognises they could do better in recording these and so would have better evidence of the efforts made by the home to meet peoples individual needs. Some people living at the home are confused from time to time. We heard staff reassuring people and talking to them about what was going on. However, a clock in the small lounge by the office was not on the wall and not working so it did not act as an aid to orientating people around the daily routine. The visitors book shows that relatives for some people are regularly in the home and records for some people show their representatives are involved in supporting people to plan their care. The manager recognises in information that she sent, that people can choose who they see and if they wish not to see someone their wishes would be respected. People can see visitors in the communal areas or in their own rooms if they prefer. We have seen this happen on our visits to the home. Peoples rooms show that they are able to bring personal possessions into the home. People who are able to do so also manage their own money and one person told us about going to the local post office. People told us that they like their food and that meals are good. One person was looking forward to tea and one said I enjoy my meals very much. On the day we visited the manager was cooking as the cook was day off. The main lunch consisted of liver, sausage, bacon, potatoes, cabbage, carrots, swede and sprouts. The menu was Care Homes for Older People Page 17 of 33 Evidence: displayed on the wall and there was a clear indication for staff that if people did not want what was on offer they needed to be offered an alternative. We heard staff discussing portion sizes. They know people well and recognised when people were good eaters and when they would be over phased by large portions and would prefer to have extra later if they wanted it. The dining room was laid out with napkins and condiments. Gravy was presented in separate sauce boats so that people could help themselves. There was fresh fruit on tables and small bottles of beer to one side if these were wanted. Soft drinks were offered with the meal and a hot drink afterwards. This means people have opportunities to exercise choice during the mealtime. The manager has records showing that she surveys people for their views about menus, changes they would like to see and what they think of the quality of the food when there is a change of chef. Recent views include that meals taste and look better and I enjoy them more now than I did before the new cook started. Care Homes for Older People Page 18 of 33 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. Peoples concerns would be taken seriously and the service works cooperatively with other agencies to ensure people are protected from harm. Evidence: One person who wrote to us did not know how to make a complaint but was confident they would be able to do so via a relative. Others, including relatives, did know who to speak to. One person told us that they felt they could talk to Jill or the seniors if I had any concerns. People we spoke to say that they feel well cared for by staff and this is confirmed by those who wrote to us. One person said that they were quite satisfied with the way they were supported and had no complaints about anything. The complaints record showed that one relative had expressed concerns informally about the management of laundry and that this had been dealt with and resolved immediately without recourse to a formal complaint. Staff have regular training about recognising and responding to abuse of vulnerable people. One staff member we spoke to was clear about the need to report allegations or concerns straight away. Care Homes for Older People Page 19 of 33 Evidence: We know that the manager has sought advice when she has been unsure how best to proceed where she was concerned that the behaviour of a visitor presented potential risk and distress to people in the home. She worked cooperatively with members of the social work team, quality monitoring team and adult protection team to ensure people were not at risk of harm. Care Homes for Older People Page 20 of 33 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. People live in a home that is suited to their needs and is clean. However, the grounds present a potential risk to their safety and wellbeing. Evidence: The manager has an ongoing programme of redecoration and replacement of items that are worn. This is written so she can keep track of what has been done and what is proposed. When we visited we were able to see that one bedroom was being redecorated while it was vacant so that it would be in good condition for anyone moving in. Extra food storage and additional freezer space is provided in an outdoor portakabin. People living at the home do not access this according to the manager, but anyone who is ambulant could use the ramp if they were wandering in the garden. Staff access it regularly. The walls of this are distorted and there is evidence of rot in part of the wall and door. The floor is uneven and gives underfoot in parts. This presents a potential hazard for anyone entering the area and for ensuring the storage is vermin proof. The roof is stained showing that it leaks in places and there is an electric supply for appliances presenting potential additional risk . Part of the rear garden is covered in a pile of broken materials that present potential Care Homes for Older People Page 21 of 33 Evidence: risk to people who may wander in the garden, visiting children or from vandalism by fire. Staff have access to protective gloves and aprons where these are needed to minimise the risk of spreading infection and we saw that these were provided in one particular case to deal with a short term problem. There have been no concerns about laundry arrangements in the past and we did not have cause to think the situation had deteriorated