Inspection on 24/03/09 for Trelana Nursing Home

This inspection was carried out on 24th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Trelana Nursing Home 24/02/10

Trelana Nursing Home 26/03/07

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Trelana Nursing Home Poughill Bude Cornwall EX23 9EL     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: Mandy Norton     Date: 2 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Trelana Nursing Home Poughill Bude Cornwall EX23 9EL 01288354613 01288354110 trelanacare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): European Care (South) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 50 Number of places (if applicable): Under 65 Over 65 16 50 4 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 One named under age service user with a physical disability for ongoing respite care. To include one additional named service user under the age of 65 years and outside of the registered category Total number of service users not to exceed a maximum of 50 Date of last inspection Brief description of the care home Trelana is situated in Poughill, a small village on the outskirts of Bude where local facilities can be found. It is near to a bus route. There is ample parking at the home. Accommodation is provided on two floors (34 beds) in the original house where nursing care is usually provided, there is a pasenger lift between all the floors. A purpose built area with facilities for people with dementia (Lowen Unit ,16 beds) is also available at Care Homes for Older People Page 4 of 29 Brief description of the care home the home. Most rooms provide en-suite facilities. There are a variety of communal areas throughout the home, that can be accessed by any residents. There is a large patio area with garden furniture accessible to residents. Care Homes for Older People Page 5 of 29 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 took place from 10 am to 3.40 pm on the 24th March 2009 with one inspector and an expert by experience. and from 9.30 am to 2.30 pm on the 25th March 2009 with one inspector. The inspection was conducted with the manager. A tour of the home was carried out and people who live at the home and people who work at the home were spoken to and observed. This report also contains information taken from the completed Annual Quality Assessment (AQAA) document , the report done by the expert by experience following the inspection and Service User and staff surveys submitted to the Commission prior to the inspection. Care Homes for Older People Page 6 of 29 An expert by experience is a person who, because of their shared experience of using services or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The three tasks that an expert by experience can do are to talk to people who use services, staff and management, observe daily life in the service and the interaction between staff and people who use services and look around the premises. What the care home does well: What has improved since the last inspection? What they could do better: Most of the care plans examined did not have a persons social history completed. Some areas of the care plans have repeated information in them if staff did not have to do this then they would have more time to complete the social history which is important when planning and providing individualised (person centred) care. Care staff should ensure that all records about peoples daily personal care interventions are up to date at all times so it is clear what care and support a person has received. Staff should not refer to people who need help with their meals as the feeders, they should use more appropriate terminology or peoples names. All staff need to have up to date safeguarding training so that they can recognise possible signs of abuse and know the current local reporting procedures. The manager should ensure that the correct mix of staff are on duty to enable all peoples needs to be met. She should continue with introducing a training matrix so that she can be sure which staff are up to date with mandatory training and training relevant to their role. She should also document how many staff have completed NVQ training and how many need to do it to demonstrate that at least 50 of care staff have at least NVQ level 2 in care. The provider (European Care) should ensure that the welfare of the staff and residents is maintained by acting on requests for repair or replacement of items such as kitchen, laundry and housekeeping equipment in a more timely manner. Care Homes for Older People Page 8 of 29 The manager should ensure that personal risk assessments are carried out and regularly reviewed to ensure staff are using safe working practices at all times. 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 29 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 29 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 who use this service have up to date information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: The Service Users Guide and Statement of Purpose seen were up to date and reflected the recent changes in the service. They contained detailed information about what the service can offer and terms and conditions of residency. The manager said that people are always assessed, by the manager or one of the senior nurses qualified to do so, prior to moving into the home to ensure their needs can be met. If people are to be admitted they and their representatives are given up Care Homes for Older People Page 11 of 29 Evidence: to date information about the service and invited to look around and spend some time at the home and ask any questions they may have. Detailed care plans done by social services prior to admission were seen in a number of care plans examined, these are also used as part of the assessment process. