Inspection on 17/11/08 for The Queensmead

This inspection was carried out on 17th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Queensmead 19/12/06

The Queensmead 23/01/06

The Queensmead 23/08/05

The Queensmead 21/02/05

The Queensmead 31/08/04

The Queensmead 19/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Queensmead Victoria Road Polegate East Sussex BN26 6BU     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Melanie Freeman     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Queensmead Victoria Road Polegate East Sussex BN26 6BU 01323487931 01323488120 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Chanctonbury Healthcare Limited Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category/ies of service only: Care home only - 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 Date of last inspection Brief description of the care home The Queensmead is registered to provide personal care for up to 37 older people, over 65 years of age. The home is situated in a residential area of Polegate, close to the towns high street with shops, the library and public transport within walking distance. There is a large lounge that is used for social activities, a separate dining room, a conservatory at the front of the building and smaller seating areas near the reception and on the first floor. There are 35 bedrooms in the home arranged over three floors; 33 of which are single occupancy (of which all have en-suite facilities) and 2 of which Care Homes for Older People Page 4 of 32 Over 65 37 0 Brief description of the care home are double occupancy: one is arranged as a self contained flat providing accommodation for married couples (both double occupancy areas have en-suite facilities). Additional toilet and bathroom areas are available throughout the premises. A shaft lift enables residents to have access to all parts of the building. There are attractive gardens surrounding the home that are accessible to wheelchair users and is used by residents and staff when the weather permits, with additional seating areas to the front of the building. There is also a parking area to front of the building. Potential new service users can obtain information relating to the home via CSCI Inspection Reports, Care Managers, Placing Authorities, the internet by word of mouth and by contacting the home direct. The fees charged (at the time of this report) is 595 pounds per week, with additional charges made for hairdressing and chiropody. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Queensmead Care Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home by the allocated inspector, who spent approximately eight hours in the home. The newly appointed manager was working in the home and received the inspection feedback at its conclusion. A brief tour of the premises was undertaken and a range of documentation was Care Homes for Older People Page 6 of 32 reviewed including, the homes statement of purpose and service users guide, preadmission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files, quality assurance systems and some health and safety records. The care documentation pertaining to two residents were reviewed in depth and the inspector ate a midday meal in the dining room. Systems and records relating to medicine handling were also reviewed. During the inspection visit time was spent with seven residents who shared their views on the home, a visiting health care professional was also interviewed. Comments shared by residents and their representatives during the inspection process included I had a good feeling about the care home as soon as I walked through the door I am happy and settled at Queens mead I am very well looked after. Its so nice for everyone here the staff are all so kind. Information provided by the home within the Annual Quality Assurance Assessment (AQAA) has also been included in this report. At the time of compiling the report, in support of the visit, the Commission received survey forms about the service, from nine residents and five staff members. What the care home does well: What has improved since the last inspection? What they could do better: The management of the home needs to ensure that all prospective residents are advised in writing that the care home is suitable for the purpose of meeting their assessed health and welfare needs. This ensures that decisions around admission to the home are informed and evidenced. The care documentation needs to be improved to reflect that all the care needs of residents have been taken into account and that a person centred approach has been adopted, this will ensure residents receive appropriate care. In addition the care documentation needs to demonstrate that residents or their representatives are involved in planning of the care to be delivered, and that their agreement has been confirmed. Suitable risk assessments need to be used to assess any possible risk, these then need to be responded to in order to promote resident and staff safety. The systems for handling medicines need to be improved. All Controlled Drugs must be stored appropriately and recorded accurately within the register. All residents must be supplied with medicines in accordance with their prescriptions. Accurate records need Care Homes for Older People Page 8 of 32 to be maintained in respect of all medicines in the home and as required medicines need to be administered in accordance with individual guidelines. The arrangements noted at the time of the inspection visit were not safe and needed urgent review. The appointed manager responded immediately to these shortfalls and confirmed that they had all been addressed ensuring safe storage, accurate record keeping, and that all residents are receiving their prescribed medicines. The bathing facilities need to be improved to provide a suitable number of facilities that can be used safely by residents, enabling their choice and preference to be respected. The systems in place