in any way. Care Homes for Older People Page 22 of 33 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. People are supported by a core of effective, competent staff. However, lack of evidence of arrangements for overseeing staff undergoing induction and pending checks shows people may be at risk. Evidence: People living at the home say that staff are available when they need them. One person says that they only have to ask and staff will help if they need it. Everyone who wrote told us that staff were available when they need them. We conclude that adequate numbers of domestic staff are employed because the home was clean and there were no unpleasant odours. Most of the staff at the home have, or are working towards, national vocational qualifications to provide them with underpinning knowledge and training to help meet peoples needs. We saw a sample of records supporting this. Recruitment records show that appropriate checks are made to ensure that prospective staff members will not present a risk to vulnerable adults and that information they provide is verified. Checks against the record for the protection of vulnerable adults are made and these are received before the person starts work, Care Homes for Older People Page 23 of 33 Evidence: based on records seen. A senior staff member and the manager, say that staff are supernumerary and supervised at all times during their induction and pending completion of their enhanced criminal records bureau checks, to make sure they do not present a risk to people living in the home. However, the absence of the duty rosters mean that she was unable to show us evidence this was always the case and who was responsible for working alongside them to oversee their work. Training records have not been well maintained. We were able to see evidence of course places confirmed in some cases, but certificates showing completed training had not been placed on file in each case. For example, the manager says that staff had training in the mental capacity act recently, but although there were applications for entry there was no clear confirmation of who attended. Records do show that staff have training in first aid and we saw confirmation on file that training in moving and handling was completed promptly on recruitment. This contributes to maintaining the safety of people living in the home. One staff members record of induction had not been fully completed within the due time and signed off showing they had demonstrated their competence in all areas. However, it was certified as complete. This means the manager cannot demonstrate a robust and thorough approach to induction which is designed to equip new members of staff with the skills they need to support people effectively. There is a core of experienced staff working at the home who have been in post for some time. The manager also maintains a regular presence on shift which means people who may be less experienced or undergoing training, would have skilled staff to refer to should this be needed. There are shortfalls in supervision and staff meetings commented on in the following section of the report. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been some improvements in this area with the manager running the home in an increasingly effective manner and more often taking account of the views of people living in the home. However, the organisation of records needs to be improved. Evidence: The manager has still not completed the training that minimum standards say she should have, however, after almost four years she says she is nearing completion of it. She needs this to give her the underpinning knowledge and skills minimum standards say she should have to support her in running the home effectively. She has participated in other training and cites the Mental Capacity Act as being one such course, to help her understand the process of decision making under the act and peoples capacity to make informed decisions about their care. The manager has feedback on some questionnaires about what people think of the Care Homes for Older People Page 25 of 33 Evidence: service. There is evidence - for example in relation to meal preparation - that people are asked for their views and are able to make some changes in the things they experience in their daily lives as a result. However, they do not have opportunities for regular meetings to express their views and discuss issues that might be important to them. The last records of a meeting for people living in the home date from November 2006. There has been an improvement in the monitoring of the service on behalf of the registered providers. However, the reports submitted do not show a robust approach to reviewing and evaluating the service each month and following up issues. For example, an experienced staff member said that they did not feel staff were asked formally for their views. We have reminded the person concerned that, being registered, they carry equal responsibility with the manager, for operating the home in accordance with the law. We know that the manager has been working with members of the local authoritys quality monitoring team to ensure that improvements have been made in the service. She has also provided us with more detail on her self assessment of the quality of the service, which she was required to send before our visit. This means she has been looking more at the quality of the service and how well people are supported. The manager does not act as appointee for service users although she does have responsibility for safekeeping of any monies where people do not wish to do this themselves. Records of transactions are kept. We looked at records for staff supervision. These continue to show a practical approach to evaluating the understanding of staff about aspects of their day to day work and how this affects individuals. However, it does not routinely cover what is set