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will always be fully met. Evidence: The manager said that the care plans are in a format used by European Care throughout their homes. The care plans seen (5) were up to date and contained a lot of relevant information about the person and their health, personal care needs. In some cases the same information had been repeated in more than one place. Only one of the care plans had a detailed life history completed, if information was not being repeated the nursing staff would have more time to complete the life history. The care plans included skin, nutritional and lifting and handling assessments and information about visits made by health care professionals such as GPs, opticians and dentists. The care staff complete daily records about what care and support has been provided to a person. The records seen were not all up to date making it difficult in some cases to see what care a person had received. Care Homes for Older People Page 13 of 29 Evidence: A tour of the home showed that equipment necessary for the promotion of tissue viability and prevention of pressure sores is available to meet peoples current needs. The manager said that they have enough equipment and showed us ongoing maintenance records for a variety of equipment. The home uses a blister pack system for administration of medicines. Each unit has its own trolley that is locked in a treatment room. The drugs fridge seen has its temperature measured and recorded daily. Nursing staff were reminded to consider where they store supplement drinks to ensure they are kept at the right temperature. The medication administration records (MAR) sheets seen were completed as required. The procedure for receipt, storage and disposal of unwanted medicines seen is in accordance with laid down legislation. A photograph of each resident should be kept either with the care plan or the MAR sheet. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner (by the inspector and the expert by experience). Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. Staff were heard referring to people who need help with their meals as feeders this is poor practice and does not help to maintain peoples dignity. Care Homes for Older People Page 14 of 29 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. A range of activities within the home and the local community mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: People are encouraged to exercise choice in how they spend their time and activities are offered individually or in groups and are facilitated by the activity co-ordinator. The manager said that it has been recognised that people who live on the Lowen Unit who have dementia need to have more stimulation so a second activity co-ordinator has been employed. Information about in-house and outside activities are displayed within the home. Chairobics was taking place on the day of the inspection and the expert by experience found out that this activity happens 3 times a week and is run by volunteers. She felt that residents would benefit from more stimulating activities. This should be addressed by the introduction of the second activity co-ordinator. The manager said that 2 people regularly go to a local day centre, Pets as Therapy (PAT) dogs visit the home and they can make use of the local Help The Aged transport if Care Homes for Older People Page 15 of 29 Evidence: trips are planned and have access to local disabled use taxis. The expert by experience was told people currently never go out on trips. Three of the four completed service user surveys indicated that there are always activities arranged by the home to take part in and one that there usually are. Comments included the activities that are arranged by Trelana and the entertainment that is arranged is far beyond what you would expect and good activities e.g. weekly church service,chairobics, other activities, craft activities etc. During the inspection people were seen in the lounge talking with staff, others were seen in their rooms reading magazines or newspapers. Where a TV was on it was on an appropriate channel. The care plans are designed so that information about peoples interests and hobbies is recorded and can be used when trying to develop person centred care. Visitors are welcomed at anytime and the manager said that some people regularly go out with friends or relatives. There are patio areas with planters and seating for people to use, there is level access to these areas. Most people have their meals in the dining room, People are asked daily what they would like for their meal and there is always a choice. Drinks and snacks are available 24 hours a day. Records are kept of what people eat to ensure they are receiving a balanced diet. The manager said that people who need a lot of help with their meals usually sit in one of the lounges so that staff are available at all times to assist them. An anonymous call received prior to the inspection indicated that staff were being asked to reduce the food intake of the people in the Lowen Unit when the manager was asked about this she said that was not the case and notices that had gone up in the kitchen areas about trying to reduce wastage had been misinterpreted. She aid she would remove the notices to reduce the chance of further misunderstanding. One comment on a completed staff survey was very good meals provided by the kitchen. Two of the four completed service user surveys indicated that they always like the meals at the home and two that they usually did. Comments included the food that is served is well presented and nutritious and that enjoys her food especially the home made cakes. Care Homes for Older People Page 16 of 29 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. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. All staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure was seen displayed in the home and is included in the Statement of Purpose and contract of terms and conditions of residency. It is comprehensive and gives options about who to contact and timescales for responses to be made. There have been 2 complaints made to the Commission since the last inspection both of which have reached satisfactory outcomes. The manager said that people are seen by senior staff daily and hopes that any issues or concerns would be bought up then on an ongoing basis. On the day of the inspection the manager was meeting with a relative following a complaint. The relative said it had been resolved and she was now looking forward to working with the manager, regarding her relative, in the future. All four of the completed service user surveys indicated that they knew how to make a complaint. All three of the completed staff surveys indicated that they would speak to the manger if a resident or relative had any concerns about the home, with one commenting that as they had had no formal induction they were not aware of the complaints policy. Care Homes for Older People Page 17 of 29 Evidence: The manager is fairly new in post and needs to familiarise herself with the local safeguarding policies and procedures. European care provide robust policies and procedures on general recognition of abuse and reporting procedures, which are available to staff at all times. The training records were not clear about when staff last had safeguarding training. The manager said she will ensure that she and the senior staff attend local training as soon as possible, followed by the rest of the staff. These dates will be recorded so that it is clear when updates are due. One safeguarding