Inspection on 07/05/09 for Turfcote Nursing Home

This inspection was carried out on 7th May 2009.

CQC 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Turfcote Nursing Home 15/04/08

Turfcote Nursing Home 14/08/07

Turfcote Nursing Home 17/05/06

Turfcote Nursing Home 01/02/06

Turfcote Nursing Home 14/06/05

Turfcote Nursing Home 13/01/05

Turfcote Nursing Home 18/05/04

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Keer Sands Residential Home

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Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Turfcote Nursing Home Helmshore Road Haslingden Rossendale Lancashire BB4 4DP     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: Marie Matthews     Date: 0 7 0 5 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 31 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 31 Information about the care home Name of care home: Address: Turfcote Nursing Home Helmshore Road Haslingden Rossendale Lancashire BB4 4DP 01706229735 01706229231 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Marshmead Limited care home 76 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD (maximum number of places: 46) Mental disorder, excluding learning disability or dementia - Code MD (maximum number of places: 30) Dementia - Code DE (maximum number of places: 30) Old age, not falling within any other category - Code OP (maximum number of places: 46) The maximum number of service users who can be accommodated is: 76 30 30 0 46 Over 65 0 0 46 0 Care Homes for Older People Page 4 of 31 Date of last inspection Brief description of the care home Turfcote is registered to provide care to a maximum of 76 residents. The home is split into 2 separate units. Tor View provides nursing and personal care to up to 46 adults and Grane View provides nursing and personal care for to up to 30 people who have mental health care needs. Turfcote is a detached, extended building set in its own grounds. Bedroom accommodation is provided on two floors with the upper floor accessed by three passenger lifts. There are a mix of single and double bedrooms, most with en-suite facilities. There are a variety of communal areas on both units. Turfcote is located on a bus route close to the towns of Haslingden and Rawtenstall and is close to local amenities such as shops, a post office, a pharmacy, a pub, churches and a sports centre. Information about the services offered by the home is provided in the form of a welcome pack and is available, with a summary of the most inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £386.00 to £675.00. Items not included in the fee include toiletries, hairdressing, newspapers, transport and staff escorts to hospital appointments. Care Homes for Older People Page 5 of 31 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: The key unannounced inspection, including a visit to the home, took place on 7th May 2009. The last inspection on this service was completed on 15th April 2008. The inspection process included looking at records, a tour of the home, discussions with the registered manager and owner of the home, one member of staff and seven residents. There was a second inspector who looked at how the home managed residents medicines as we had been told of some concerns. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the last twelve months and where further improvements were needed. Care Homes for Older People Page 6 of 31 Information was also included from survey forms filled in by two members of staff and comments from one visitor. What the care home does well: What has improved since the last inspection? The information in the care plans had improved and detailed the care each resident should have to meet their needs. People had been involved in decisions about the care they received; this would help to make sure they received the care they needed and wanted. A number of residents were able to participate in meaningful activities of their choosing such as visits to the local pub, meeting with friends, walks in the grounds of the home; one resident assisted the hairdresser each week and another enjoyed tidying up and Care Homes for Older People Page 8 of 31 clearing tables after meals. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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 were given sufficient information about available services and were assured their needs would be met. Evidence: The service user guide had been reviewed and updated. It was included in the Welcome Pack which was sent anyone enquiring about the home and given to existing residents. The registered manager said the information could be made available in different formats and she would be available to answer any questions. Post admission surveys were used to obtains peoples views of the admission process and used to improve the service. Information from these surveys indicated that people were given useful information about the home and had been encouraged to view the facilities and to meet other residents and staff. Each resident had a contract or statement of terms and conditions; this would advise Care Homes for Older People Page 11 of 31 Evidence: them of their rights and obligations during their stay at Turfcote. Residents should sign to confirm they have received and agree with the wecome pack as part of their contract/terms and conditions with Turfcote. Detailed assessments were completed before anyone was admitted to the home. A senior member of staff collected information from a range of sources to ensure every aspect of peoples needs were considered; this helped to determine whether Turfcote was the right place for them. The manager was advised