Care Home: Acorn House Residential Home Ltd

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What the care home does well The home offers a homely and comfortable place to live and staff are considerate, caring and respectful. The internal environment is pleasant and relaxed with individual bedrooms well personalised. The people who live there say it is comfortable and homely. The people who live there also say the food is good and there are always sufficient drinks available. There was very positive feedback from the people who live there with regard to the level of care shown by the staff and the support given by the management team. Daily choices and routines are flexible and met the needs of the people who live there. Visitors spoken with on the day of the inspection said they could visit at any reasonable time and that there were always made very welcomed by the staff and management. All said the home kept in contact with them with regards to their relatives condition at all times and were encouraged to remain involved with their relatives care. The home listens to the people living in the home and endeavours to respond positively to their comments. The home also produces a monthly magazine to inform them of the activities and of any changes. What has improved since the last inspection? The laundry room has been renovated and is now cleaner and following better infection control guidelines. Most of the radiators are now covered and work is ongoing in completing this work. Medication administration had improved and the home now manages this well. Staff training has improved since the last inspection. What the care home could do better: The owner is advised to look closely at the management structure of the home and consider reinstating the role of deputy manager. The registered manager is conscientious and works well to maintain and develop the home, but is in danger of being overwhelmed with the amount of work expected. Supervision needs to be improved and implemented for all staff. Staff induction also needs to comply with `The Skills for Care` guidelines. The windows on the upper floor need restrainers fitted as detailed in the report. If the restrainers are not fitted, there needs to be a very robust risk assessment in place to highlight why these are not required.Some bedroom carpets need replacing as highlighted in the report. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acorn House Residential Home Ltd 39 Maidstone Road Chatham Kent ME4 6DP     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: Sue McGrath     Date: 2 8 0 4 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: Acorn House Residential Home Ltd 39 Maidstone Road Chatham Kent ME4 6DP 01634848469 01634813889 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Acorn House Residential Home Limited care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admisison to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Acorn House is within easy reach of Chatham town centre; the home is located on a main road with bus stops a short walk away. There are local shops, surgeries, churches etc. within the local vicinity. The home occupies detached premises with accommodation arranged over two floors. All the bedrooms currently offer single accommodation; one of the bedrooms can be converted for occupation by two people if this required; fourteen of the bedrooms offer en-suite facilities. There are call bells and television points in each bedroom; some bedrooms also have a telephone point fitted. There are two allocated parking bays Care Homes for Older People Page 4 of 30 Brief description of the care home adjacent to the building. A manager is employed at the home that has day-to-day control. The manager works closely with the proprietor whom visits the home regularly and maintains frequent contact. Current fees range from £460 to £480 per week. Contact should be made with the manager for further information. 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: This was a key unannounced inspection that took place on 28th April 2009 and was conducted by Sue McGrath, Regulation Inspector for the Care Quality Commission. The actual date of the site visit is unannounced. Additional information was also obtained through the Annual Quality Assurance Assessment (AQAA) , which all services registered with the Care Quality Commission (CQC) must complete on a yearly basis. At the site visit, service users and staff were spoken to, records were viewed and a tour of the environment was undertaken. Judgements have been made based on Care Homes for Older People Page 6 of 30 records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the CQC to be able to make an informed decision about outcome areas. Further information can be found on the CQC website with regards to information on KLORAs and AQAAs. The requirements made at the last inspection had been complied with. Overall this was a positive inspection with generally good outcomes for the people who lived in the home. The inspector on leaving the home was satisfied that the people who lived there were both safe and well cared for and wishes to thank the manager and her staff for their assistance and hospitality. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the care home does well: What has improved since the last inspection? What they could do better: The owner is advised to look closely at the management structure of the home and consider reinstating the role of deputy manager. The registered manager is conscientious and works well to maintain and develop the home, but is in danger of being overwhelmed with the amount of work expected. Supervision needs to be improved and implemented for all staff. Staff induction also needs to comply with The Skills for Care guidelines. The windows on the upper floor need restrainers fitted as detailed in the report. If the restrainers are not fitted, there needs to be a very robust risk assessment in place to highlight why these are not required. Care Homes for Older People Page 8 of 30 Some bedroom carpets need replacing as highlighted in the report. 