for infection control need to be improved to ensure a good standard in all areas. Care staff should receive regular formal supervision. These sessions should cover all aspects of practice, the philosophy of care in the Home, and the development needs of the individual. This will ensure staff are suitably supported and feel valued. All environmental risks need to be assessed regularly to identify any possible risk. These then need to be documented and responded to in order to maintain a safe environment for staff and residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives are provided with information about the home in order to make an informed choice about whether to live at the home. The admission procedures ensure that all prospective residents are fully assessed by a competent person before admission and are assured that their needs can be met by the home. Intermediate care is not provided at Queensmead Care Home. Evidence: The homes statement of purpose service users guide was available on request at the reception area and it was noted that each resident had a copy of these documents, that are held within a combined folder.The AQAA also confirmed that the home has a brochure and a web site where further information can be accessed. These documents Care Homes for Older People Page 11 of 32 Evidence: were informative and contained useful information, it was however identified that they need to reflect the changes in the management arrangements and should include a copy of the terms and conditions of residency, along with residents views on the service. Surveys received indicated that some residents were unclear about what contract arrangements were in place. Discussion with the appointed manager confirmed that these were being reviewed and that she was seeing each resident individually, with regard to this matter. An assessment of the admission process followed included the review of the documentation relating to the last three admissions to the home. This confirmed that all prospective residents are assessed by the head of care, who meets with them, and their representatives whenever possible, enabling a full discussion, which takes into account their individual needs and what the home can offer. Although it was confirmed that residents and their representatives are told verbally if the home is able to meet their needs following their assessment, this is not currently confirmed in writing. All residents are admitted on a trial basis which ensures that the admission is suitable, and effective for the residents as well as the home. The management of the home have recognised that the admission process needs to be updated, and following a recent marketing consultant review, are using the information provided, to make sure the home improves how it supports prospective residents in making informed choices. The pre admission assessment documentation is also to be reviewed to capture all essential information in a clear way. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst plans of care are devised these do not clearly set out residents personal and health care needs or reflect a person centered approach to care. Appropriate up to date risk assessments need to be completed to inform the care and residents or their representatives views need to be taken into account. Residents health care needs are met with the advice and support of community health care professionals. The practice in the home does not ensure residents medicines are handled safely. Care is delivered in such a way that promotes and protects the residents privacy, dignity and individuality. Evidence: The care documentation pertaining to two residents were reviewed in depth as part of the inspection process and each of these residents were seen during the inspection visit to the home. Although there was evidence within the care documentation that an Care Homes for Older People Page 13 of 32 Evidence: assessment process had been completed in some areas and that plans of care had been generated. Overall the documentation was fragmented and did not provide adequate up to date guidelines for staff to follow in all areas of care, and did not promote a person centered approach. Feedback from staff also identified that they did not feel up to date with regard to residents changing needs if they had not been working in the home recently. There was also no evidence that residents or their representatives are involved or agree to any plan of care, or have any input into the review or evaluation of the care provided. Some risk assessments are completed but again it was noted that they were not up to date and some important area including nutrition were not assessed. Again the management team has recognised the shortfalls in the care documentation and recorded in the AQAA The whole care plan system urgently needs updating and some staff need skills developing in recording information. Despite the lack of clear documentation the care provided at Queensmead is individualised with staff knowing the residents well, and responding to their health and personal care needs. Observation during inspection confirmed that residents care is tailored to them promoting a level of independence and decision making. The head of care accesses the community professional as necessary and the visiting nurse was able to confirm that this contact was appropriate and that the standard of care in the home is good. All feedback about the care provided was positive and comments included, I am happy and settled at Queensmead I am very well looked after I have been very impressed with the care and I am so relieved that my mother is here now. The home uses a monitored dosage system for medicines and administers directly from a trolley that can access all areas in the home. The medicines storage room is of an adequate size and the temperature of this room is being monitored. The storage arrangements and records relating to the Controlled Drugs in the home were