Inspection on 22/10/08 for Whittington Village

This inspection was carried out on 22nd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whittington Village 02/09/09

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Whittington Village 119 Handley Road New Whittington Chesterfield Derbyshire S43 2EF     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: Rose Moffatt     Date: 2 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Whittington Village 119 Handley Road New Whittington Chesterfield Derbyshire S43 2EF 01246455000 01246453018 bridgethodgkinson@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Whittington Village Ltd Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 18 The registered provider may provide the following category of service only:- Care Home - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Older Persons Code OP Date of last inspection Brief description of the care home Whittington Village, formerly known as Handley House, was bought by new providers and registered under its current name from 1st November 2007. The home provides personal care for up to 18 older people. It is situated on the main road in New Whittington, on the outskirts of Chesterfield. The home is a detached house that has been extended. The majority of the bedrooms are single with en-suite facilities. The home is set back from the road and has a garden area at the rear. Local amenities, Care Homes for Older People Page 4 of 32 Over 65 18 0 Brief description of the care home including a post office, shop and pub are located nearby. Fees at the home range from £263.00 to £343.20 per week. This information was provided by the acting manager on 22nd October 2008. Information about the home, including CSCI inspection reports, is available in the main entrance area of the home, or from the acting manager. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. The last key inspection of the home was on 20th November 2007. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key Care Homes for Older People Page 6 of 32 inspection or annual service review. This included: surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place over six hours on one day. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out ten surveys to people living in the home and received six completed responses. Five of these stated that staff at the home had assisted the person to complete the survey. We sent out ten surveys to staff employed at the home and received three completed responses. There were ten people accommodated in the home on the day of the inspection visit. People who live in the home and staff were spoken with during the visit. The acting manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. Three people were selected and the quality of the care they received was assessed by speaking to them, observation, reading their records, and talking to staff. What the care home does well: What has improved since the last inspection? 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 8 of 32 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had sufficient information about the home and there was a satisfactory assessment process so that people were confident their needs could be met at the home. Evidence: At the previous inspection in November 2007, we found that there was no accurate Statement of Purpose and Service User Guide available to people living in the home and so a requirement was made for this to be provided. At this inspection we found that the Statement of Purpose and Service User Guide had not been updated and still included out of date information about the ownership of the home. We made an Immediate Requirement that there must be an accurate Statement of Purpose and Service User Guide available to people living in the home. The acting manager provided an accurate Service User Guide within the timescale of the Immediate Requirement. The Statement of Purpose had not been updated. The acting manager Care Homes for Older People Page 11 of 32 Evidence: said the providers had agreed to do this, but no updated version had been received. We wrote to the providers to say they had partially complied with the Immediate Requirement, and gave them an extended timescale to produce the updated Statement of Purpose. We received six completed surveys from people living in the home who all said they had received enough information about the home before moving in. One person spoken with said they had come for a look around the home before deciding to live there. Three people who completed surveys said they always received the care and support they needed, three said they usually did. One person said they were very happy with the care here. Staff who returned our surveys, and those spoken with, told us they usually had enough information about people they were caring for. Staff told us they had appropriate training to help them meet the needs of people living in the home. We looked at the care records of three people living in the home. Each had an assessment of their needs completed by Social Services before coming to live in the home. There was also a brief assessment by the home of the persons needs. Standard 6 did not apply as there were no people in the home receiving intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The approach to care planning and reviews was not consistent or sufficiently robust to ensure that people were fully involved and consulted about their needs and preferences. Evidence: Of the six people who returned surveys, three said they always had the care and support they need, three said they usually did. Four people said they always had the medical support they need, one said they usually did, and one said they sometimes did. All six said that staff always listened to them and acted on what they said. People we spoke with told us they had the care and support they needed at the home. They said, the staff know what I like, and, the staff come when I need them. We observed that staff were knowledgeable about the needs and preferences of people in the home. We saw staff take appropriate action to ensure peoples needs were met. For example, checking the person had heard and understood what the member of staff was saying about their medication, and helping people with eating their lunch. We Care Homes for Older People Page 13 of 32 Evidence: observed that staff spoke to people in an appropriate and respectful way. We looked at the care records for three people in the home. Each had assessment information and a care plan from social services. One had a care plan produced by the home, two did not. The care plan produced by the home had sufficient information about the persons needs and the action required by staff to meet them. There were details of the persons preferred daily routine, and