Inspection on 09/06/09 for Westcroft Nursing Home

This inspection was carried out on 9th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westcroft Nursing Home 13/06/07

Westcroft Nursing Home 03/11/06

Westcroft Nursing Home 11/01/06

Westcroft Nursing Home 22/06/05

Westcroft Nursing Home 09/02/05

Westcroft Nursing Home 14/10/04

Westcroft Nursing Home 09/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Westcroft Nursing Home 5 Harding Road Hanley Stoke-on-trent Staffordshire ST1 3BQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Dawson     Date: 0 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 28 Information about the care home Name of care home: Address: Westcroft Nursing Home 5 Harding Road Hanley Stoke-on-trent Staffordshire ST1 3BQ 01782284611 01782215265 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: None Pradeep Arvind Patel care home 28 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 who can be accommodated is: 28 The registered person may provide the following category 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: Dementia (DE) 28, Old age, not falling within any other category (OP) 28 Date of last inspection Brief description of the care home Westcroft Nursing Home is a small nursing home providing personalised care for up to 28 people. It is located close to Hanley town centre and is a large pre-war house with purpose built 2 storey extension. There are 17 singe and 5 shared bedrooms, 18 having en-suite facilities. There are 2 bathrooms (one assisted) and a walk-in shower room. There are 3 lounges, a conservatory, separate dining room and the usual office, kitchen and laundry facilities on the ground floor. There is a small attractive garden/patio area for residents use accessed directly from the Care Homes for Older People Page 4 of 28 28 0 Over 65 0 28 Brief description of the care home conservatory. Bedrooms are located on both floors and there is a shaft lift access to the first floor. The home provides care with nursing for up to 28 people, some of whom may have a physical disability, mental disorder or dementia care needs. The home is staffed by nurses at all times as well as adequate numbers of care and other support staff. Care Homes for Older People Page 5 of 28 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 last key inspection of this service was 13th June 2007 and was rated 2 Starsmeaning the outcomes for people using the service were good. An annual service review was completed on 17th June 2008. This was based upon our knowledge of the service and ongoing information we received about the service, including a self-assessment and written feedback from users of the service. We were satisfied that the 2 Star rating was still applicable to the service. This unannounced key inspection was carried out on one day by one inspector from 08:30 - 16:00 hours. The provider completed an AQAA (Annual Quality Assurance Assessment) which was sent to us. This is a legally required self assessment document containing information about what the service think they do well, what progress they have made over the past Care Homes for Older People Page 6 of 28 year, what they think they could do better and their plans for improving the service over the next 12 months. Some people using the service also sent written feedback directly to us about their experience of the service. During the inspection most people were seen and several spoken with individually. Two visiting relatives were also spoken with and expressed their views about the quality of the service. Comments were positive, indicating a good standard of care being provided by a committed staff group. Members of staff on duty were spoken with including nurses, care and catering staff. They provided helpful information about the service. The inspection was carried out with the Registered Manager and also present was the Providers Operations Manager. We inspected the communal areas of the home and also a sample of bedrooms were seen. Records inspected included: risk assessments, care plans, daily notes, medication records, staffing records and other documents relating to the inspection process. There were 25 people in residence at the time of this inspection, there were 3 vacancies and enquiries had received in relation to them. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? The Statement of Purpose and Service Users Guide have been reviewed and updated as required in the last report. Some additional information is needed and will be added by the Manager. A requirement to safely store bleach and other potentially harmful products has been actioned. Bleach has been replaced with sanitizer and all cleaning materials are now securely stored. Some improvements have been made in the 2 main toilet areas. Hygiene is improved and new sealed flooring has been added. New bedroom furniture has been provided in most bedrooms resulting in improved presentation of those rooms. A new quality assurance system has been introduced. Questionnaires have been circulated to all people in the home and their families. There has been an excellent response and the results have been collated and presented in a document readily available in the home for general information. Care Homes for Older People Page 8 of 28 Pastoral care, absent in the home at the the time of the last inspection has been reintroduced. People felt this was important and are pleased they have access to clergy of their choice. Staff meeting minutes are now well documented and available to all staff, whether they attend or not. 