Care Home: Alexander Nursing Home

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What the care home does well Management make sure that they assess the needs of people before they are admitted to the home. This is to make sure that staff only care for those people whose needs they feel they can meet. The staff are very good at caring for people who are extremely ill and need a lot of nursing care. The care plans contain a lot of information about how people are to be cared for, what they can do for themselves and what they need help with. Residents feel that they are well looked after by the staff. Residents and relatives made the following comments: "The care is second to none". " I can think of no way that they could do better". " They give a first class service". The meals provided are varied, nutritious and the residents have a good choice of menu. The residents live in a safe and pleasant environment. Management make sure that they check people out thoroughly before offering them a job. This is to prevent the residents being cared for by unsuitable people. Management make sure that the staff are properly trained so that they have the knowledge and skills they need to protect and meet the needs of the residents. What has improved since the last inspection? The registration of the home has changed since the last inspection and the home is therefore classed as a new service. Because of this we do not comment on any improvements since the last inspection. It needs to be noted however that there has been a major change to the environment. A new dining room and lounge area have been added to the home. In addition two new en-suite bedrooms have been built. They have been furnished and decorated to a high standard and have further enhanced the already very pleasant living facilities for the residents. What the care home could do better: Management and staff need to ensure that all medicines are stored safely. This is to make sure that they can not be mishandled and put people`s health at risk. Management need to check out the quality of care and the services provided for the residents. They then need to make sure that they document their findings and act on anything that can be improved upon. The providers need to seriously consider providing the manager with some supernumerary hours so that she can fulfill her duties as a manager. Key inspection report Care homes for older people Name: Address: Alexander Nursing Home 164 Rochdale Road Bury Lancashire BL9 7BY     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: Grace Tarney     Date: 2 0 0 1 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Alexander Nursing Home 164 Rochdale Road Bury Lancashire BL9 7BY 01617931104 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Fulcare Limited care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of people who can be accommodated is: 31. Date of last inspection Brief description of the care home The Alexander Care Home is a care home providing nursing and personal care for mainly older people. 24 hour care is provided by registered nurses who are supported by a team of trained care assistants. It is a large detached converted vicarage, built on two floors with an added extension to the rear. The home is situated on the main bus route leading into the centre of Bury. There is nearby access to the motorway network. There is a park to one side of the home and a church to the other side. There is a large garden to the rear of the home, which is bordered by mature trees and shrubs. The main door at the side of the home allows level access for wheelchair users and people who have problems climbing Care Homes for Older People Page 4 of 28 Over 65 31 0 Brief description of the care home steps. The home is registered to care for 31 residents and provides accommodation in single bedrooms on the ground and first floor. All but 1 of the bedrooms has an ensuite toilet facility. There are 2 lounges, a dining room and a conservatory on the ground floor. The toilets and bathrooms have aids to assist any resident with a disability or mobility problem. The provider informed the inspector that the weekly fees within the home ranged from 388.89 pounds to 495.19. The fees charged depend on the needs of the resident( if residential or nursing) and whether they are privately funded. Additional charges are made for hairdressing, chiropody and private newspapers and magazines. This information was received on the 25th February 2010. 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 staff at the home were not told that this inspection was to take place although many weeks before the inspection we (The Care Quality Commission) sent out questionnaires (comment cards) to some of the residents and to the staff. The questionnaires asked what people thought about the care and quality of the service provided. We received 6 cards back from the residents and 4 from staff. What they felt about the care and services provided is written in different sections throughout this report. Also before the inspection we asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they did at present, what they felt they did well and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we do. We spent 8 hours at the home and during this time we examined care and medicine records to make sure that the health and care needs of the residents were being met. In addition we looked at what activities were available for the residents and whether they were given choices about how they spent their day. We Care Homes for Older People Page 6 of 28 looked at what the residents were having for their meals to make sure that there was a choice of meals and that they were varied and wholesome. We also looked around the building at most of the bedrooms, bathrooms, toilets and sitting areas to check if they were clean, warm and well decorated. We checked how many staff were provided on each shift to make sure that the residents needs were being met. We then looked to see if management recruited and trained the staff properly and safely. This is so the staff can do their jobs properly and the residents are protected from being cared for by unsuitable people. We also checked to see if management check that the care and services they provide is what the residents and their relatives want or expect. In order to get further information about the home we spent time talking to 3 residents, 1 visitor, the cook, a visiting