that the pre admission assessment should be dated at the time of the visit. Staff said they were provided with a range of training to give them the skills and knowledge to meet residents needs. Training records supported this. Care Homes for Older People Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of care planning had improved although some medication practices could place residents at risk. Evidence: The individual care records of four residents were looked at in detail. The care plans had been developed from initial assessment information and generally detailed how residents needs would be met. However staff needed to ensure that care plans consistently reflected the care that was being given; examples included one care plan did not have details regarding the residents catheter care and another did not include information regarding an ongoing medical condition. Care plans had been reviewed and updated and it was clear that residents or their relatives had been invited to review meetings and involved in decisions about care. The care plans included some personal detail regarding residents likes, dislikes and preferences but this was not consistent; this information would help staff to provide care that was both needed and wanted. Care Homes for Older People Page 13 of 31 Evidence: Records showed that residents had access to health care services; residents health had been monitored and appropriate advice and support had been sought in response to any changes. One resident said he had been able to see his GP when he was feeling unwell. Aids and adaptations had been provided to support residents with maintaining their independence and to provide comfort. Any risks to residents had been identified and action taken to reduce or eliminate the risk; this would ensure residents were protected from harm. The use of bed rails had been assessed, discussed with the resident or their relatives and kept under review; this would ensure their use was appropriate. There were systems in place to check whether care documentation was up to date and whether staff were following procedures. Staff were trained in health care matters and one resident said staff listened to him and he received the care he wanted, he said they do things the way I want. Staff said they had regular meetings to discuss residents individual needs; this would ensure residents received the care they needed and wanted. As part of the inspection a pharmacist inspector looked at how medicines were being handled.We found medicines stock and records to be well organised and a clear system of stock control was in place that made accounting for medicines usually simple and easy to do. However, our checks of the records and current stock showed that some medicines were not being given to people correctly. We found numerous examples of stocks not adding up which meant that some medicines had been missed even though the records were signed as given. One person who was taking three different strengths of a medicine was given the wrong doses on numerous occasions. Another person missed their medicine used to prevent blood clots on at least seven occasions in the last month and we saw numerous examples of doses being missed for several other people. We found short courses of medicines such as antibiotics not adding up, showing staff had signed the record but not given a dose of the medicine. Missing medicines can seriously affect a persons health and wellbeing. We found the records of medicines receipt and disposal were not always complete as they were not always dated, which made accounting for medicines sometimes difficult to do and we found some examples of medicines being out of stock because they had not been ordered in time. We gave some advice to the manager about how the necessary improvements could be made in these areas so that medicines are given and recorded correctly. Care Homes for Older People Page 14 of 31 Evidence: We checked how controlled drugs (medicines that can be misused) were handled. The cupboard used for storage was secure and a special register was used for record keeping. Stock levels were correct and all entries were properly witnessed. Secure storage and detailed records help prevent mishandling and misuse. We looked at how people were supported to look after their own medicines. We saw good paperwork and procedures for one person and these were reviewed every month when a new supply of their medicines was given to them. We spoke with this person who was very happy managing their own medicines and they said the staff gave exactly the right amount of support. Supporting people safely to look after their own medicines helps them retain their independence. Medicines were regularly audited (checked) and detailed records of this were made, however, these audits had not always found the types of mistakes that we had found so we gave some advice to the manager about how to make the necessary improvements. The manager said all staff had received regular training and staff were made of aware of the findings of the medicines audits but we found no formal procedures for assessing staff competence when giving and recording medicines. We gave some advice to the manager about how to include competency as part of staff supervision because the mistakes we had found had been due to staff not following the correct procedures. Regular checks on medicines, formal training and regular competency checks help make sure staff have the necessary skills to handle medicines safely. Staff had received training on the principles of privacy, dignity, choice and fulfillment; this would help staff to respond to people properly and as individuals. During the