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 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 28 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 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission procedures mean that people can be sure that their needs can be met. Contracts will ensure people know the terms and condition of their stay. Evidence: A requirement of the last report to update the Statement of Purpose/Service Users Guide has been actioned. The last update was April 2009. This will be reviewed annually. A copy is now readily available in the reception area of the home. The range of fees for care at Westcroft must also be added. The criteria for admission or range of needs do not mention the service provided for people with dementia care needs or the fact that external health care specialists are also accessed. This additional information will ensure people have all the required information to make a judgment about the suitability of the home for them. We checked to ensure that all people who were using the service had contracts. Those funded by Local Authorities had contracts provided by them, people who were funding Care Homes for Older People Page 11 of 28 Evidence: their own care should have contracts with the home. The home were unable to produce a contract provided for a person funding her own care. Contract must always be provided at the point of moving into the home. Peoples needs are assessed, usually by the Manager, prior to moving into the home. In the 3 care plans seen this information was available and comprehensive assessments had been carried out in the persons current location prior to admission. Also multi-disciplinary assessments had been obtained. This means that people are sure that their needs are known and can be met by the home before they make the final decision about admission. Care Homes for Older People Page 12 of 28 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 sure that their health and personal care needs are known and met and that a safe system of medication is in place. Evidence: A sample of care plans and information relating to health and personal care were seen. The standard of recording is generally satisfactory. All were based upon pre admission assessments by the home and the multi-agency assessments also provided. They were regularly reviewed to reflect changes in a persons condition or health care needs. Clinical recording has improved and this includes the recording of pressure damage. Body maps, charting and grading of pressure ulcers are now to a good standard. The records of one person with pressure damage was reviewed. Charts, mapping and grading the wound was recorded but the actual treatment was not. The Manager said that this was recorded in the daily notes, but examination of the notes showed this was not the case. There was no record of the changing type of wound dressings used, when they were changed or the progress being made. It is good practice to record the Care Homes for Older People Page 13 of 28 Evidence: condition of the wound when dressing are changed. The wound is now reported to have healed, although nothing in the care plan recorded or evidenced this. It is important that a wound care plan is established to monitor closely the progress of pressure wounds, or any other wound care. In this instance a pressure relieving mattress had been provided (airwave mattress) the person being clearly at risk of further pressure damage. This person was seen in the lounge sitting on a domestic type chair with no pressure relieving cushion. It is important to provide this where there is assessed risk and actual previous evidence of pressure ulcers. At the time of this inspection there were no pressure wounds in the home. Risk assessments were in place relating to moving and handling, nutrition and aspects of personal care needing support from staff. The care plan of a person admitted for 2 weeks respite care ending on the day prior to the inspection was seen. Good and adequate information was present and a detailed assessment had been obtained prior to the admission. Recording was good. There was a recorded history of nutritional deficits with some weight loss and food supplements had been prescribed. This person was not weighed upon admission or during his stay, although records showed that he had been eating and drinking well. It is suggested that in instances of known weight loss and poor nutritional status the person is weighed upon admission, providing a baseline for monitoring nutrition. There is a positive approach to reablement and maximising peoples independence wherever possible. Evidence of this was seen in two instances: In one a hoist had been used prior to the admission of the person who was found able to weight bear and able to move and take steps with assistance from staff. The other example was 2 people who had made progress, reviewed and changed from nursing to residential only status. There are four DNAR orders in place. One was inspected and seen to have been made whilst the person was in hospital 7 months ago. It is on the form required by the Primary Care Trust but had not been reviewed by the GP. DNAR orders made in hospital must be reviewed by the GP within 5 days of discharge. This has not been done and should urgently be brought to the attention of the GP, otherwise the validity of the forms may be questioned and the wishes of people may not be acted upon. In this instance the person had not been consulted about the decision and it was unclear whether family members had. It is the GPs responsibility to ensure people are consulted and involved in the decision about a DNAR wherever possible. The medication system was inspected. Records were good showing in detail the Care Homes for Older People Page 14 of 28 Evidence: receipt, storage, administration and disposal of medication. Two shortfalls were identified to the Manager one related to clear instructions for a cream to be applied 3 times a day for 2 weeks but had only been administered twice each day, the other was a missing signature on records although the medication had been given. There is a safe system of medication administration in the home. Replacement bedroom furniture in most rooms means that each person now has a lockable facility to store medication securely if needed. Presently only creams in use are stored there. There is no self-medication. There are no ongoing reviews of medication by the GPs. Reviews are only undertaken when the GP is called to see a patient for a specific reason. Several deaths earlier in the year were reviewed, some were in hospital others in the home. It was clear that a person with a terminal illness had been nursed with input from Palliative Care Nurses. There had been good dialogue with GP and arrangements for pain relief. Relatives were involved but not local and specific time was spent by nursing and care staff in supporting the person in the final days of life. Westcroft Nursing Home were given a Dignity in Care Award in 2008 by the Local Authority. They have competed for a further award this year and have been entered in the final part of a the competition for a special award. The home were also awarded the Investors in People Award in 2008. Care Homes for Older People Page 15 of 28 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 can be sure that their individual lifestyles are known