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 using this service have the information they need to make an informed decision about whether the service is right for them. People who live in the home benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. People and families also benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. Evidence: The home has a statement of purpose and a service users guide that meets with regulation and the registered manager confirmed copies were given to all people in the home. Both documents were updated in March 2009. Care Homes for Older People Page 11 of 30 Evidence: Information given in the AQAA confirmed that when an initial enquiry was made the prospective resident and/or their family was provided with the homes brochure and were encouraged to visit the home. Before accepting any person an initial assessment is carried out, based on the persons current condition. The assessment process looks at their strengths and weaknesses, their actual needs and any physical limitations. Their preferences and their ability to fit into the home environment is also assessed. If the prospective person has a care manager information would also gathered from them. A detailed care plan based on their daily needs is then drawn up and the details discussed and agreed with all parties. If a person had previously been assessed by a care manager any pre-identified care plan needs would also be incorporated into the plan. The registered manager confirmed they do not admit any person who they feel they will not be able to meet their needs. The home does offer a four week trial, but the homes experience has shown that they have rarely had to reject anyone at the end of the trial period or that people themselves have asked to leave the home. Once the person had made the decision to move into the home, they were allocated a key worker who would be the primary person to help them settle in. The registered manager confirmed that people do have a contract of terms and conditions and it clearly identifies in the service user guide that some items such as newspapers, magazines, personal toiletries and hairdressing for example, are extra to the normal fees. Intermediate Care is not offered at Acorn House. 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 receive personal support from staff in a way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicines, the care home supports them in a safe way. People who live in the home are treated with respect and can be assured the home will handle the issue of illness and ageing sensitively. Evidence: Each person had a care plan that the manager confirmed was drawn up by staff with the involvement of that person where possible. One person spoken with was familiar with the contents of her care plan. Four care plans were reviewed and evidenced that health care needs were well met. Evidence was seen that most were signed either by the person or their relative. These plans were stored securely and staff had easy Care Homes for Older People Page 13 of 30 Evidence: access to them. The plan continues to be developed by the manager and risk assessments have improved since the last inspection. It is advised that this work be continued. Documentation seen confirmed that all people had access to a GP and visits from other health professionals were arranged and enabled as required. No person currently had pressure areas. The manager said that risk assessments and treatment plans would be maintained for the individual, if this were the case and the Community Nursing Team would support and treat them. Several people were spoken with and they confirmed they could see their own GP if necessary and that the home kept their conditions and general well being constantly under review. All said they were happy with the level of health care they received. Relatives spoken with were very satisfied with the level of care the home offers. The administration of medication was viewed and was found to comply with the recommendations of the British Pharmaceutical Society of Great Britain. The system used was well managed with all the necessary checks and monitoring procedures in place. Mar sheets (Medication Administration Sheets) were viewed and no errors were found. The home has made considerable progress in this area since the last report. The AQAA confirmed that both the manager and a senior carer have completed a level two ASET course in the safe administration of medication and other staff who administer medications have undergone a one day course. The AQAA stated that further courses are planned when spaces become available. The AQAA confirmed that all people were treated as individuals and all staff respected their dignity and privacy. Help with personal care was always carried out in private and anyone needing medical attention was attended to in their own bedrooms. Staff were seen to be courteous and caring and people spoken with said this was always the case. Comments made by residents included: Staff look after me very well Very happy with the level of care here The staff are very good to me and I could not wish for better Care Homes for Older People Page 14 of 30 Evidence: It was a good choice to come here. The home works hard to ensure they can meet the needs of the people inthe home when they are nearing end of life. They work closely with the District Nurse team and provide care to the best of their ability and in a supportive and caring manner. Care Homes for Older People Page 15 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. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability and gender. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People who live in the home are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. People who live in the home receive a wholesome appealing balanced diet in pleasing surroundings. Evidence: The atmosphere within the home was relaxed and pleasant, with people seen to be interacting and involved in conversation with one another and their visitors. There was positive and supportive interaction and conversation observed between people and staff. Care Homes for Older People Page 16 of 30 Evidence: Most people said they were happy with the level of activities although one or two did say that at times they get bored. The manager described some of the regular activities that were planned and these ranged from bingo and other games to exercise sessions and old time musical sessions. Outside entertainers were regularly at the home and PAT dogs were also invited to the home. Church service were regularly carried