inspection staff were observed responding to residents and visitors to the home in a welcoming, friendly and respectful manner. Two residents said their privacy was respected and said staff always knocked on their door before entering. A number of staff had been enrolled on customer services training; this would help to develop their skills when dealing with people. There were procedures to support residents who were nearing the end of their lives. A number of key staff had completed specialised training to help them to support residents and their families and staff with death and dying. The home had developed good links with MacMillan nurses; this would help staff to provide high standards of care and to meet peoples needs in this area. Care Homes for Older People Page 15 of 31 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. Routines were flexible and residents were able to make choices although their social and recreational needs were not always met. Residents were provided with a choice of healthy and nutritious meals that met their dietary needs and preferences. Evidence: Residents said routines were flexible and they were able to make choices about how they spent their day; one said I can do what I want and another said I get up when I want and go to bed when Im ready. Not all residents had information in their care plans to indicate how their social needs would be met. Memory diaries had been introduced in an effort to obtain information about residents lives prior to admission however these were incomplete; this information would help staff to plan suitable and meaningful activities for individuals. Activity records were not always completed and did not support that regular activities had been provided or who had been involved. However from discussion it was clear that some residents were supported on an individual basis; one resident said he was able to go to the local pub and meet with friends or walk in the grounds whilst another had enjoyed watching the activity in the grounds, one lady assisted the hairdresser each week and another enjoyed clearing tables after meals. Comments included there Care Homes for Older People Page 16 of 31 Evidence: isnt a lot to do but I enjoy my own company and prefer to stay in my room and watch TV and there is not enough going on; residents said staff respected their wish to stay in their rooms. Ministers visited regularly to meet residents religious needs although it was unclear who had attended the services. There was an open visiting policy and visitors were welcomed in a friendly manner. Residents who were independent or had friends or family were able to get out and about in the local community. Records showed that residents were offered a varied, nutritious and healthy diet. There was a lighter lunch with the main meal served later in the day. Residents were involved in changes to the menu and their suggestions for improvement were regularly sought. Comments from residents included there is always a choice of meals, I like the food, its lovely, there is always a choice, the food is not to my tastes but there is a choice and the food is very nice. There had been a recent concern that residents on the dementia unit were not given a choice of appropriate cutlery; on the day of the visit it was noted that some residents were using plastic cutlery although the reasons for this had been included in the care plans. Staff were observed giving assistance and encouragement during mealtimes and ensuring everyone had enough to drink throughout the day. There was a choice of pleasant rooms for residents to dine in. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were protected by the organisations procedures and by staff awareness. Evidence: There was a clear complaints procedure that explained who people could speak to if they were unhappy; this could be made available in other formats to ensure everyone could access the information. Surveys indicated staff knew the importance of listening to and responding to peoples concerns; a number of staff had attended training to help them to improve the way they responded to people. The number and nature of complaints were reviewed as part of the quality monitoring systems; this helped to improve the service. Residents spoken to at the time of the visit knew who to speak to if they were unhappy; one resident said I would speak to Jim (owner) or Liz (manager) and they would make sure any problems were sorted and another said I would speak to Liz (manager), I can talk to her. Residents confirmed that both the manager and owner were available at any time; one resident said they are always here and often ask how things are. Residents were happy with the service they received and were able to discuss any concerns freely. Records showed there had been one complaint since the last inspection visit; this had been dealt with according to procedures. There was information about how to contact an advocate; advocates would offer advice and support to people. Care Homes for Older People Page 18 of 31 Evidence: The safeguarding procedures were clear although should include the POVA referral process to ensure the procedure was available to senior staff. Records showed that staff were trained in safeguarding adults and were able to discuss any issues with their manager; this would ensure staff had the skills to recognise and respond to any reports of abuse or neglect. Following a recent update of safeguarding training the registered manager had made a referral about a recent incident of poor practice; this showed that senior staff understood the referrals process and recognised the importance of reporting any incidents to ensure