and met and that they have control over their lives. Evidence: Westcroft has traditionally provided a good progamme of activities, embracing the diverse needs of people. Some have high dependency needs and may have limited communication or social skills. Activities are tailored to the needs of individuals. Many people have 1:1 engagement and support as part of their activity needs, this may sometimes be simply talking to people, reading to them or providing hand massage whilst engaging with them. Activities are led by two of the nursing/care staff who know the needs and limitations that people may have and provide a supportive, individual and constructive experience. Activities are sometimes planned and at other times provided spontaneously. They are recorded and all people using the service have a record of activities provided with them. At the time of the last inspection pastoral care was not being provided, based upon people not making requests for this care. This has improved since the last inspection Care Homes for Older People Page 16 of 28 Evidence: two people spoken with have regular input from the Roman Catholic church, others have had input from other clergy. Two people spoken with said that input from clergy is important to them and would like even more involvement. Contacts with families and friends are promoted as an important aspect of care for people. Two visiting relatives were seen and spoken with at length. Both said that they were welcomed into the home by staff, always given a tray of tea and biscuits, staff were friendly, helpful and described by one as marvellous, they will do anything for my (relative). One visitor said that her mother who has dementia care needs was helped to settle quickly and well into the home, she tells her she is happy here and that allays their fears and concerns about the move to care. Another person visiting her husband was full of praise for staff and the home generally. She said she visited many homes before making a decision about Westcroft but finally felt that the relaxed, homely atmosphere with attentive staff was the obvious choice. After caring for him at home for 8 years she was told he had a life limiting illness. She visits daily and able to see him in the privacy of his large bedroom, with space for other family visitors and also able to remain involved in his care by means of assistance with eating in the dining room and other inputs. She is delighted to have found the ideal home where she feels comfortable and able to enjoy the remaining time they have together Peoples chosen lifestyles are accommodated in this home. Another person spends virtually all his time in his bedroom and apart from breakfast has all other meals provided in his room. He has many interests, able to socialise as he wishes but his time alone is very important to him and facilitated by the home. Changes to menus are ongoing to provide variety and choice. All people spoken with said that they were very happy with the food provided, one said we can have anything we want. It was interesting to see fresh fruit provided with the mid-morning tea and biscuits -the importance of nutritional food being evident. Care Homes for Older People Page 17 of 28 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 can be sure that complaints are listened to and acted upon and that procedures are in place to protect them. Evidence: There is a satisfactory complaints procedure in place and is available in the home for people using the service and visitors. It is replicated in the Service Users Guide. No complaints have been received by the service in the past 2 years and none have been received by us. There has been training in the protection of vulnerable adults in the past, but further updated training is needed in Safeguarding Vulnerable Adults. This has been sourced by the home and will be offered to all staff when arrangements are finalised. The Manager and 6 of the nursing staff have attended training in the Deprivation of Liberty Safeguards that came into effect in April this year as part of the Mental Capacity Act. This training is being made available to other staff. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the environment have improved presentation but maintenance and renewal of some equipment is necessary for the safety and well being of people in the home. Evidence: A requirement was made at the time of the last inspection to improve they hygiene and presentation in main toilet areas near the reception area. Improvements have been made in fitting new vinyl flooring and the standards of hygiene have been improved. It was concerning to see in one toilet area that the radiator had no integral metal cover fitted and was exposed presenting a hazard for people using the toilet. Sharp metal struts were exposed. This radiator was in an unsatisfactory state at the time of the last inspection and must urgently be repaired, replaced or guarded to ensure peoples safety. Most areas of the home have been refurbished, redecorated and re-carpeted in the past 2 - 3 years. Since the last inspection most bedrooms have been fitted with new furniture and their presentation improved. All now have a lockable drawer in the new bedside cabinets where medication or valuables can be secured. A sample of bedrooms seen were well presented generally and were well personalized reflecting the individuality of people. Care Homes for Older People Page 19 of 28 Evidence: There are 3 bathrooms, one has an assisted bathing facility (hoist), one is a conventional unassisted bathroom and there is a walk in shower room. The hoist in the assisted bathroom has been removed for repair and been absent for the past 2 weeks, awaiting a replacement part. This means that there is currently no assisted bathing facility on the ground floor which was extensively used. People have been offered a choice of the shower room or a bed bath. It is concerning that this facility is not presently available and means the home is unable to meet the bathing needs of some people in the home. This must be resolved as soon as possible. A requirement was made at the last inspection that bleach and other hazardous items should be stored securely to ensure peoples safety. The Manager reported that Sanitizer is now used as an alternative to bleach and no potentially harmful products were seen in any areas of the home. Care Homes for Older People Page 20 of 28 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. Well trained