prompts for staff about promoting the persons independence. This care plan had been reviewed monthly until the end of 2007. The care plan had not been signed by the person or their representative to indicate their involvement and agreement. The three care records seen each included an assessment of the dependency of the person that had been reviewed monthly. Each had a manual handling assessment and a risk assessment about mobility. Two people had records of their weight, checked and updated every month. There was no record of the weight of one person who had been admitted to the home about three weeks before the inspection visit. There were records of the visits of the GP, District Nurse and chiropodist. People had been referred appropriately for specialist healthcare advice and support, such as assessment of continence needs and dental treatment. Some items in the care records had not been fully completed, some were not signed or dated. The care records were stored in a filing cabinet in the dining area. The filing cabinet was not kept locked. We looked at the daily records for each person. The records were informative and showed that staff took appropriate action when there was a change in the persons needs. For example, one person was noted to be unwell, was seen by their GP and antibiotics started for an infection. The care records included the signed consent of people for staff to deal with their medication. There was no-one who managed their own medication at the home at the time of the inspection visit. Medication was stored in a trolley chained to the wall in the dining area and a large cupboard, also in the dining area. The medication administration records seen were correctly completed and each had a photograph of the person. There was a protocol in place for each person who was prescribed medication as required with details of why and when the medication should be offered. There were records of the receipt and disposal of medication. There were regular audits and checks by the pharmacist. The senior care assistants administered medication and all had received appropriate training. Care Homes for Older People Page 14 of 32 Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were suitable activities and reasonably flexible routines so that the lifestyle offered in the home generally met the needs, preferences and expectations of people living there. Evidence: Four people who returned our surveys told us there were usually activities arranged by the home that they could take part in, and two said there sometimes were. There were pieces of artwork and crafts on display by people in the home. During the inspection visit, people enjoyed singing along to music with staff. Staff told us that they offered activities such as playing dominoes, watching a film, and painting and crafts, usually in the afternoons. Every two weeks people had the opportunity to join in with gentle exercises provided by a visiting company. There were regular visits by people from a local church. Staff said they sometimes went with people to local shops, but did not always have enough staff to do this. The home did not employ an activities organiser. People told us they were able to get up and go to bed when they wanted to. We observed that breakfast time was flexible and that people could still have breakfast if they got up later in the morning. We observed people moving freely around the ground Care Homes for Older People Page 16 of 32 Evidence: floor of the home and using the three lounge areas. One person told us they liked to watch television in the small lounge. We observed a good rapport between people in the home and staff, creating a good atmosphere. People were encouraged to bring in personal items for their bedrooms, such as photographs and ornaments. There were no visitors in the home on the day of the inspection visit. The acting manager said that most visitors came at the weekends. One person told us they were looking forward to a friend visiting the following day, and also to a visit from their spouse at the weekend. They were pleased they could share a meal at the home with their visitors. Four people who returned surveys told us they always liked the meals at the home, two said they usually did. People spoken with said they enjoyed their meals and there was always enough. The dining area was clean and bright. There was no menu displayed. The lunchtime meal on the day of the inspection visit appeared appetising and included fresh vegetables and fruit. Some people used adapted dishes and cutlery so they could feed themselves. The main meal was served on plastic plates, although the puddings were served in ordinary pot dishes. We observed that people who needed assistance were given appropriate help by staff. The main cook in the home was also the deputy manager. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory policies in place and good staff awareness so that people were protected and appropriate action was taken to address their complaints. Evidence: Four people who returned our surveys told us they knew how to make a complaint, two said they did not. Three people told us they always knew who to speak to if they were unhappy, two said they usually did, and one said they sometimes did. One person we spoke with said they would go to the acting manager with any problems and they were confident she would take appropriate action. The complaints procedure was updated with the Service User Guide to provide the correct address for CSCI. There were no formal complaints recorded and none had been received directly by CSCI since the last inspection. We saw that some,less formal, complaints were brought to regular meetings for people living in the home. Details of action taken was not always recorded. Since the last inspection, all staff had received training about safeguarding vulnerable adults. The home had a copy of the recently updated multi-agency guidelines for the protection of vulnerable adults. Staff were aware of safeguarding issues and of the correct procedures to follow if abuse was suspected or alleged. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and suitably equipped so that people had a homely and comfortable environment. However, the home was not always sufficiently well maintained to ensure people had a safe environment that met all their needs. Evidence: The home was originally a large detached house that was extended several years ago to create additional bedrooms, lounge space, laundry, and storage facilities. There was a passenger lift to allow access to all floors, handrails throughout to help people with mobility problems, and bath hoists to help people in and out. There was a lifting hoist, although the acting manager said this was not needed for any of the people currently living in the home. At the previous inspection in November 2007, we found there were items that required maintenance. At this inspection, we found these items had still not been addressed, specifically, the ceiling in bedroom 8 was stained and damaged following a water leak, and the double glazed windows in bedrooms 9 and 10 had failed, causing misting of the windows. An Immediate Requirement was made for the home to produce a plan of when this maintenance would be carried out. The home complied with the Immediate Requirement in the allowed timescale. The action plan produced stated that the work required would be completed by 31st December 2008. Care Homes for Older People Page 20 of 32 Evidence: There were three lounge areas in the home, all furnished in a domestic style. Some people said they preferred to sit in the smaller lounge, whilst others preferred the busier lounge area that was part of the lounge/dining room. The lounge/dining room contained a filing cabinet for care records, a large cupboard and a trolley for storing medication. This detracted from the domestic style of the room. The ground floor bathroom had been decorated to look welcoming. The first floor bathroom had recently been fitted with a new bath hoist and new flooring. The bath panel and radiator cover required suitable decoration. The bedrooms were mostly well personalised with peoples photographs and other belongings. In addition to the work required as detailed above, bedroom 5 had a piece of skirting board missing, and the en-suite toilet in bedroom 8 needed redecorating following a water leak. Some bedrooms had a lockable cupboard or wardrobe. There were keys available for all bedroom doors, though the acting manager said no-one was using a key at present. The home was generally well decorated, although there was an area of damage to a wall in the first floor corridor that required redecoration. A first floor toilet had been converted to a storage room. There was a sliding door that was difficult to open. It was not clear that the room complied with the requirements of the fire service. Two bedroom doors on the first floor did not close properly as they caught on the carpet, also the doors to the basement laundry and ironing rooms did not close properly. The doors were fire-resisting doors and so needed to close completely to help prevent the spread of fire. We found that several doors were wedged open during the inspection visit. When brought to the acting managers attention the door wedges were immediately removed. There was a patio at the back of the home, reached through doors from the lounge/dining room. The patio had furniture for people to use if they wanted to sit out. There were no plants or pots on the patio so it looked bare. There was an area next to the patio that was overgrown with weeds and not accessible to people living in the home. There was a front garden with a lawn and flower beds. The laundry was suitably equipped. There was a washing machine with a sluice facility for soiled clothes and bedding. There was a sluice sink in the laundry for the emptying and cleaning of commode pans. Staff were aware of infection control procedures and Care Homes for Older People Page 21 of 32 Evidence: had received appropriate training. The home was clean and free from offensive odours throughout on the day of the inspection visit. Four people who returned our surveys said the home was always clean and fresh, two said it usually was. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment, induction and training were not sufficiently robust to ensure that people were fully protected and that staff were fully competent to give the care and support required. Evidence: Three people who returned our surveys said there were always staff available when needed, two said there usually were, and one said there sometimes were. People we spoke with said there were usually enough staff available. They said the staff were always there when I need them. Staff who returned our surveys and those we spoke with said there were usually enough staff to meet peoples needs. We looked at the staff rotas for the home. There were two staff on duty for each shift morning, afternoon and night. The acting manager was included in the staff on duty for three days per week and had supernumerary time on two days per week. The deputy manager also did the cooking on four days per week. This meant that there times when there was one care assistant to meet peoples needs. Although staff said this did not have an impact on providing basic care for people, it did limit the social activities that could take place. The acting manager said that there would be additional hours provided for cooking when there were more people living in the home. Care Homes for Older People Page 23 of 32 Evidence: Nearly all of the staff at the home, (eight out of nine staff), had already achieved National Vocational Qualification (NVQ) Level 2 in care. This exceeded the National Minimum Standard of 50 of care staff with NVQ at level 2 or above. We looked at the records for three members of staff. All three had a Criminal Records Bureau (CRB) disclosure and POVA First check in place. Two had provided a full employment history, one had not. Two had one written reference each, one person had no written references. None of the records included a recent photograph. There was no evidence of an induction programme that met Skills For Care standards. Staff training certificates were displayed in the entrance hall of the home and showed that all staff had received training such as manual handling, food hygiene, first aid, and safeguarding vulnerable adults. Staff had also received training about the care of people with dementia. There were no records of fire safety training. Staff said this had taken place around December 2007. There were records of staff annual appraisal. There were no records of regular supervision of staff. Staff confirmed there was no formal system of supervision in place, although there was informal supervision through individual discussion with the acting manager. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were gaps in records relating to personal care, staff, and health and safety so that people were not fully protected. The quality assurance system was not sufficiently developed to ensure the home was run in the best interests of people living there. Evidence: The acting manager had worked at the home for two years as a senior care assistant and approximately two months as acting manager. She said she was about to start working towards NVQ level 4. People living in the home told us they liked the acting manager. Staff told us they had confidence in the acting manager. As noted earlier in this report, the providers partially complied with the Immediate requirement made, but did not produce an updated the Statement of Purpose within the timescale allowed. We allowed an extended timescale for the Statement of Purpose to be produced. Care Homes for Older People Page 25 of 32 Evidence: The Annual Quality Assurance Assessment (AQAA) was not returned by the date we requested. During the inspection visit the acting manager said she was working on the AQAA and agreed to complete and return it to CSCI by 7th November 2008. The quality assurance system included monthly satisfaction surveys completed by people living in the home, mostly with help from staff. The acting manager said she also tries to get relatives to complete surveys, but they are not always willing to do this. The completed surveys were kept, but there was no analysis of the results and no report produced to show people what action had been taken in response. The acting manager said that the provider made regular visits as required under Regulation 26, but there were no records available of this on the day of the inspection visit. The acting manager said that nearly all the people at the home had relatives that dealt with their personal money and so there was no personal money held in the home. The acting manager said the personal money for two people was held at the providers head office and was supplied as needed to pay for hairdressing, toiletries, clothes, and so on. Records of weekly checks of the fire alarm system were up to date. The last fire drill recorded was in 2006. According to the stickers on the fire extinguishers they were last serviced in 2006, there were no records available of this. As noted previously in this report, there was no record of staff fire safety training, although staff said they had training around December 2007. The electrical safety certificate was satisfactory. There was no current gas safety certificate. The passenger lift had been serviced in June 2007. There were no records available of the servicing and maintenance of hoists in the home. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 Records relating to the personal care of people living in the home must be kept securely. This will help to protect people and ensure confidentiality of personal information. 30/11/2008 2 7 15 Each person living in the 30/11/2008 care home must have a care plan in place that details how their needs will be met at the home. This will ensure that people receive the care they require. 3 19 23 There must be a 31/12/2008 maintenance programme in place that addresses all the items in the Environment section of this report with timescales of when the work is to be completed. A copy must be provided to CSCI. Care Homes for Older People Page 28 of 32 This will help to ensure that the home is well maintained to provide people with a safe and pleasant environment. 4 29 19 Staff records must include all the required information and documents, specifically, a full employment history, two written references, and a recent photograph. This will ensure people are better protected by a more robust recruitment system. 5 30 23 All staff at the home must have training in fire prevention. This will help to protect people living in the home. 6 38 23 All equipment used for the 31/12/2008 manual handling of people in the home must be regularly maintained and serviced. This will ensure compliance with relevant health and safety legislation and promote the safety of people in the home. 7 38 23 There must be a current Landlords Gas Safety certificate available in the home. This will promote the safety of people living in the home. 8 38 23 Fire drills must be carried 31/12/2008 out at the home at suitable intervals as advised by the local fire and rescue service. 31/12/2008 31/12/2008 31/12/2008 Care Homes for Older People Page 29 of 32 This will promote the safety of people living in the home. 9 38 23 All fire safety equipment at the home must be maintained as advised by the local fire and rescue service. This will promote the safety of people living in the home. 31/12/2008 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 7 Care plans should be reviewed at least every month, or more frequently if there is a change in the persons condition or circumstances. This will help to ensure that peoples changing needs are met. People living in the home, and/or their representatives, should be actively encouraged to take part in care planning, and should sign the care plan to indicate their involvement and agreement. This will help to ensure that peoples needs are met in the way they prefer. The range of activities should be further developed and an activities coordinator should be employed. This would help to ensure that all people living in the home are offered opportunities to be involved in appropriate activities in and out of the home. There should be records of the outcome of any complaints or concerns raised at the meetings for people living in the home. This will ensure peoples complaints are taken seriously and appropriate action is taken to address them. The patio and adjacent garden area should be improved with planting to enhance the area for people to enjoy. People living in the home could be involved in planting pots and containers or raised beds. Doors should only be held open by a device that allows the door to close when the fire alarm sounds. This will protect people in the event of a fire. All bedrooms should be provided with a lockable drawer or cupboard so that people can keep items securely and Page 30 of 32 2 7 3 12 4 16 5 19 6 19 7 19 Care Homes for Older People privately if they wish. 8 19 The filing cabinet and large cupboard used for medication storage should be moved out of the lounge/dining room to make the room look more homely for people living there. The hours provided for cooking should be in addition to care hours so that there are always two care staff available. This will ensure there are always sufficient care staff available, and could help to improve the range of activities offered to people living in the home. There should be an induction programme that meets Skills For Care standards to ensure that staff are fully prepared and competent to meet the needs of people living in the home. Staff should have training about fire safety and fire prevention every year, and staff working nights should have training twice every year. This will help to protect people living in the home. The acting manager should apply for registration with CSCI as soon as possible to ensure she is a fit person to be managing a care home. The quality assurance system should be further developed to include analysis of completed surveys and details of the action taken to address any issues raised. 9 27 10 30 11 30 12 31 13 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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