Care Home: Alexandra Lodge

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What the care home does well The service users are provided with a homely and clean environment that meets with their needs accessible to the gardens. The meals at the home are well managed and the service users say meet with their satisfaction. There is a varied activity programme including the gardening club that people say they enjoyed. The recruitment process is good and ensures that the service users are protected. There is a good process in place for the management of the service users personal allowance. What has improved since the last inspection? The programme of refurbishment and upgrade of equipment continues to ensure that the home is well maintained and appropriate to the needs of people using the service. Regular staff supervision has been developed and put in place. The home undertakes regular meetings with the service users as part of their reviews. What the care home could do better: The records of assessments and care plans are inadequate to meet the needs of the service users. Detailed care plans must be developed for all the service users to show how the home plans to meet their needs. Arrangements must be in place to ensure that the staff maintain accurate records of food and fluids as required. The registered person must ensure that that the service users receive their prescribed medication. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alexandra Lodge Wyllie Road Hilsea Portsmouth Hampshire PO2 9NA     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: Anita Tengnah     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 31 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 31 Information about the care home Name of care home: Address: Alexandra Lodge Wyllie Road Hilsea Portsmouth Hampshire PO2 9NA 02392660551 02392651046 deidre.mills@portsmouthcc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Portsmouth City Council Name of registered manager (if applicable) Mr Christopher James Aldous Type of registration: Number of places registered: 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 to be accommodated is 50 The registered person may provide the following category/ies of service only: Care home only - (PC) to service users 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 (OP). Date of last inspection Brief description of the care home Alexandra Lodge is a purpose built residential home accomodating older persons,situated in a residential area of Portsmouth.The home is owned and run by Portsmouth City Council Social Services Department.The accomodation is arranged into four living units each with its own lounge /diner,with a kitchen area,bedrooms ,bathrooms and toilets.There is a shaft lift to the upper floor. Care Homes for Older People Page 4 of 31 care home 50 Over 65 50 0 Care Homes for Older People Page 5 of 31 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: An unannounced inspection visit was carried out on the 28th April 2009. The visit was carried out over one day and lasted for six and a half hours. As part of our inspection process we sent out the Annual Quality Assurance Assessment (AQAA). This gives us information about the service and was completed and returned to us. The AQAA provided us with good information about the future developments that are planned for the service. During our visit we looked around the building and spoke to five service users and staff. We also looked at care and staff records and we observed the staff practices. The manager assisted us with the visit. We used information that we have received from the AQAA. We sent out service users surveys to the service, we have received Care Homes for Older People Page 6 of 31 ten service users and six staff returned surveys at the time of writing this report. The comments we have received were positive regarding the care that people were receiving. These will be reflected in the body of the report as appropriate. 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.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 8 of 31 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 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission assessment process was not consistent. Further development is needed to ensure that all prospective service users needs are assessed prior to moving into the home. The home does not provide intermediate care. Evidence: We looked at the pre admission assessments for two recently admitted service users at the time of the visit. The manager reported that the service users are offered an opportunity to visit the home and a senior staff carries out an assessment prior to people moving into the service. Other information the home provided them with a statement of purpose and the service users guide. A care management assessment is also sought as part of information gathering and informs the assessment. Comments from the service users regarding information received prior to moving into the service, Care Homes for Older People Page 10 of 31 Evidence: five said yes and three said no. All say that they had received a contract on moving into the service. One person commented I was in hospital and this was where I was placed. I came in for respite care two years before becoming resident and very impressed with the care. Another comment was that information was received when they moved in as this was in the wardrobe. The two records we looked at showed that the pre admission process was not consistent with the homes policy and procedures for admission. One record contained a pre admission assessment and a care managers assessment . The manager reported that this person was on a transition bed and was requiring minimal support for maintaining his personal care needs. A care managers assessment was also available in the records seen for this person. The other service users told us that they had visited the home the previous day and was transferred into the service the following day from another care home. We were unable to see any assessment record that the home had completed as these could not be located. A care managers assessment completed in December 08 was in place. The registered person must ensure that there is a robust process inn place that the service users needs are assessed prior to providing care. The prospective service users should be issued with written confirmation that following assessment the home is able to meet their needs. The manager reported that the home provides respite care to some service users. The home does not provide intermediate care. The AQAA states that the service has a transitional Bed that admits service users from Hospital up to four weeks. Care Homes for Older People Page 11 of 31 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 care plans and records of care given are inadequate and must be further developed to protect the service users and to ensure that their assessed needs are met. There is a good process in place to ensure that the service users are supported and receive the support of healthcare professionals as required. The medication management is satisfactory. Further development for people who are self medicating is needed to ensure