nurse and 2 care assistants. Care Homes for Older People Page 7 of 28 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 on page 4. Care Homes for Older People Page 8 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed before they are admitted to the home and this gives an assurance to everybody that a person is only admitted if the staff at the home feel they can meet their needs. Evidence: Before any resident was admitted, a member of the senior nursing staff from the home undertook an assessment of their needs. The assessment looks at what help and support the prospective resident needs in all aspects of their daily life. The 1 assessment that we looked at was detailed and gave a clear indication of the residents needs and what she could and could not do for herself. Based on this information it was decided that the staff at the home could meet her needs and therefore her admission to the home was possible. The home also admits people from the Rapid Response Team. Rapid Response is a system whereby people who require urgent nursing care, but not admission to hospital, can be cared for on a 24 hour basis by qualified nurses for a short period of time, normally no longer than 2 weeks. When Care Homes for Older People Page 11 of 28 Evidence: a person was admitted under this scheme they had an assessment undertaken by qualified nurses from the Rapid Response Team. The AQAA document sent to us stated that before admission the staff carefully consider the prospective residents existing care plan and involve other professionals, the resident and their families when making the needs assessment. We were also informed in the AQAA that potential new residents are given the opportunity to visit and spend some time at the home. In addition the home now has a website that will greatly improve potential and existing residents access to information about the home. Standard 6 does not apply. The home does not provide Intermediate Care. 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. Care plans and care practices ensure that the residents needs are met in a caring and dignified way. Evidence: Individual care plans were in place for each resident. A care plan details the individual care and support needs that a resident may have and also shows how those needs are to be met by the staff. The care plans of 2 of the residents were looked at. They were detailed and gave clear instruction and guidance on how the care needs of the residents were to be met. They also provided information about the residents daily routine, their past life and their interests. The care plans were checked regularly by the staff so that any change in the residents condition could be identified and action taken if necessary. The care plans detailed the religious needs of the residents. At the time of the inspection there were no residents of any ethnic minority. Neither were there any residents who required special diets to meet their religious or cultural needs. The staff looked at whether or not there was any risk in relation to the residents Care Homes for Older People Page 13 of 28 Evidence: developing pressure sores. They also looked at and they wrote down how any resident was to be assisted with being moved around and by how many members of staff and what equipment, if any, was to be used to assist in safe moving and handling. They also looked at whether there was any risk of the resident falling and also if a resident was at risk due to problems with their food and fluid intake. We saw that the residents were weighed regularly and their weight was recorded in their care notes. We went to look at the care being provided to 2 of the residents being cared for in bed. These residents looked very well cared for. Specialised equipment was in place to ensure that every comfort and care was being delivered. Equipment necessary for the prevention and treatment of pressure sores was available and in use. We saw that staff wrote in the care notes when the residents had received visits from health care professionals, such as dentists, opticians, district nurses and chiropodists. We spoke to 1 visitor who told us that he felt his relative was very well looked after. Some of the comments from the surveys returned were: The home does well with its caring and helpfulness at all times. The care and attention I receive here is second to none and I am very happy. Whilst we were at the home we also spoke with a visiting Rapid Response Nurse who told us that the people they admitted to the home were always very well looked after. We looked at the how the medicines are managed. We looked at how medicines, including controlled drugs, were ordered, stored and recorded. The registered nurses are responsible for managing the medicines. The medicine room was kept locked and the medication keys were held securely. Residents have their own individual medicine cupboard located in their bedroom. What we did see however was that lots of medications were left on top of the cupboards in the bedrooms. The manager told us that this was because the individual cupboards were not big enough. It is unsafe practice to leave medications unlocked. This could put the residents at risk of harm. The manager informed us that she would look at a safer system of storing these medications. The way that medicines were recorded when given was satisfactory. We did see however that staff do not always record the amount of medications that have been brought into the home, particularly the residents who are admitted under the Rapid Response system. It is important to do this so that medicines can be fully accounted for to prevent any mishandling. We saw that controlled drugs were being stored and administered correctly and safely although the controlled drug cupboard was small and very cramped. We advised the manager to consider using the outer cupboard for controlled drugs but then confirmed that no other drugs but controlled ones could be stored in this bigger outer cupboard. We also noted that as well as having the computer prescription and administration records from the pharmacist, the staff were also keeping a handwritten record of the medications that the residents were on. This list was not always being kept up to date and we asked why this list was Care Homes for Older People Page 14 of 28 Evidence: necessary. We were told that it was an easy point of reference. If that is the reason, and it is not something that we would recommend, then it needs to be kept up to date. Throughout the day we saw that the staff spoke to the residents in a very friendly and respectful way. They knocked on bedroom, toilet and bathroom doors before entering and responded to the residents needs in a very dignified way. The residents looked clean and comfortable, were suitably dressed and looked well cared for. Staff confirmed that the importance of ensuring privacy, respect and dignity is part of their initial training. 