out for those who wished to participate. The home produces a monthly news letter to advise people of any forthcoming activities and to keep them informed of any changes or improvements that may have taken place. One visitor were spoken with confirmed they could visit at any reasonable time and that the home always kept in contact with them if any changes occurred in their relatives conditions. The AQAA stated that all people were encouraged to maintain as much contact as possible with outside groups that they were involved with prior to moving to the home. Visitors were encouraged and made welcomed, this was confirmed by some visitors on the day of the inspection. People were encouraged to maintain their independence where possible and support was given to those who were able to deal with their own affairs and manage their own finances. All of the people spoken with said the food was good and there was always plenty of drinks available at all times. Several commented they were not always aware of what the main meal of the day was until it was served. It was noted that a menu board was displayed near the dining room and the home may wish to consider another alternative method of letting people know what is for dinner as well as the menu board. Breakfast is taken to peoples bedrooms on trays with the two other main meals of the day served in the homes dining room. People could have a light supper if they wished and bedtime drinks were always offered. The menu plan was seen to be varied, balanced and nutritious. Peoples likes and dislikes were taken into consideration and an alternative choice was offered at the main meal. The manager said staff gave assistance to those people who needed help to eat in a discrete and sensitive manner. Care Homes for Older People Page 17 of 30 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. People who live in the home are protected by a robust complaints system and residents and relatives feel their views are listened to and acted upon. The home has robust adult protection policies and procedures to ensure that people are protected from abuse. Evidence: The home had a complaints procedure in place that was comprehensive. Evidence was seen that the home records all complaints appropriately and responds effectively within the allocated timescales. The home had received one complaint since the last inspection and had managed the situation well. Evidence was also seen that the owner responds in writing to any negative comments made during the quality assurance exercise. The manager remains the first point of contact for people however, people spoken with in the home found her and the staff helpful and easy to approach if they had a concern. All said they felt safe and secure in the home. The Commission had not received any formal complaints regarding the home and no Safeguarding Vulnerable Adults(SVA) alerts have been raised. The home had now adopted Kent and Medways Safeguarding Vulnerable Adults Polices and Procedures as recommended from the last report. The majority of staff have Care Homes for Older People Page 19 of 30 Evidence: completed POVA training and the remainder are booked to complete the course. The staff spoken with were able to display a good understanding of adult abuse and protection. Two senior staff have completed an introduction to DOLS (Deprivation of Liberty) and are scheduled to attend the next level during April 2009. Since the last inspection the home has notified the Commission of events affecting the welfare of people, as regulation requires. 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 benefit from living in a clean, safe, well-maintained environment and have safe access to comfortable indoor and outdoor communal areas. People are encouraged to maximise their independence by having access to the range of specialist equipment supplied by the home. Evidence: Acorn House is a comfortable and homely place to live according to the people who live there. It had two lounges and a conservatory plus a dining room. One of the lounges was used as a quiet room and had a small library. The books were mainly on loan from KCC Libraries and were exchanged on a regular basis. A selection of talking books were also available for people to use. All of the bedrooms offered single accommodation and fourteen of them offered ensuite facilities. All of the rooms had a call bell and a TV point and people could have a personal telephone line installed in their room at market cost to them. There was also a public telephone available for people to use. The majority of the bedrooms that were viewed were well personalised and looked comfortable. Three of the bedrooms require new carpets as the existing ones were badly stained. The fitting of radiator covers was Care Homes for Older People Page 21 of 30 Evidence: ongoing, but some areas have radiators that were still exposed. The manager confirmed that work was ongoing to ensure all radiators were covered as soon as possible. The upstairs windows do not have restrainer fitted to ensure they restrict the opening to 100mm (based on NHS guidance) as advised by the HSE (Health and Safety executive). Chemicals were stored appropriately on this visit and the manager confirmed the home has safety information in the form of safety data sheets in place. COSHH procedures in the home are covered on staff induction by the manager and the AQAA confirmed staff have been trained in COSHH and are aware of their responsibilities. Cleaning schedules were in place but they do not appear to be realistic and only allow time for basic cleaning. Domestic staff spoken with confirmed extra hours would be well spent. It will be recommended that more domestic hours are undertaken to ensure activities such as spring cleaning and light shade dusting can be accommodated. The gardens were well maintained. The laundry area had improved since the last inspection. 