that this is managed safely. The service users are treated with respect and had positive comments about the way that they are treated. Evidence: We looked at the care records of four service users as part of this visit to assess the process that the service has in place to meet the needs of the service users. Two of Care Homes for Older People Page 12 of 31 Evidence: the records contained risk assessments such as pressure risks, nutritional assessments, moving and handling and continence. These assessments were detailed and care plans gave information such as how many carers would be needed to transfer them and provide assistance with personal care. One of these service users was nursed in bed and required regular turning and their food and fluid balance monitored. Pressure relieving equipment was available and some of the service users had been provided with specialist beds as part of managing their pressure risks. We observed that one person had been assessed as high risk following their nutritional screening assessment. Staff reported that they were receiving fortified drinks, the fluids and food charts that we looked at showed that there were gaps of twelve to eighteen hours where they had not received any food. We found that the staff did not maintain record of the service users weights as required. The senior staff said that all the service users must have their weights monitored at least monthly. However the charts we looked at were blank. The staff reported that this person was receiving regular care and that the carers had not maintained the records as required. However there were no other records available to demonstrate that this person was receiving adequate nutrition. This was brought to the attention of the manager as action was required. We looked at the other two new service users care records and found that these were inadequate and there were no care plans in place to demonstrate what support they required in order for the staff to meet their needs. The manager reported that the senior carer had told him that care plans had been developed for one of them, however this could not be located at the time of the visit. The registered person must ensure that care plans are developed and the staff have adequate information to meet the assessed needs of the service users. We looked at the records of care that people were receiving and found that these were inadequate. This is particularly important for people who were nursed in bed and depended on the staff for support to meet all their care needs. The manager reported that these would be developed and put in place. The lack of detailed records of care impinge on the quality of care and does not provide staff with the right information about the service users current state . There are also risks of lack of continuity of care to the detriment of the service users. The service users were supported to access external health care services as required. Care Homes for Older People Page 13 of 31 Evidence: All the service users were registered with the local doctors surgeries and staff said that the local trust was supportive and they could access care for the service users as required. We found that the district nurses were supporting and treating one of the service users requiring dressings to pressure ulcers and wound care plans were available. Pressure relieving mattresses were in place according to the assessed needs of people. We looked at the medication management that the home undertook on behalf of the service users. All medications were stored securely. The staff reported that they were using the blister pack system that runs over a twenty -eight day cycle and that this worked well. A random sample of creams and ointments seen and in the service users bedrooms confirmed that these were dispensed to the people as prescribed. Detailed records of medication received and returned to the pharmacy were maintained. The staff reported that they regularly audited the medicines to ensure that they only order amount that was required. Two of the service users were administering their Insulin and these were maintained securely. There was no risk assessment in relation to these two service users administering their Insulin and must be developed to ensure that this is managed safely. A sample of the MAR charts records showed that staff maintained accurate records of medication administered. The staff reported that a separate record was maintained of creams and ointments applied. We did not view this record during this visit. The service has a system in place where the staff check the MAR charts at each handover, any anomaly can be rectified quickly and safeguard people. Medications at the service were maintained safely and securely and this included controlled medication. Record of prescriptions for fortified drinks must also be maintained on the MAR charts as these were not available. Two staff signatures for any medication that is handwritten on the MAR charts should be adopted as good practice. We were concerned about one of the service users who had not received their medication for a month and no action had been taken. This was brought to the attention of the manager at the time of the visit. We issued the service with an immediate requirement notice as urgent action was Care Homes for Older People Page 14 of 31 Evidence: required regarding the medication management for one of the service users. The manager responded positively and immediate action was taken and a GP referral made at the time of the visit. The manager has since written to us to confirm the action that had been taken to ensure that care is provided appropriately and their needs are met. Procedure for the management of as required medication was not available and must be developed to inform staff practices and ensuring that this is managed safely. Comment that we received from the staff included Although as staff we are trained how important it is to report and record. Not all shifts record in the client contact, and in handover if you have recorded something on your previous duty of importance. Comments from the service users included happy with the support and the staff are very nice. Carers are very good. Care staff are always ready to listen. One comment was would like a bath more often. We observed that the staff interacted well with the service users and care was provided in a sensitive manner when staff were observed assisting people in the lounge. Care Homes for Older People Page 15 of 31 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 is a varied activity programme in place, the development of a designated activity coordinator would ensure that this is better managed and to the satisfaction of the service users. The service users are supported well in maintaining contacts with their family and friends. The meals are well managed, offering choice and variety and meet with the satisfaction of the service users. Evidence: The home has a planned programme of activities for the welfare of the service users. On the day of the visit we observed a church service was taking place in one of the lounges and sixteen service users attended. The service users we spoke to said that this occurred weekly