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. The residents are supported and encouraged by staff to make choices about what they do, so that they can find enjoyment and satisfaction in their daily life and with the activities available to them. The residents are given a choice of well-balanced and nutritional meals. Evidence: The residents routines of daily living, and their social interests are recorded in their care plans. The home has an activities organiser who works 4 afternoons a week between the hours of 2-4pm. Various activities such as bingo and board games are undertaken. Whilst we were there we saw that the residents were having a game of bingo in the lounge. Some of the residents responded in the surveys by stating that there are always activities going on that they can take part in. In the AQAA document we were told that the activities person also arranges in house entertainment and visits from outside entertainers. The hairdresser visits weekly and was there during the inspection day. The AQAA document sent to us stated that all the residents were of the Christian Faith. Staff told us that clergy visit by request. A visitor confirmed that there were no unreasonable restrictions to him visiting at the home and he was always made welcome. Care Homes for Older People Page 16 of 28 Evidence: At lunchtime some of the residents were seated in the dining room and some were sitting in the lounge or were having their meals in their rooms. The tables were very nicely set with tablecloths and napkins. We were concerned to see however, that the residents who were served their meals in their rooms or in the lounges, were served all their meal at the same time on the tray. Serving everything together could result in food going cold before the resident is ready to eat it. It can also be overfacing for them. The meals were home made, looked appetising and the portions were good. The residents told us that the food was very good indeed. The menus showed that there was always a choice of main meal and dessert at every meal time. Fresh fruit and jugs of water were available in the lounges for the residents to help themselves. 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. There are systems in place to ensure that people know how to and to whom they can complain. Staff have a good knowledge and understanding of what abuse is and know what to do if it happens. This helps reduce the possible risk of harm to the residents. Evidence: A notice is displayed in the reception area explaining to people how and to whom they can complain, and how their complaint will be dealt with. It is easy to understand and tells people that complaints will be looked into and a full written response will be given within 28 working days. We saw that a record is kept of any complaint made and includes details of the investigation and any action that the management may have taken to put things right. 1 complaint has been made to us in the last 12 months. We feel that this was handled properly by the home and we know that the complainant was satisfied with the outcome. We spoke to some of the staff and asked them to tell us what they would do if they felt that a resident had been mistreated or abused in anyway. They were very aware of what to do and how to report it. They told us that they had been trained so that they could, as far as possible, protect the residents from harm. We saw evidence of this training in their training files. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in suitably adapted, clean, safe and pleasant surroundings. Evidence: The home is a large detached and extended property with a large garden to the rear. Accommodation is provided on two floors and can be reached either by a lift or stairs. Downstairs there is a large lounge to the front of the home and a newly built lounge and dining room. In addition there is also a conservatory. These rooms were warm, clean, nicley decorated and comfortably furnished. There are enough toilets and bathrooms to meet the needs of the residents. Toilets are close by to bedrooms and lounge areas and they have aids and adaptations to assist the residents to use them safely. The bathrooms and toilets have an overiding lock on the door to ensure privacy and safety. All but one of the bedrooms have ensuite toilet facilities. Some of the toilets and bathrooms were without a call bell lead. To summon assistance, both by staff and residents, these must be in place. In one of the bathrooms we saw lots of communal toiletries such as sponges and razors, Sharing these type of toiletries can result in the spread of infection so the manager was advised to remove them. We looked at all the bedrooms. They were clean, warm and decorated and furnished to a good standard. They had an overiding door lock for privacy and safety and each Care Homes for Older People Page 19 of 28 Evidence: room had a lockable space for the resident to store anything that was of value or importance to them. The heating system within the home was good. All the rooms were centrally heated with radiators that were suitably protected. Thermostatic control valves were in place on immersion baths and showers. Whilst we were in the home was saw that the plumber was present and servicing the control valves. The home was clean and there were no unpleasant smells. Disposable hand washing equipment (liquid soap and paper towels) was in place in bathrooms, toilets and bedrooms and disposable gloves and aprons were provided for the staff to wear. Providing this equipment helps to reduce the spread of infection and therefore helps to protect the residents health and wellbeing. 