referral has been made since the last inspection and it was dealt with appropriately. Care Homes for Older People Page 18 of 29 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. An ongoing maintenance and redecoration programme means people have a comfortable, and safe environment in which to live. A variety of communal space and personalised individual rooms means that people have a choice of where to spend their time in comfortable surroundings. Evidence: Trelana is currently registered to take up to 50 people. The ground and first floor are used by people who require nursing care and the lower ground floor (Lowen Unit) is used by people who have dementia. People from all over the home often mix together on the ground floor for activities. A tour of the home showed that peoples rooms are personalised with furniture and momentos they have bought in with them. The AQAA states that residents bedrooms are individualised to the resident. The expert by experience noted that the peoples individual rooms were warm, light and pleasant. Communal space consists of a 2 lounges and a dining room on the ground floor and a lounge dining room on the lower ground floor. They all contained furnishings and fixtures that made the rooms look homely whilst being practical. The home is built on a split level so the ground and lower ground floor have access to separate patio areas that are provided with garden furniture for people to use. There is a passenger lift for Care Homes for Older People Page 19 of 29 Evidence: people to use to move around the building. Behind the main reception area are an administrative office and access to the kitchen and laundry. There are enough assisted bathrooms and toilets throughout the home to meet peoples assessed needs. Many of the bedrooms have en suite toilet and shower facilities. The expert by experience noted that some toilet seats were missing in the en suite facilities and was told that the flimsy toilet seats keep breaking and are removed for safety and that it seems to be difficult to get replacements for them. On the day of the inspection the home was clean, tidy and hygienic. That was despite the housekeeper saying that there is currently only one vacuum cleaner working in the home. Evidence was seen that the manager has requested European Care to replace or repair broken equipment at least twice with no satisfactory outcome at the time of the inspection. Policies and procedures around infection control (provided and reviewed by European Care) are up to date and available to staff at all times. There was no evidence of any staff recently attending any infection control training. The home has mechanical sluicing facilities and a laundry the provides hand washing facilities for the staff and houses appropriate equipment for the amount of laundry generated by the residents. A full time maintenance man carries out a programme of routine in house maintenance to ensure the home remains functional and comfortable. A recent inspection by the local fire officer showed some areas of non compliance with fire regulations. The manager has submitted plans of how compliance will be achieved to the inspector and the work will be carried out as soon as possible. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix are generally satisfactory meaning peoples needs are being met most of the time. The robust recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Some training is ongoing and more is being introduced. The manager is introducing a training matrix to ensure that all training is monitored meaning that people will be receiving care and support from people who are well trained to provide it. Evidence: The manager nursing and care staff are supported by administrative staff, an activity co-ordinator ( shortly to be 2 activity co-ordinators), catering, domestic, laundry and maintenance staff. The manager and the duty rota seen confirmed that during the morning there is the manager plus 1 trained nurse and 5 care staff on the nursing unit (for 34 people) and 1 trained nurse and 3 carers on Lowen Unit (for 16 people), one of the carers on each unit is a senior carer. Overnight there are 2 trained nurses, 1 for each unit and 3 care staff, 1 for Lowen Unit and 2 for the nursing unit. The staff on the Lowen Unit work a different shift pattern to those on the nursing unit. The AQAA states that the home is staffed according to the needs of the residents. The expert by Care Homes for Older People Page 21 of 29 Evidence: experience noted that there is a feeling amongst the staff that they are short staffed and said that little interaction was seen between staff and residents but what she did observe was of a caring nature. She added that the staff seemed to be rushing around to get their chores finished with little time left to pay attention to the residents. It is noted that at the time of the inspection there was a shortage of staff due to a variety or reasons and the manager was making every effort to fill the vacant shifts by asking staff to work extra shifts and by using agency nurses where possible. Two of the three completed staff surveys indicated that there are never enough staff to meet the individual needs of the people that use the service and one indicated that there are usually enough staff. The manager said and one of the completed staff surveys commented that the skill mix of staff on duty needs to be reviewed to ensure that residents have the benefit of experienced carers working with those who have less experience to provide guidance. European Care have a robust recruitment procedure that includes getting 2 written references and a CRB check. The manager said that the staff files in place when she took over have not yet been checked to make sure they have the required information in them. The 5 staff files examined during the inspection did have all the required information in them and were stored securely. The manager said she did not know how many people had the benefit of a formal induction programme when they started at Trelana as individual records do not exist and she has not been able to go through the staff files to find out if information about induction is in them. A trained nurse on duty during the inspection was on an induction programme. One of the completed staff surveys indicated that their induction did not cover everything they needed to know about the job when they started, one said it did mostly and one indicated that theirs had covered everything well but that new staff are not informed enough about things like fire alarms and drills. Training records seen could not confirm whether staff have received the minimum of 3 days paid training days a year or not as each person does not