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. People have safe an appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure they are suitable. Evidence: The AQAA confirmed that the home employs nineteen care staff as well as domestic staff and cooks. The normal deployment of staff is three carers in the morning, two in the afternoons and two waking night staff. More staff would be deployed if necessary at peak times. The home has a history of not using agency staff, with the homes regular staff covering for any sickness or annual leave. The rotas confirmed these levels were rigorously maintained. Currently the home has 13 of its staff qualified to NVQ level 2, with another two currently undertaking their award. Staff training was ongoing and the home does have a training matrix. This evidenced that the majority of training was either up to date or booked. It was noted that although all staff had completed a moving and handling course, for some it was over three years ago and a refresher course should be arranged. It is also recommended that at least one person per shift has undertaken the First Aid at Work course that is recognised by the HSE. The induction programme Care Homes for Older People Page 23 of 30 Evidence: seen on the day did not meet with the Skills for Care guidelines but the manager stated that she had recently obtained a copy of the programme and was intending to use it from then on. This will be viewed at the next inspection. Several staff files were viewed and evidenced that the home had robust employment procedures in place to ensure the safety of the people who lived in the home. All staff had undergone POVA first checks and held a current CRB. Discussion with staff confirmed all held contracts and had job descriptions. Staff spoken with all said there was a lot of good team work in the home and that it was a pleasant place to work. One staff member said she felt there were sufficient staff on duty but it could get busy at times. Several of the people who lived in the home confirmed the staffing levels were adequate and said they did not have to wait long for staff to answer their calls for assistance. All said the staff were very kind to them and gave a high level of personal care. During observations on the day of the site visit there was every indication that staff try their hardest to meet the people who live there needs efficiently and effectively. All of the people spoken with praised the staff for their kindness and care. A lot of positive care practices were observed and staff were clearly dedicated to their roles. Some very good examples of staff using the hoist were observed, with very good communication skills seen. 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. People have confidence in the care home because it is run and managed appropriately. Peoples opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. Evidence: The home manager was very experienced in the care of the elderly and had been at the home for over ten years. She had been the manager since 2002 and had completed NVQ 4 in care and had obtained her RMA (Registered Managers Award) qualification. The AQAA confirmed she attends the necessary refresher courses and had recently completed the Safe Administration of Medication Award, as recommended from the last report. However she does not have a deputy to support her in the management role and there was concern on the day that the workload was very high. Care Homes for Older People Page 25 of 30 Evidence: The manager was very conscientious and would benefit from more regular management support hours being available. It is recommended that the provider look at this area urgently. Both the staff and the people who lived in the home commented that the managers approach to the home created an open, positive and inclusive atmosphere. Everyone said the manager was approachable and helpful. Regular quality assurance questionnaires were undertaken to ensure the views of the people who lived in the home and other interested parties were taken into account. The manager was currently asking GPs, Dns and other professionals for their opinion on the home. people who live inthe home and staff had already completed questionnaires. When all of these have been returned the manager confirmed she intends to review all the results with the owner and write an action plan and a report and make it available to all. Letters were seen from the owner to relatives about concerns raised at the last quality assurance review and the action taken. Regular residents meeting are arranged where any concerns can be discussed and actioned. Staff supervision is not completed as regularly as expected and this was confirmed by records and in discussion with staff. Again the manager is expected to undertake all supervisions and the owner needs to look at giving more managerial support. Discussion took place regarding the format of supervision. The AQAA confirmed that full insurance cover was in place to ensure any unforeseen occurrences do not affect the business or the daily lives of the people who live in the home. The health, safety and welfare of the people in the home and staff are promoted with all the necessary maintenance and servicing being undertaken. The manager undertakes the majority if these checks, apart from ones that require professional attention, and discussion took place about the necessity to delegate to a senior member of staff, such as a deputy manager, some of these tasks. The temperature of the water was of a concern as the water in the bathrooms was exceptionally hot. Bedrooms sinks did have Thermostatic Mixer Valves fitted and the provider is advised to fit them to the baths or have a more robust system in place for monitoring the temperatures. A full risk assessment must be carried out to identify potential scalding risk from hot water temperatures and to assess vulnerability of those who have access to bathing and washing facilities. Care Homes for Older People Page 26 of 30 Evidence: Care Homes for Older People Page 27 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 28 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 19 19 31 It is recommended that the windows on the upper floor are restricted to 100mm as recommended by the HSE. It is recommended that carpets in rooms 10, 11 amd 16 be replaced. It is recommended that the provider looks to provide more management support for the manager and reinstates the role of Deputy Manager It is recommeded that a full risk assessment is carried out to identify potential scalding risk from hot water temperatures and to assess vulnerability of those who have access to bathing and washing facilities. 4 36 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. 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