out in minimum standards - which is intended to ensure that staff have a clear understanding of their roles and how to support people effectively in line with the homes aims and objectives. Evidence also shows it does not take place as frequently as expected to ensure that there is ongoing monitoring and discussion of peoples conduct and practice. For example, one staff member had one session listed as taking place in April last year, but with no other evidence in the form of a record of discussions, that it had taken place. There were no records of supervision for new staff showing that they had opportunities to discuss their roles, performance and development needs since they were recruited. Care Homes for Older People Page 26 of 33 Evidence: Staff meeting minutes show the manager calls these in response to problems but not on a regular basis to ensure the team stay on the right track. The staff meeting file presented showed the last records of discussion found were for July 2007. There was an agenda for a meeting in July 2008 but no minutes. This means that the manager may be lacking in systems to proactively identify problems and issues with staff so she can respond constructively and promptly to make sure standards of care and practice are maintained. The manager has improved the way that she tells the Commission about things that have happened in the home, including deaths and accidents. We sampled a range of records to do with the safety of the home. These showed regular testing of fire equipment and servicing of appliances as well as aids to mobility. This helps ensure that peoples safety is promoted. However, the assessment for risk of fire and how this was to be minimised required by law now, was not available although the manager says she has completed it. This means the manager cannot show she robustly monitors these measures to ensure the risk is managed, and people may be at increased risk. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 36 18.2.a Outstanding requirement 30/06/2008 Staff must receive supervision with the agenda and frequency set out in national minimum standards. This is so the management team can be sure that people understand their roles, work effectively with service users and can identify shortfalls or training needs at an early stage. Previous timescale of 31/12/07 has not been met. Care Homes for Older People Page 28 of 33 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 9 13 Medicines that are sensitive to temperature and have short shelf lives, must be stored appropriately and dated on opening. This is to ensure that such medicines remain safe and effective in use. 20/03/2009 2 9 13 Records of the 20/03/2009 administration of medication must show whether medication has been given or withheld/refused and why. This is so the records are complete and show consistently safe practices in recording and administration. 3 19 23 External grounds must be maintained appropriately. This is to avoid unnecessary risks to people living in the home (or any young visitors to the home). 17/04/2009 Care Homes for Older People Page 29 of 33 4 19 23 The external food/freezer 30/06/2009 store must be maintained in good order or replaced if this is not practicable. This is to avoid any unnecessary risk to people living, working in or visiting the home. This is to avoid potential electrical incidents arising from leaks. 5 30 17 Duty rosters must be kept at 20/03/2009 the home showing the shifts people work and in what capacity. This is so there is evidence the work of new staff is properly overseen by trained staff while they are undergoing induction. This is needed so that staff who are completing checks and preliminary training, do not present a risk to vulnerable adults. Regulation 17(2) Schedule 4, number 7 requires a copy of the duty roster be kept by law. 6 36 18 Staff must be supervised appropriately as set out in standards. This is so the management team can be sure that people understand their roles, work effectively with service users and can 24/04/2009 Care Homes for Older People Page 30 of 33 identify shortfalls or training needs at an early stage. 7 38 23 A fire risk assessment must be completed and held at the premises for the purposes of monitoring by the manager If this is not completed, the home is in breach of the Regulatory Reform (Fire safety) Order 2005. If this is not complete and regularly checked against practice, people may be at increased risk of a fire breaking out and of sustaining harm during an outbreak. 20/03/2009 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 Individual care plans should be organised consistently so staff can more easily find particular guidance about meeting needs. This would also help the manager to monitor more easily and effectively that they are kept up to date, signed by the person accountable, and reflect how peoples current needs are to be met. The manager should consider with staff, how their interactions and banter with people may be misconstrued and influence what others think of the service. Consideration should be given as to how people who are confused, are supported to orientate themselves to time and so reduce possible anxiety or distress about their routines - including ensuring clocks are kept in working order. The person carrying out visits on behalf of the registered provider, should ensure that records of complaints and concerns are always checked and that they follow up with Page 31 of 33 2 10 3 14 4 16 Care Homes for Older People the person, whether they are satisfied with the response. 5 35 The person visiting on behalf of the registered provider, should incorporate random checks on finances held for safekeeping, to ensure that people are safeguarded and financial guidelines are followed. Care Homes for Older People Page 32 of 33 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). 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