yet have an individual training and development profile. The manager is aware of this and is keen to introduce individual training plans as soon as possible. The manager is aware that statutory fire training and lifting and handling training is out of date for some people and is dealing with this as a matter of priority. She said that the staff are soon to attend specialist dementia training provided by a specialist trainer from European Care. Care Homes for Older People Page 22 of 29 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 systems and procedures now in place are designed to meet the needs of the service as they strive to improve the service the home offers to the people that live there. The attitude to health and safety shown by the manager, nursing, care and ancillary staff means that people generally live in a safe and well maintained environment. Evidence: The manager has been recently appointed, she was previously the deputy manager. She is a level one nurse (BSc in adult nursing) and has an NVQ level 4 in management. Her background prior to working at Trelana was in service management of learning disability services. She said that although this is her first managers post in a care home she has a lot of experience to bring to the job and feels supported by European Cares area manager. Care Homes for Older People Page 23 of 29 Evidence: A formal quality assurance assessment , used by all European care homes, is in place and involves seeking the views of the residents and their representatives. Company representatives carry out monthly visits (regulation 26 visits) to the home. They speak to staff and residents and conduct a tour of the home a report is then prepared and any required actions as a result of the visit are documented. The manager said she has already introduced weekly internal audits of care plans and medication and the AQAA states that a bi annual health and safety audit is carried out. She said she will send out residents surveys in the near future once people have had time to get used to the new management structure and then she can get a view of what the residents think of the service offered by Trelana. The manager showed that money held on behalf of the current residents is kept securely in the administrative office, records are kept of income and outgoings and receipts are kept as evidence of the transactions. Residents have access to their money at all times. The manager said that she is aware that some staff are out of date with their statutory training including fire safety and lifting and handling, she is dealing with this as a matter of priority. A number of routine servicing and maintenance documents and the fire log book were examined and found to be up to date. The Environmental Health Office carried out a routine assessment of the kitchen in March 2008. Some recommendations were made which have since been carried out. The maintenance man checks the defect book daily and carries out repairs as requested. He also carries out ongoing in house and outdoor routine maintenance tasks. The expert by experience was told that a number of appliances in the kitchen were not in working order including the fly zapper, the salad bar and the hot and cold taps are continuously running and she was also told that the home only has one working vacuum cleaner and the industrial iron is not working. When these things are not repaired or replaced it leaves the staff feeling undervalued. We saw evidence that the manager has put in numerous requests to European Care for these items to be repaired or replaced and is still waiting for the outcome. The manager has introduced some new risk assessment since taking on the role for example for staff who are pregnant. She was reminded to introduce some personal risk assessments for staff if they have mentioned a medical condition on their application form or during regular supervision sessions that may have an impact on their ability to carry out their full range of tasks. Care Homes for Older People Page 24 of 29 Care Homes for Older People Page 25 of 29 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 15 17(2)Schedul Records of the food provided 30/04/2007 e4 for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. Care Homes for Older People Page 26 of 29 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 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 2 3 7 The care plans should include details of a persons social history. All care plans should include a detailed life history to enable staff to use a person centred approach to providing care and support. Care staff should ensure that all records about peoples daily personal care interventions are up to date at all times so it is clear what care and support a person has received. The manager should ensure that staff members do not refer to people who need to help with their meals as feeders. The nurses compiling the care plans should ensure that life histories are up to date and interests and hobbies are recorded to ensure that activities can be tailored to meet individual as well as group needs. The manager should ensure that all staff have up to date safeguarding training so that they can recognise possible signs of abuse and know the current local reporting procedures. The manager should ensure that numbers and skill mix of staff are appropriate for the number and dependency of the Page 27 of 29 3 7 4 10 5 12 6 18 7 27 Care Homes for Older People Service user group at all times. 8 28 As part of the training matrix to be implemented the manager should document how many care staff have acheived at least NVQ level 2 (in care) to ensure she can demonstrate that a minimum of 50 of care staff have these qualifications. The manager should implement a staff training and development programme to ensure all staff are up to date with statutory training and training relating to the Service User group. (The manager had already recognised prior to the inspection that this is an area that needs to be developed). The manager should ensure that personal risk assessments are carried out and regularly reviewed to ensure staff are using safe working practices at all times. The provider (European Care) should ensure that the welfare of the staff and Service Users is maintained by acting on requests for repair or replacement of items such as kitchen, laundry and housekeeping equipment in a more timely manner. The manager should ensure that all staff are up to date with fire safety and moving and handling training in line with laid down legislation to ensure safe working practices are in place. 9 30 10 38 11 38 12 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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