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. The residents are cared for by staff that are suitably trained and safely recruited. This helps to keep them as safe as possible. Evidence: A check of the duty rotas and inspection of the training files showed that there was enough suitably trained staff on duty throughout the day and night to care for the residents presently residing in the home. Staff did tell us however in the surveys that were returned to us, that at times, especially when occupancy is high or there a lot of admissions through the Rapid Response system, that care can be affected due to low staffing levels. It was noted also that the manager had no supernumerary hours and was always the designated nurse on duty. During the inspection we saw that she was regularly called away from her nursing duities to speak with visiting relatives, the rapid response nurse and to undertake a review of a residents care with a social worker. She was extremely busy throughout the day. The manager should be given some supernumerary hours so that she is able to take responsibility for fulfilling her managerial duties. Some of these duties include direct supervision of staff and the checking of services and practices within the home. Inspection of the proposed quality assurance document that was to be used showed that this was not being undertaken. Staff did mention in the surveys that the manager is working many hours to cover shifts when nurses are on leave and that she has little time left for managerial duties. Care Homes for Older People Page 21 of 28 Evidence: The residents told us in the survey forms returned that the staff looked after them well and that they listen and act on what they say. They told us that the staff are always cheerful and helpful. The information that we looked at in the training files and the information given to us in the AQAA document showed that almost 100 of the staff had obtained their NVQ level 2 or above in care. This is an excellent achievement. We looked at how management recruit their staff. The personnel files of 2 staff members were inspected. All were in order and these staff had been properly and safely employed. This helps protect residents from being cared for by unsuitable people. The information received from the AQAA form showed that management provide a staff induction programme for all newly employed staff. We also saw that lots of training has been provided for the staff. This is to make sure that they understand what is expected of them and that people are cared for safely and properly. The staff that we spoke to told us that the training was good and that they get paid for attending training sesssions. 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 safe and well maintained. The manager however does not receive enough supernumerary hours to fulfil her managerial duties. Evidence: The Registered Manager is a registered nurse with many years of experience in the NHS and in the private sector. She has been the manager of the home for several years and holds a management qualification. There was evidence to show that she has undertaken periodic training to update her knowledge, skills and competence. Staff told us in the surveys that the manager was very approachable and knowledgeable. A quality assurance system that the management want to use was in place, however we saw no evidence that any audits/checks on services or facilities had been undertaken. A quality assurance system is about checking on the quality of the care and services that are being provided. The manager told us that she had undertaken an audit of the medicine system but the information could not be found. We were also Care Homes for Older People Page 23 of 28 Evidence: told that survey forms are sent to residents and relatives asking for their views on the care and services provided. We saw no evidence of any results. There had also been no recent documentation about any relative meetings that may have been held. It is the responsibility of management to ensure that a quality assurance system is in place. The manager should have some supernumerary hours so that she can fulfil her managerial duties, one of which is to ensure that there is a quality assurance system. Management do not take responsibility for the residents personal allowances. The responsibility lies with the resident or their family. Management invoice the family for any expenditure incurred, such as hairdressing, chiropody etc. The home had a detailed Health and Safety Policy. We saw that regular weekly checking and testing of the fire detection system, fire exits and emergency lights was undertaken and documented. The fire risk assessment was also up to date. We looked at the accident book and saw that any accidents that happen are properly recorded and monitored. The information taken from the AQAA showed that the equipment and services within the home were serviced on a regular basis. We did a random check of some certificates and saw that the 5 year electrical certificate, the nurse call bell system, gas safety and small electical appliances had been regularly serviced. This helps keep the home safe. 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 9 13 Medicines must be stored safely and securely. Medicines must be stored safely to make sure that they can not be mishandled and put peoples health at risk. 01/03/2010 2 9 13 Effective arrangements must 01/03/2010 be put in place at the home to ensure that all medication records regarding receipt of medicines are completed accurately. So that medicines can be fully accounted for to prevent mishandling. 3 21 23 Call bell leads need to be fitted to all bathrooms and toilets. So that assistance can be easily summoned . 01/03/2010 Care Homes for Older People Page 26 of 28 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 4 33 24 Effective quality assurance 30/04/2010 and quality monitoring systems need to be in place. So that the quality of the care and services provided can be regularly checked on and improvements made if deemed necessary. 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 15 The system for serving the residents with all their meal at once should be changed so that each course is served individually. This should ensure that their meal is unhurried and does not get cold. To reduce the risk of spreading infections, communal toiletries should be removed from bathrooms and toilets. Serious consideration should be given to providing the manager with some supernumerary hours so that she can fulfil her managerial responsibilities. 2 3 26 31 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. 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. 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