residents protection. There were procedures to support staff with reporting or blow the whistle on any poor practice; this would ensure residents were protected from abuse. Some staff had received training that would help them to support residents who were unable to make decisions for themselves. Procedures supported staff with dealing with any verbal or physical abuse; this would ensure they responded properly and kept people safe. Staff understood the meaning of restraint. The use of bed rails had been assessed, discussed with the resident or relatives and kept under review; this would help to determine whether this method of restraint was appropriate. Care Homes for Older People Page 19 of 31 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 was safe and well maintained providing residents with a comfortable and pleasant place to live. Evidence: During a tour of all areas it was clear the home was well maintained, safe and comfortable. There were records of ongoing maintenance although it was recommended these were dated when work was completed. As indicated at the last key inspection a number of double glazed units had failed; the owner said these had been identified for repair or replacement. Gardens were safe and accessible to residents and their visitors and further improvements were planned. There was a variety of communal areas where residents could enjoy the company of other residents or their family and friends or sit quietly. A number of bedrooms had en suite facilities; other rooms were located near to clearly marked toilets and bathrooms. The home was well equipped with aids and adaptations to meet residents needs and to maintain their comfort and independence. All rooms had accessible call facilities to Care Homes for Older People Page 20 of 31 Evidence: enable residents to summon help from staff; one residents said staff always responded to any calls for assistance. Residents spoken to were happy with their rooms; comments included I like my room it is always clean, the facilities are very good and my room is fine I have everything I need. Some residents had brought in personal items to enhance the homely feel. Residents could have keys to their rooms and secure storage; this would help to promote residents privacy. Residents said the home was clean, bright and odour free. The laundry was very well equipped for the size of the home. The manager carried out infection control audits to ensure the home was clean and staff had received training in this area; this would help to reduce the risk of infection. Care Homes for Older People Page 21 of 31 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. Staff were suitable, competent and provided in sufficient numbers to meet residents needs. Evidence: Duty rosters showed there were sufficient staff available to meet residents needs. Residents and staff confirmed there were sufficient staff. Residents made positive comments regarding staff including they are very nice people and staff are very kind they look after me very well. Residents were looked after by staff of various ages, gender and culture; this would help to ensure all aspects of their needs would be met. The files of three staff were looked at in detail. These showed that a safe recruitment process had generally been followed; this would ensure residents were protected from unsuitable people. It was recommended that a recent photograph as a means of identification was provided by new starters. Each file had the appropriate checks in place prior to employment other than one reference that had been obtained after the start date; consideration should be given to following references up with a telephone call to check their validity. Staff were given job descriptions and contracts to ensure they were aware of their responsibilities. It was recommended that the referee information on the application form and the reference forms indicated the designation of the referee; this would ensure the reference had been obtained from the appropriate person. It was also recommended that a record of the interview was Care Homes for Older People Page 22 of 31 Evidence: maintained to support an equal and fair process. Records showed that new staff had been supported through a period of induction during which additional training was provided and that most staff had achieved an appropriate qualification in care; this would ensure they had the skills and knowledge to look after people properly. Staff said they received relevant and up to date training to help them to meet residents needs; the training records supported this. Care Homes for Older People Page 23 of 31 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 home was safe and well managed and people were able to express their views and opinions about the service they received. Evidence: The manager of the home is a registered nurse with many years of experience in care of older people; she has a recognised management qualification and has updated her skills and knowledge. The residents know the manager and say she makes time to talk to them; residents said I like her and I can talk to her. Staff were confident that management would listen to their views and opinions. There were clear lines of responsibility and the manager was supported by a deputy manager and the owners of the home. The home held the Investors In People award; this is a nationally recognised quality assurance system that monitors the management of the home and development of staff. There were also other internal systems in place to monitor the standards of the home, whether residents needs were being met and whether staff were following safe Care Homes for Older People Page 