checked. The head of care advised that there had been some discrepancies in the past which she had dealt with. However on return from leave last week she had noted that records relating to Temazepam were inaccurate. She had not completed an investigation and report and was asked to do so. On checking the Controlled Drug register it was identified that the index and page numbering was incorrect, making it difficult to confirm the accuracy of records. It was also noted that the register was not always being double signed when drugs were being administered. On examination the records in the register corresponding to a residents Oramorph were found to be incorrect. Although the Controlled Drugs were being stored separately the cupboard in use did not comply with current legislation. Care Homes for Older People Page 14 of 32 Evidence: Two surveys received from residents before the inspection visit raised concerns around the supply of prescribed medicines and when the head of care was asked if this had been a problem she confirmed that there had been some difficulties in ensuring an appropriate supply for all residents. A review of the medication administration record (MAR) sheets evidenced that this was still a problem as one chart recorded a resident did not have all her prescribed medicine for a week at the beginning of that month. The MAR charts also confirmed that the administration of prescribed creams is not being recorded, and a new medicine prescribed although recorded had not been signed. A record of signatures for those staff able to administer medicines used for audit purposes was not available and individual guidelines on when to give as required medicines is not provided. All the shortfalls in respect of the medicines were raised with the regional manager, appointed manager and the head of care. Contact with the appointed manager following the inspection visit, and later confirmed in writing, confirmed that she and the head of care, had re-checked all the Controlled Drug and re written and updated the register to ensure accurate records and that an appropriate controlled drug cupboard has been purchased. In addition that all prescribed medicines are now available in the home for each resident. Residents were seen to be well dressed and were being addressed in accordance to their recorded wishes. The relationship between staff and residents was seen to be respectful and inclusive, both responding well to each others company. When care needs are being attended to this is completed in privacy. During the inspection visit one residents said that it would be useful if staff wore name badges so that she knew who she was talking to. This view was passed on to the homes management. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides social, cultural and recreational facilities, including a specialist diets to residents, with residents choice and wishes being respected. Evidence: Contact with residents confirmed that they enjoyed many of the homes activities and that the home staff were flexible in allowing residents to choose the level of activities attended, many residents are able to source their own entertainment and activity. One relative recorded I have also visited my Aunt when entertainment has been going on and it is all very good and the residents appear to enjoy it very much. Other residents said that the activity although good did not meet their specific need. The assessment of peoples social care needs to be established and followed through with individual plans of care recording how people like to spend their time, what interests them and what they like to do. Residents choices are also not well documented although their preferred name is recorded and used. The Activity and entertainment in the home could therefore be improved to promote more one to one time that will allow for more accompanied walks, shopping trips and daily life activity. The new appointed manager shared her ideas on promoting themed activity that families and visitors can be involved in. Care Homes for Older People Page 16 of 32 Evidence: Contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the residents wishes. There are areas in the home that allow for residents to see visitors in private. Residents are treated with respect and a good rapport was noted between staff and residents. In the past residents meetings have been held on a two monthly basis to share views and information. The new appointed manager demonstrated that she is committed to responding to residents views and has already initiated good communication systems. Residents were all complimentary about the food and felt that they were looked after individually by the chef who they were able to discuss their specific requests with directly. Comments received included The chef has become a personal friend, he tries hard to get what suites people, he consults individually with people, and tries to respond to individual needs I suffer with reflux and the chef is very good at providing a suitable diet. The meal that was eaten with residents was both attractive and good to eat, a choice was available and residents said that the evening meal was also very good. The dining room is well presented and the tables are attractively dressed. Staff were available for assistance if required but otherwise provided a waitress service. The new manager is doing some work on reviewing the menus to fully reflect individual preferences. The Environmental Health Officers most recent report indicated that high standards are being maintained. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a robust and efficient complaints procedure, and the homes procedures, processes and staff training should protect residents in the event of an allegation or suspicion of abuse. Evidence: Contact with the home before the inspection visit and evidence within the AQAA, and the homes records, confirmed that complaints are taken seriously. They are responded to appropriately and used as a quality improvement tool. A clear complaints procedure is in place and readily available to residents. Some of the returned surveys recorded that people were not aware of how to make a complaint. This was raised with the homes management who said that they would re advertise the complaints procedure internally ensuring residents and their representatives have a clear understanding of what to do. The home has an Adult Protection procedure and the AQAA recoded that this had been updated and that staff are well trained on Safeguarding Vulnerable Adults. The management team has a clear understanding of adult protection issues and is aware the local reporting procedures. Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adult (POVA) Care Homes for Older People Page 18 of 32 Evidence: checks are carried out on all new staff. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable, clean and safe environment for those living in the home and visiting. Some improvement is required to ensure suitable bathing facilities, and that infection control procedures are adhered to at all times. Evidence: Queensmead is a purpose built home located in a residential area close to the centre of Polegate. The location and layout of the home are suitable for its stated purpose. The home is well maintained and all areas of the home, including the garden, are accessible to residents. Although the home is reasonably well maintained there is a plan to upgrade the whole home to provide a high standard of furnishing and decoration. These plans would of been progressed this year but the replacement of the heating system took priority and has now been completed. The reception area is central to the home life with residents and visitors referring to the receptionist regularly for information and for conversation. The home has several separate recreational spaces that residents can access at will. Care Homes for Older People Page 20 of 32 Evidence: The environment was found to be clean and fresh throughout and standard of cleaning was high. During the inspection visit it was noted that the home only has two bathing facilities that can be used to assist residents with a bath or a shower. This is not an adequate provision and needs to be improved to ensure residents can have access to a suitable bathing facility as often as they wish. This matter was discussed with the the homes management team who recognised the need to improve the facilities to reflect the increasing dependency, differing needs, choices and expectations. All rooms are single with en suite facilities, apart from two that can be used as shared accommodation if wanted and requested by a couple. The ground floor has a small sluice room that is used to clean commode pots and urinals. This cleaning is done by hand as there is no electrical disinfector. It was noted that appropriate hand washing facilities were not provided in this room. The appointed manager needs to review the sluicing facilities and infection control practice in the home to ensure good infection control measures are followed in all areas. A separate hairdressing saloon area is provided in the home. It was noted in this room there was an unguarded radiator that posed a possible risk to residents. Once this was identified to the appointed manager she made arrangements for it to be covered, which was progressed within the week. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers and skill mix provides a competent staff team that meets residents health and personal care needs. Residents are protected by the recruitment practice followed. Evidence: At the time of this inspection visit the home was occupied by 30 residents and staffing levels observed were found to be appropriate to meet the needs of residents, and records held by the home confirmed that these levels are maintained over the week. Surveys and discussion with staff confirmed that suitable staffing arrangements are in place. The surveys recorded that the oganisation of work and communication between staff had been lacking in the past. Clear instruction and updates on care were not always passed on. There has been an instability in the homes management over the last year a recent re structuring and appointment of a manager with a separate head of care will improve lines of communication and ensure updates on care are recorded and shared. All feedback received about the staff working in the home was very positive and comments received included The staff are always friendly and helpful and nothing is Care Homes for Older People Page 22 of 32 Evidence: too much trouble Its so nice for everyone here, the staff are all so kind. The recruitment files pertaining to three staff were reviewed as part of the inspection process and and on the whole were found to be comprehensive. They included an application form, evidence of two references and the required Criminal Records Bureau (CRB) and POVA checks on all staff. It was however noted that not all staff had a photograph on file and the appointed manager said that this would be addressed. Staff training has been maintained and a training matrix provided confirmed that over the last twelve months the home had provided a range of training, including Induction Training, Fire Training, Health and Safety, Moving & Handling, Medication, Nutrition, Risk Assessing and First Aid. The AQAA confirmed that over 50 of staff have a National Vocational Qualification in care at a level 2 or above, or equivalent. An external training provider supports the home in identifying the training needs and how these can be met. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home has lacked a stable manager over the past year a new manager has been appointed. She is demonstrating good management skills and should provide the necessary leadership and direction that is needed. Quality monitoring processes are well developed and take into account residents views, the financial interest of residents are safeguarded. Systems are in place to protect the health, safety and welfare of residents and staff. Evidence: As mentioned previously in this report the management arrangements at the home have not been stable over the past year and the home has not had clear leadership and direction. This has been difficult for staff and particularly for residents who said that they had missed having a stable manager that they could speak to. The Care Homes for Older People Page 24 of 32 Evidence: established manager of 10 years was moved to another position in the Organistation. Two further appointed managers have not remained in post. A new manager has now been appointed and started working in the home 11 days before this inspection visit was undertaken. She has already introduced herself verbally to residents and staff and provided a written introduction explaining her role. One residents said how she appreciated this contact and had a better understanding of the what was involved in the running of the home. The appointed manager has a strong background in management and will focus on the administrative side of the home and the previous manager has taken on the role of Head of care. This new structure will provide clear lines of accountability. The home uses a variety of quality auditing systems which include audits completed by other home managers in the Organisation, the required regulation 26 visits completed by the regional manager. Health and safety audits and regular feedback from residents and staff within meetings and questionnaires. The AQAA was well completed and used as an audit and quality improvement tool. The home does not take any responsibility for any of the residents finances and most residents have family, friends or representatives who protect their financial affairs. Small deposits of money accounts are held for some residents. These accounts were checked and found to be correct with evidence that appropriate procedures are in place for all monies entered and debited. Staff surveys recorded that staff have not felt well supported by the management with some indicating that supervision is not provided on a regular basis. Although there was some evidence in the home that staff supervision is provided support systems for staff need to be robust and effective and need to be established throughout the home. There are systems in place to ensure suitable health and safety measures are in place and the home has an allocated health and safety officer who does regular audits in the home. The records relating to hot water checks were seen and confirmed that these are maintained. Specific environmental risk assessments are not well completed and need to be addressed. Once adopted these will identify such risks as unguarded radiators. Care Homes for Older People Page 25 of 32 Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Prospective residents must 01/01/2009 be provided with written confirmation that the care home is suitable for the purpose of meeting their assessed health and welfare needs. This ensures that prospective residents, are kept fully informed and can make an informed choice about where they live. 2 7 15 Care plans must be 01/01/2009 composed and reviewed with input from the resident and or their advocate, unless the offer is declined. This will ensure that residents and/or their representatives are in agreement with the care provided. 3 7 15 That the Registered Person ensures that the care plans accurately reflect residents 01/01/2009 Care Homes for Older People Page 28 of 32 care needs, promote person centered care with personal choices, preferences and abilities being recorded. This will ensure that residents receive care that is tailored to their specific care needs. 4 8 13 That the Registered Person 01/01/2009 ensures that appropriate risk assessments are in place to cover all area of risk, and are kept up to date and include those associated with nutrition and skin damage. This will identify possible and risks, and ensure appropriate measures are put in place to address the risk. 5 9 13 When medicines are prescribed on as required basis this is done in accordance with individual guidelines. This will ensure that such medicines are given in a consistent way and in accordance with the prescription. 01/01/2009 6 9 13 Controlled drugs must be 01/01/2009 stored within an appropriate cupboard that meets current legislation and accurately recorded within a controlled drugs register, with any discrepancies fully investigated and responded to. Care Homes for Older People Page 29 of 32 This will ensure Controlled drugs in the home are handled safely. 7 9 13 There must be arrangements in place for the supply of all prescribed medicines and the accurate recording of all medicine administration. This will ensure residents are given their medicines as prescribed 8 26 13 The registered person must 01/01/2009 ensure suitable arrangements are in place to prevent the risk of cross infection. This should include suitable hand washing facilities available in all hand washing areas. This will ensure a high standard of infection control through out the home, and enabling staff and residents are able to wash their hands effectively. Care staff should receive 02/02/2009 regular formal supervision. The sessions should cover all aspects of practice, the philosophy and care in the Home and the development needs of the individual. This will ensure staff are suitably supported and feel supported and valued. 10 38 13 The registered person shall make arrangements to 01/01/2009 01/01/2009 9 36 18 Care Homes for Older People Page 30 of 32 ensure areas accessible to residents are so far as reasonably practicable free from hazards to their safety. Appropriate risk assessments need to be completed recorded and responded to. This will ensure any risks are identified and actioned to promote staff and resident safety. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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