and committed staff in adequate numbers provide a good standard of care for people at Westcroft. Evidence: Staffing levels have been consistently maintained in this home. There are usually two nurses and 4 carers on duty from 8am - 4pm. One nurse and 3 carers on duty 4 - 10 pm At night time there is one nurse and 2 carers on duty. An additional carer is recruited from 4-6 pm as needed. Ten hours per week are allocated to provide activities. Additionally there are adequate numbers of catering, domestic, laundry and maintenance staff. The staffing levels of the home at this time are satisfactory. Staff training is good. This is provided in both statutory and non-statutory areas of training. A staff training matrix has been established since the last inspection and clearly shows the training that has taken place and also areas where more or updated training is needed. At this time training in Safeguarding is needed and a course is presently being arranged. On the day of this inspection the nurse who is also the Care Homes for Older People Page 21 of 28 Evidence: Moving & Handling Trainer was attending a one day course on Falls Prevention. NVQ training exceeds the required 50 minimum of care staff trained to NVQ standards and is ongoing. Staff meetings are held regularly and minutes of the recent meeting were seen. A range of issues were raised and discussed from practical issues to practice issues. This provides staff with the opportunity raise ares of concern and to express their views of the service. Two awards have been obtained by the home since the last inspection they are: Investors in People Award and Dignity in Care Award. This reflects the importance of staff in providing good standards of care. A sample of 2 staff files were seen and contained all the required checks, references and documents required under Schedule 2 of the Regulations. POVA (Protection of Vulnerable Adults) checks were obtained prior to employment and staff supervised until CRB (Criminal Records Bureau) checks had been obtained. This meant that people using the service were protected. Staff spoken with said that they were offered the training they needed to provide good standards of care. They said that they were supported well by managers and felt that they could raise any concerns they had without fear of negative responses. During the inspection carers and other staff showed good engagement with people in the home and concern and respect were evident including when people presented repetitive or demanding behaviours. Care Homes for Older People Page 22 of 28 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 is well run and managed by a competent qualified Manager. People have ready access to both managers and home owners on a daily basis and the home is run in their best interests. Evidence: The Registered Manager is a registered nurse and has considerable experience in providing a service to older people. He has completed the Registered Managers Award and also has the Diploma in Nursing. The provider, Mr Patel has also completed the Registered Managers Award. The Manager works hand-on in the home several days each week when he has the opportunity to monitor the standards of care and have a detailed knowledge of the nursing and care needs of all people using the service. This is a distinct advantage in this smaller nursing home. Care Homes for Older People Page 23 of 28 Evidence: An Operations Manager also works several days in the home providing administrative and operational back-up for the service. All managers have a daily presence in the home and are readily available to people using the service, their visitors and external professionals. People in the home spoke highly of the manager and his team one said they are always around and we can speak to them about anything. A previous requirement that bleach must be securely stored and not left in areas accessible by people using the service has been actioned. Bleach is no longer used and cleaning and potentially harmful items are locked securely away. Regular audits are carried out by managers. The home has introduced a comprehensive Quality Assurance system that was introduced in February 2009. All people in the home and their relatives are given comprehensive questionnaires with 35 questions about the level of satisfaction people experience of key aspects of care. Most questionnaires were completed and the results presented in a document readily available in the home for visitors to see. There was a high level of satisfaction with the service and some areas identified where improvements could be made have been actioned. Staffing records and discussions with staff identified that there is no formal supervision of staff. Whilst there is an open and ongoing dialogue with staff it is also important that they have the opportunity to have formal one to one discussions with managers. This should be arranged at least 6 times per year. The Manager stated his intention of establishing regular supervision for all staff. Staff do presently have an annual appraisal and this can be one of the six periods of supervision. Care Homes for Older People Page 24 of 28 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 25 of 28 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 19 23 The heater in one of the main toilet areas presents a safety hazard to people and must urgently be repaired, replaced or guarded. This will ensure the safety of people using the toilet area 27/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 People financing their own care must be provided with the contract at the point of admission. This will ensure people know the terms and conditions whilst living at the home. Wound care treatment plans must be established to monitor the progress of the treatment of pressure damage or other wound care provided in the home. This provides evidence of the standards of care that people receive. Plans to provide training for all staff in Safeguarding Vulnerable Adults with further protect people using the service. The bath hoist must be repaired or replaced urgently to ensure the needs of people can be met. 2 8 3 18 4 22 Care Homes for Older People Page 26 of 28 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 5 36 Formal supervision should be provided for all care staff at least 6 times per year. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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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