and was always well attended. Another service user was seen in the garden during the morning tending to some new plants. This is a voluntary service that Where two gardeners came in at least once a Care Homes for Older People Page 16 of 31 Evidence: week and spent time with the service users tending to vegetables and flowers. This was an invaluable service that these people provided on a voluntary basis, as there was no fund at present . The service user we spoke to said that they very much enjoyed getting out in the garden and tending to the plants in particular the flowers. The AQAA states that the service aims to promote their gardening club for the service users to attend. The service has a summer house that the manager was planning to have staff supporting the service users and encouraging them to make more use of during the summer. On the day of the visit another service user went out to a day care centre. The manager reported that this was an area that the home was looking at further developing and maintaining links with an ethnic minority group. We also observed an animated painting/ art group that took place on a regular basis and people we spoke to were highly complimentary about the facility and passionate about the skills that they had developed. Comments included: I did not know I could do this. We all enjoy meeting up and we are not bad at this. The staff reported that the activity coordinator has been taken off and was at the time supporting the senior staff in the office. Comments included: This could be more be improved if someone was employed just to provide this service. Staff would not feel they should be carrying out other daily tasks instead of doing the activities. We know our colleagues are stressed with room buzzers needing to be answered. when they are providing activities. The home has an open visiting policy and we observed that people arrived at the home at different times of the day. There was a record of visitors as required that the home maintained, evidence from this supported the view that there was no restriction on visiting. We observed the lunchtime meal on the day of the visit and this corresponded with the menu. The meals looked well balanced, varied, freshly cooked and nicely presented. We spoke to seven people at lunchtime and they all said that the meals were very good and had no complaint. The service users were offered choices and staff stated that they went round and helped them with their choices from the menu. We saw that the staff had a list from which the meals were served at lunchtime from a hot trolley. Care Homes for Older People Page 17 of 31 Evidence: Comments about the food included: Food very good. There is always plenty to eat. You can have something else if you dont want what is on the menu. The puddings are very good. Meals very nice. Nice menu, nice food. One comment was sometimes when asked do you like the meals. Care Homes for Older People Page 18 of 31 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. The complaint process is satisfactory and people say that they would talk to the staff with their concerns. There is training for staff in safeguarding and procedures are in place to protect people. Evidence: We looked at the complaint log and the procedure available to people using the service. The complaint log showed that the service had received five complaints since the last inspection. There was also a number of compliments regarding the care that people had received. One of the complaints was referred as safeguarding and this has now been resolved. Record showed that the team made some recommendations that the home has followed and put in place. The complaint log seen did not contain accurate details of the investigation and outcome for three of the complaints as required. The manager reported that these were dealt with by the last manager who has since left the service. The manager is aware of records that need to be maintained and this would be developed for future concerns. There is a good recruitment process in place that ensures that necessary staff checks Care Homes for Older People Page 19 of 31 Evidence: are completed prior to employment in order to ensure that the service users are safeguarded from harm. The AQAA states that all staff receive training in adult protection, awareness and alertness. The service is planning to reassess the staff group in order that training in Adult protection is kept up to date. Care Homes for Older People Page 20 of 31 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 physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Infection control procedures were in place to ensure people are not put at risk of harm. Evidence: We looked at a number of the service users bedrooms, communal lounge, dining areas and bathrooms as part of this visit. The home offered the service users with a well maintained environment with evidence that there is an ongoing programme to ensure that the home is maintained in good order. We looked at some of the service users bedrooms that showed that these were highly personalised and the service users were supported to bring with them items of personal belongings. Comments received from the service users were complimentary about their accommodation and included: This is a very nice home All say that the home was always clean and fresh. Care Homes for Older People Page 21 of 31 Evidence: This is my room and I have all my things around me, its lovely. The AQAA states that as part of the ongoing refurbishment programme at the service, the lounges have now have DVD players and new dining room furniture have been replaced. The bedroom furniture has been replaced in some service users bedrooms. Two new lounge chairs, the bedroom doors have been upgraded with fire door release system.Emergency lighting has been upgraded within the home. There was one room that had some odour when we walked through the home and the manager was aware of this and taking action to resolve this. One of the communal bathrooms was found cluttered with equipment and the manager stated that this would be cleared in order to ensure it is homely and safe for the service users. The home has a laundry that was sen and found to be well equipped with industrial sized washing machines and driers. Protective equipment and hand washing facility was available to the staff. The staff spoken with reported that the carers did follow procedures for infection control and used different coded laundry bags as appropriate. The laundry was well managed and in good state of repair. An area that should be given consideration is the staff access to the back of the machines when changing the detergents and softeners. This is to ensure that this is carried out within a risk assessment framework and protect the staff from risk of injury, as this was a concern raised during the visit. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate staff to meet the current needs of the service users. There is a good recruitment and the training programme ensures that people are safe and staff are supported to provide care safely. Evidence: We looked at the duty roster that was in place and this showed that there were on average 6 carers on day duty and three carers on night duty. The senior management included the manager and two senior staff on day duty and a senior staff provided sleeping in cover on night duty. The service has a separate roster that included chef and kitchen assistants, domestic and laundry support and this ensured that care hours were not eroded by non care duties. We received six staff comments regarding the care that the service provided and the support that they received as part of their work. The staff were positive and those we spoke to said that this was a good place to work. Staff said that they felt usually there are enough staff to meet the individual needs of Care Homes for Older People Page 23 of 31 Evidence: the service users. The service users reported that the staff were very kind and they were treated with respect. They say that usually they did not have to wait long when they asked for assistance. Comments from the service users included: The staff are very good. You dont have to wait long and you can go and see them in the office. We asked the staff what they thought the service did well and the responses were: Provides very good care for residents. Provides good standard of care for service users. Other comments were : More staff on day duty could spend more quality time with the service users Some would benefit from more one to one sessions. Another staff commented that Given more staff the service could give more time to certain clients whose needs are greater than others. We noted that the staff and the service users interacted well at the time of the visit and they had developed good relationship with each other. We looked at the recruitment process that the home has in place and found that all prospective staff completed an application form and references were sought, as part of the recruitment. Other records included Criminal Record Bureau (CRB) and POVA first checks as required prior to employment. Staff requested CRB confirmation for those employed through an agency. This applied to a staff member from an agency who was working at the home at the time of the visit. Staff had positive comments about the induction programme that is in place. The manager reported that all staff complete the corporate induction programme on employment. The AQAA states that two staff have obtained NVQ level 2 in Care and a staff member obtained NVQ 3 in Care in the last twelve months. One staff commented Did not have induction 20 years ago as this did not happen, have many courses to attend though. There is an ongoing training programme and record of training seen included challenging behaviour,deprivation of liberty, diversity. Two moving and handling training had been completed recently. Care Homes for Older People Page 24 of 31 Evidence: The development of a training matrix would be beneficial in capturing all mandatory training and also would help in identify any gaps in mandatory training/ updates as required. Care Homes for Older People Page 25 of 31 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. There is a management structure in place that supports the day- to -day management of the service. The financial interests of the service users are protected through good system and accounting. There is an ongoing process for the servicing of equipments to ensure that they are safe. Evidence: The service has appointed a manager who has been at the home since January 09. The AAA states that the manager has twenty-one years experience in social care. He has NV 4 in social care has recently completed the Registered Manager Award RMA. The manager has submitted an application to register with the Commission as part of the fit person process as required and this was being processed at the time of this visit. Care Homes for Older People Page 26 of 31 Evidence: The service users and other people we spoke to were complimentary about the manager and one person commented You can go and see the manager any time and he will help. The service has in place an internal audit process that included two monthly staff and the service users meetings. Records of these were maintained at the service. Unannounced visits as required by Regulation was also carried out by a nominated person on behalf of the Responsible Individual. The manager reported that reports of these visits are sent to the service. The records seen showed that the last visit was completed in January 09. The manager reported that city council was looking at new arrangement to be in place for someone to take over this role. We looked at a sample of the personal allowance that the service was managing on behalf of the service users. We found that the administration assistant maintained good records that included receipts of all transactions. The money is held in individual bank account and the service users receive interest report that is added to their personal account. The city council also undertook regular audits of these accounts and the last audit was completed last week. The manager has developed a structured supervision programme for all the staff and records of these are maintained. This ensures that the staff are supervised as part of their practice and the manager stated that this also helps in identifying training needs. The manager keeps us informed and sends us reports of incidences that are to the detriment of the service users as required. Records of these were also maintained at the home. Information from the AQAA shows that there is an ongoing programme for the maintenance and servicing of equipment to ensure that these are safe. The gas appliances and the hoists were serviced in January 09. The record from the AQAA showed that the policies and procedures would benefit from regular reviews as some of these have not been updated in the past year. This would ensure that they are up to date and meet with current legislation. As reflected in previous section of this report the medication management and care planning were inadequate to support and protect the service users. Care Homes for Older People Page 27 of 31 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 31 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 3 14 The registered person must ensure that new service users are only admitted following a thorough assessment of their needs prior to providing care. So that the staff have the correct information and the home is able to meet the service users needs. 15/06/2009 2 7 15 The registered person must 30/06/2009 ensure that appropriate care plans are developed and put in place to demonstrate how the individual care needs will be met So that you can ensure that the service users receive the care according to their assessed needs 3 8 12 The registered person must 30/06/2009 ensure that accurate records of food and fluids are maintained. Care Homes for Older People Page 29 of 31 So that you can ensure that people are not put at risk of malnutrion and they receive the care as required. 4 9 15 The registered person must ensure that arrangements are in place for the safe management of the service users medication. So that they receive their medicines safely at all times. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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