24 of 31 Evidence: procedures; the results were used to improve and develop the service. Residents and their relatives were able to express their views and opinions about the service and were involved in day to day decisions regarding the running of the home. Annual surveys were sent out to residents and their relatives; it was recommended that the results of these surveys should be analysed and be available for inspection. Minutes from residents meetings showed they had been consulted about mealtimes and suggestions for a new menus and some residents were aware of the recent improvements made to the home and plans for further improvement; this showed they had been involved in discussions about changes to their home. The home usually kept us up to date of any changes that affect residents well being; however two recent incidents had not been notified and were further discussed with the registered manager. The home sent us their annual quality assurance assessment (AQAA) when we asked for it; this gave us a good picture of what changes had been made since the last inspection and of any improvements needed. The home had responded to any concerns raised at the last inspection; this showed they were committed to improvement. The registered provider said the home did not deal with residents finances other than payment of fees; there were clear procedures to support staff with management of residents finances. Policies and procedures had been reviewed and updated and provided clear and safe guidance for staff in all aspects of their work. Staff met regularly with senior staff; this helped to identify whether they needed any additional support or training to meet residents needs. All staff received training that would help to keep them and others safe. There had been a concern about the way staff had moved or lifted residents; on the day of the visit residents were being handled safely and appropriate equipment was used as needed. Records showed that staff had attended moving and handling training updates; this would ensure peoples safety and comfort. Fire drills had taken place to help staff to respond appropriately in the event of a fire; the records should detail the names of staff who attended to help identify those who needed further training. It was also recommended that staff were provided with fire safety updates; this would update staff skills and ensure peoples safety. Care Homes for Older People Page 25 of 31 Evidence: Cleaning products had been clearly identified and were stored appropriately to ensure residents safely. Care Homes for Older People Page 26 of 31 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 7 15(1) Care plans must clearly identify health care needs and provide sufficient directions to staff to meet those needs. 31/07/2008 Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must clearly identify residents health care needs. This will ensure staff have clear information about how residents needs will be met. 22/06/2009 2 9 13 Accurate records of all medicines received into the home and disposed of must be made. This is important so that all medicines can be fully accounted for. 15/06/2009 3 9 12 Medicines must be given to people correctly. Giving medicines at the wrong dose, wrong time or not at all can seriously affect a persons health and wellbeing. 15/06/2009 4 37 37 The Commission must be informed of any incident listed under Regulation 37. 30/06/2009 Care Homes for Older People Page 28 of 31 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 This will ensure the Commission are kept informed of any incidents affecting service users. 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 Each service user should sign that they have been provided with a statement of terms and conditions at the point of moving into the home; this would ensure people were aware of their rights and obligations during their stay. Pre admission assessments should be dated at the time of the assessment. The care plans should include personal information regarding residents likes, dislikes and preferences; this information would help staff to provide care that was both needed and wanted. Information regarding residents routines, hobbies and interests should be included in their care plan; this will help to identify and meet their social needs and expectations and to assist with the provision of meaningful activities. Records should support that residents are provided with a range of suitable and meaningful activities and entertainments. The safeguarding procedures should include the POVA referrals process; this will ensure any referrals are responded to promptly. Maintenance records should be dated on completion of the work. The referee information on the application form and on the reference form should be reviewed to include the designation of the person supplying the reference; this would ensure the information was from an appropriate person. Page 29 of 31 2 3 3 7 4 12 5 12 6 18 7 8 19 29 Care Homes for Older People 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 9 10 11 12 13 29 29 29 33 38 A record of the interview should be maintained to support that a fair and equal selection process was followed. A recent photograph as a means of identification should be provided fro staff files. References should be followed up with a telephone call to check their validity. Service user surveys should be dated, the results analysed and made available to interested parties. Fire training updates should be provided for all staff; this will ensure staff have the skills and knowledge in fire safety. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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