Inspection on 31/03/09 for WCS - Drayton Court

This inspection was carried out on 31st March 2009.

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

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

Other inspections for this house

WCS - Drayton Court 31/01/07

WCS - Drayton Court 02/11/05

WCS - Drayton Court 10/06/05

WCS - Drayton Court 15/12/04

WCS - Drayton Court 11/08/04

WCS - Drayton Court 13/02/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Bank House

Inspirations

Ashcroft Hollow Nursing 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: WCS - Drayton Court Cedar Road Camp Hill Nuneaton Warwickshire CV10 9DL     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: Julie McGarry     Date: 3 1 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: WCS - Drayton Court Cedar Road Camp Hill Nuneaton Warwickshire CV10 9DL 02476392797 02476393020 admin@draytoncourt.f9.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Warwickshire Home Care Services Limited care home 45 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 45. The registered person may provide the following category of service only: Care Home Only (Code PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the folllowing categories: Old age not falling within any other category (OP) 45 Dementia (D) 45 Date of last inspection Brief description of the care home Drayton Court is situated next to the church of St Mary and St John in Cedar Road, Nuneaton. It is located approximately 50 yards from the local amenities including post office, chemist, newsagent, supermarket, florist, greengrocer and hairdressing salon. Care Homes for Older People Page 4 of 30 Over 65 0 45 45 0 Brief description of the care home Drayton Court is located close to Stubbs Park and pool, with water lilies, ducks, swans and childrens play area, all of which are adjacent to a landscaped area, which provides pleasant walks. Drayton Court is a three-storey building, which was comprehensively refurbished in 1997 in order to meet the needs of 45 older people. All corridors are fitted with handrails, all doors are wheelchair accessible and there is a shaft lift to all floors. The home offers a range of adaptations and equipment, which assist service users in attaining greater independence and promotes their health and safety. All bedrooms are single rooms, 22 having en-suite facilities. All bedrooms have washbasins, call bell systems to call for assistance, central heating, wardrobe and dressing table as standard. Service users can, if they choose, furnish and redecorate their room to their own taste. Telephone points are not fitted in bedrooms, service users wishing to have a telephone can do so at their own cost. The current scale of charges are £370 - £437 per week. Additional charges are made for taxis, chiropody, hairdressing, newspapers/magazines, toiletries, alcohol, cigarettes and outings/holidays. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at all aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. The inspection visit took place on Tuesday 31st March 2009 between 9:15 am and 7:00pm. Before the inspection we looked at all the information we have about this service such as information about concerns, complaints or allegations, incidents and previous Care Homes for Older People Page 6 of 30 inspections and reports. The last Key inspection carried out in 2007. Information about the service was also received in the form of an annual quality audit assessment (AQAA). This gives us information about the home and its development and was completed by a manager in the organisation. At this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with residents in the lounges watching to see how residents were treated and looked after. These observations were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report, the Care Quality Commission will be referred to as us or we. At the end of the visit we discussed our preliminary findings with the home manager. What the care home does well: What has improved since the last inspection? What they could do better: Risk assessments must be available to assist the staff in determining the level of risk, such as use of hoists, and the development of sores to the skin due to pressure. Plans must be developed that clearly state the actions to be taken and the equipment to be used. This will assist the staff to give consistent care and be able to clearly evaluate if the care given is effective. The auditing system for the management and administration of medication must be followed and action taken to rectify problems as they are recognised. All medicines Care Homes for Older People Page 8 of 30 brought into the home need to be recorded to ensure a clear audit trail can be maintained. Staff need to monitor the temperature of the medication rooms, to demonstrate whether temperatures fall outside the recommended range. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: The case files of two people recently admitted to the home were identified for case tracking to assess the pre-admission process. Assessments provide details of health and personal care needs which include information on mobility, history of falls, health history, communication and wellbeing. Records on peoples files show that information was received from health and social care professionals was also sought prior to people moving to the service. The availability of this information helps to ensure that the specific care needs of each person can be identified and used to help complete a plan of care. One resident told us that they were supported by family to make a choice about which Care Homes for Older People Page 11 of 30 Evidence: care home to move in to and they were able to visit the home and talk to staff before they moved in. On records seen there is sufficient information available so that the home could confirm they could meet each persons needs and develop care plans. The manager said that it was usual practice for her to visit people either in their own home or hospital who are considering moving into the home to undertake an assessment of their needs and abilities. The Statement of Purpose and Service User Guide are available at the home. These documents help people to make an informed decision about whether they move in. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their needs are being met. There are minor issues with the management and administration of medication that may result in mistakes. Evidence: Residents receive personal support in the way they prefer and require as evidenced through observations during the inspection discussions with staff and examination of records. We looked at the case files of two people identified for case tracking. Each person had a care plan, daily records, and monitoring records. Care plans were based on information secured during the pre-admission assessment and supplemented by further assessments after admission. Although staff regularly review all care plans, further work needs to be done to ensure that all records are detailed and up to date. It is evident that staff are responding to changes in peoples needs and when appropriate seeking medical advice. However, care plans are not always updated to reflect a change in care practice. Clear guidance Care Homes for Older People Page 13 of 30 Evidence: to staff needs to be in place to ensure staff provide appropriate and consistent care for each individual. For example, one persons care plan states that a hoist is required for all transfers, however later in the care plan, records state that this person is able to transfer and the wheelchair is to be used. There is no risk assessment in place for the use of the hoist, and information to staff is conflicting which could result in staff providing the incorrect support to this person when getting in and out of their bed. Risk assessment plans are not always detailed for all identified needs of residents. For example, two peoples records looked at show the need for support with the management of skin integrity. Both files lacked clear information on how care needs to be provided and how the risk is to minimised. However staff spoken to were able to tell us what was required to minimise the risk of skin damage and knew the equipment needed. There is also evidence of support from district nurses to help manage pressure risks. Preventative measures such as a pressure relieving mattress were seen to be in use for two people who are prone to pressure sores. There is evidence of good recording practice with some peoples records. For example, one persons records shows a general deterioration their needs. Their GP is kept informed of changing needs, Macmillan nurses have been requested, nutritional and fluid charts are maintained. Other aspects of this persons care plan have also been regularly updated to reflect the change in needs and level of staff support required. Equipment needed to support this person was also available. Residents on going health care needs are being met with evidence of visits by the GP, District Nurse, Macmillan nurses, chiropodist, and optician in the care files looked at. People who live their and relatives confirmed that external professional support is being provided when required. There is evidence on some files that families have been involved in the reviewing of their relatives care plans. There were no written records to tell us if families who were not involved had declined. Staff spoken with had a very good understanding of the peoples individual needs. Information provided by staff reflected that detailed in the care and risk assessment plans. Staff were able to inform us of training they have received that guides them in the way care is to be provided. All the staff spoken with were enthusiastic and had a positive attitude on promoting peoples independence. Care Homes for Older People Page 14 of 30 Evidence: Medication administration and management was examined in all areas of the service. Each unit has its own medication trolley and storage area. A senior member of staff who has received medication training administers the medication in each unit. Time was spent examining four Medication Administration Records (MARs) checking the medication recording, storage, and disposal of medicines. Whilst the systems of recording, storage, and disposal of medicines are good, some shortfalls were found. In one persons records we found unexplained gaps in the recording of their medication on one day. An audit of this persons medicines shows that all medicines were accounted for indicating that the member of staff administered the medication, but did not sign for it. Another person who recently moved to the service brought their own medication. An audit of this persons medication was not possible, as there was no record of how much of each medication they brought in with them. All other medication looked at was correct and auditable. Staff are maintaining temperature records of medication stored in the homes fridges. However no temperatures are kept of the rooms were the medication trolley and controlled drugs are kept. Staff need to monitor the temperature of the medication rooms, these temperatures need to be recorded to demonstrate whether temperatures fall outside the recommended range at any time during the day. The manager informs us that the home has plans in place to address this. All controlled drug balances examined were correct and records are being accurately maintained. This meets the requirement set out at the last inspection. Staff who have received training in medication were knowledgeable about the medicines they were administering and knew where to get further information if required. A list of specimen signatures and initials for all staff trained in medication administration was available on request. This is good practice to enable the manager to recognise who has administered the medication. Administration of medication was observed on two units and it was noted that staff did this in a professional and caring manner, ensuring that the resident took their medication before signing the MARs. During the inspection, it was noted that all people living at this service are treated Care Homes for Older People Page 15 of 30 Evidence: with respect and dignity. Personal care was carried out in privacy and all those seen were appropriately dressed in clean clothes and looked comfortable and neat. Each person was able to spend time where they choose and it was observed that the staff and those living there had a comfortable and trusting relationship, with laughter smiles and respect. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a nutritious and varied diet and have sensitive assistance to eat their meals Evidence: Observations made and discussions with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives such as, when to get up and go to bed, what to eat, and where to spend their time. Visiting was unrestricted and visitors were seen to be welcomed and to have comfortable rapport with the manager and staff. One relative spoken with felt that a good standard of care was being provided and had no concerns or complaints about the care provided. They told us that they knew who to contact if they had any concerns and felt that they would be listened to. Two weeks of menus were seen and show a varied and balanced diet with a choice of two meals offered each day. We observed the lunchtime meal in two units including the dementia care unit. There was meal choice of salmon or meat loaf, potatoes and vegetables or salad. An appetising pudding was offered. Staff were seen to assist people where necessary. One to one support was offered to people who remained in Care Homes for Older People Page 17 of 30 Evidence: their rooms during meal times. Meal times gave a sense of a social occasion as people chatted and laughed during the meal. Meal times were relaxed and unrushed. There were positive comments made about the food at Drayton Court such as there is plenty to eat and the food is very good. All of the meal was well presented looked appetising and nourishing and appropriate plates and cutlery were used. A choice of drinks were offered during the meal. Opportunities for stimulation and meaningful activities are recorded on individual daily records. There is a program of activities at the home which includes reminiscence, hairdressing, fizzical fun, outings to the parks, theatre trips and entertainment such as line dancing . The activities are available to all people who live in the home. The service links with other homes owned by the organisation, and people meet up with residents of other homes. Staff spoken to are aware of those people who do not enjoy group activities and told us of one to one support that is provided to ensure all residents receive stimulation. Peoples daily records show that staff are spending time with people and engaging in such activities as reading the papers and looking at photographs. Staff in the dementia unit explained to how they provide specialist care to those in that unit. We were shown memory boxes for each person, and how staff have developed life stories to ensure they understand each person individual experience of life, and their likes and dislikes. There is evidence that people are able to maintain links with their families and friends. A member of the Christian clergy visits the home every month for prayers. Two residents spoken to stated that their faith is important to them and visits from the member of clergy are important aspects of the care they receive at Drayton Court. Residents were observed to spend time in the privacy of their own rooms or join others in communal areas for company or meals. People were seen to potter about at the home and move freely between units on the same floor. Residents interacted well with each other and staff. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements are in place for respond to peoples concerns and complaints and staff are being trained to recognise and respond to suspicions of abuse so that people are protected form harm. Evidence: There is a complaints policy and procedure available and families are given this information. Relatives spoken to felt they could approach staff or the managers should they have any concerns. Comments from one relative include: Staff keep in touch with you very good, no complaints. Staff were aware of how they should deal with concerns and complaints and it was evident that minor concerns are dealt with day-to-day. Records seen during this visit showed that five complaints made about the home in the past twelve months. Records show that the management respond to families when they complain in a suitable manner, and that the families are satisfied with the outcomes. Staff spoken with were fully aware of how they should respond in cases of alleged or actual abuse. They could explain what would be abuse and were aware of the Whistle Blowing process. People confirmed that they know who to talk to if they are not happy with something or want to complain either within a house meeting or individually. Care Homes for Older People Page 19 of 30 Evidence: One person spoken with said I will talk to staff if Im unhappy, another said they would tell their daughter. One relative spoken with told us that they felt staff were approachable and felt they would be listened to if they had any concerns. Staff records at Drayton Court show that staff are trained in the protection of vulnerable adults. An adult protection procedure is in place at the home to inform staff of the measures to take to report any suspicions of abuse. All recruitment practices safeguard residents from the employment of unsuitable people. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and organised home that allows them to move around freely. Evidence: Drayton Court offers comfortable, homely, and well maintained surroundings for the people living at the home. The home has three units, the dementia unit on the ground floor. The second and third units are located on the first and second floors. Staff were spoken with and told us that they have enough time to carry out their duties, and are supplied with all materials to ensure that the home remains clean. These surroundings are free of offensive odours. Rooms were personalised and presented as clean and tidy. Three people spoken to state that they were happy with their rooms and that they are kept clean and tidy by staff. Care staff ensure that the small dining areas and lounges remain comfortable and inviting during the day. There is an ongoing programme of routine maintenance and redecoration that ensures the home is maintained to a good standard. A number of items of equipment were Care Homes for Older People Page 21 of 30 Evidence: looked at and were in good working order. There is a passenger lift and staircase giving access to the first floor and second floors. The kitchen was clean and well organised. Records were kept of the fridge and freezer temperatures showing appropriate temperatures to maintain good food safety. The home ensures that all products used for cleaning are stored away safely in a locked room. The laundry is done on the premises. One the day of the inspection, a large collection of peoples unwashed clothing was being stored in the laundry room. The manager informs us that the day prior to the inspection, the drier broke down and has created a back log of items to be cleaned and dried. The home needs to ensure that immediate action is taken to address such matters. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of staff on duty to meet the needs of the people living in the home. The homes recruitment policies are robust. Training is provided to make sure staff have some knowledge and skills to deliver a service to the people who live at the home. Evidence: The home has a stable staff group with some existing staff having worked at the home for over ten years. Each unit is staffed separately to ensure that there are enough staff in each area to meet each persons needs. The rota confirmed that over the two days of this visit there was enough staff on duty. Each unit has a senior member of staff during the day shifts to ensure that the needs of each person are met and to supervise the carers. There is a full time registered manager whose hours are supernumerary, and a full time deputy manager . There are 32 carers, and one administrator. There are also staff to work in the laundry kitchens and to maintain the cleanliness of the home. The home has access to maintenance support when required. Three files of staff employed since the last inspection were seen. These contained all Care Homes for Older People Page 23 of 30 Evidence: the information required to ensure that they are suitable to work with vulnerable people. Induction is carried out for all new staff. There is evidence to show that staff are receiving formal supervision either on a one to one basis or in small groups. Comments about staff made by residents and visitors were positive. There are sufficient care staff available to meet the needs of the residents. Staff spoken to are very clear about peoples needs and staff files show that they are well trained to meet peoples needs. Information supplied by the manager state that the number of care staff are qualified to National Vocational Qualification in Care Level 2 (NVQ level 2) is above the national Minimum Standard for 50 per cent of staff to be qualified. This should mean that residents benefit from having their needs met by staff that are appropriately experienced and qualified. The training records of staff working at the home were seen and demonstrate that staff receive mandatory training. It was evident that staff have opportunities to attend various training programs this ensures the requirements set at the last inspection has been met. Staff told us that they felt supported by the management and could express ideas and concerns. They also told us that they felt moral among staff was good at the home. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person with the appropriate qualifications and who has management experience manages the home. The people who live their and their families are provided with opportunities to make their opinions of the service known and the organisation has systems in place to monitor quality performance. Evidence: The manager is well qualified to manage the service, and discussions with her show an open, positive and inclusive approach to management. The service is well set up with the correct policies and procedures and staff training for when new people move in. During this visit the manager spent some of her time in the communal areas of the home, this indicates that the manager makes herself accessible to listen to people who live and work at Drayton Court. From discussion with people living at the home, staff, the manager, the examination of records and observation of care practices show that a competent and skilled Care Homes for Older People Page 25 of 30 Evidence: manager runs the service. There are clear lines of accountability within the home with lead carers reporting to the manager, who in turn is supported by the organisation. Care staff are clearly aware of the lines of accountability in everyday care practices and in relation to whistle blowing matters. Staff have the opportunity to attend a variety of training both for statutory training and specialist training. There was evidence from a random check of records, that equipment is regularly serviced and maintained, health and safety checks are carried out and that in house checks on the fire system are up to date. The home keeps a float of peoples monies. This is held securely in the homes safe. Individual account sheets are available for each resident detailing income and expenditure, along with receipts accounting for any expenditure. We examined a sample of account sheets which we found to be accurate. Access to monies is dependent upon the administrator or manager being at the home. The home needs to ensure it has processes in place to enable people to access their money outside of office hours. The fire records are maintained and these told us that staff have regular fire practices and feedback is given to ensure that they are up to date with the process. There is a contract with a firm to check the fire systems and equipment as required by law. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans should state 08/05/2009 actions to be taken to minimise risk for those individuals who have been assessed as being at risk. Specifically in realtion to use of equipment and pressure care. This will ensure that all staff are fully aware of the risks and actions to take to minimise the risk. 2 7 17 The registered manager 08/05/2009 must ensure that all the care plans detailed in providing clear guidance on care to be provided. This is to ensure that appropriate and consistent care is provided by staff. Care Homes for Older People Page 28 of 30 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 9 The purchase of a maximum, minimum thermometer is advised to accurately read the maximum, minimum and current temperatures on a daily basis to ensure that the medicines held in the medication refrigerator are stored in compliance with their product licence to maintain their stability. The manager should ensure that systems are in place to enable people to access their money at all times. 2 35 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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