Care Home: Allison House

What the care home does well Allison House provides people that use the service with a warm, friendly and comfortable environment. The home has a welcoming atmosphere and visitors are made to feel welcome at any time. The home is single storey, with a number of lounge areas that are easily accessible for people who use the service. The design/lay out of the home gives people that use the service plenty of space to mobilise. The home ensures that a robust recruitment procedure is followed . Eighty seven percent of care staff working at the home have achieved a minimum qualification of NVQ level 2 in Care or equivalent. People who use the service are well looked after. Comments made by relatives of people who use the service included, "The first priority is always the resident" "The care is excellent I couldn`t ask for better" "On the whole we love Allison House. We have a good rapport with the carers, nurses, cleaners and management" "Staff are always very friendly and approachable and there if you need them" What has improved since the last inspection? Since last inspection of Allison House activities taking place and outings have improved. The Manager plans activities, outings and entertainment for the month ahead. People that use the service have been enjoying afternoon tea at the home with china crockery, trips to the local pub and Teeside Park for shopping. Singers are booked to come into the home on a monthly basis to entertain people that use the service. Improvements have been made to the homes environment. Two lounge areas have been redecorated, fitted with new fire places and one of which has benefitted from a new large screen television. The home`s induction training for staff has been developed to ensure that it includes all of the required elements and ensure that staff are well trained to meet the needs of people who use the service. What the care home could do better: Care plans of people that use the service were inconsistent. Some were better than others and contained detailed information about the person and the help that they needed whilst others only contained basic information. Care plans should be developed to include what the person can do for themselves, assistance needed, likes, dislikes, evidence of personal choice and preferences. This will help to promote independance, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. Risk assessments in relation to bed rails need to be updated to include all of the required information in relation to safe fitting, assessing suitabilityand ongoing maintenance as detailed in the MHRA device bulletin on "Safe use of bed rails" The Manager should ensure that staff who are responsible for administering medication have their competency checked on a regular basis to ensure that they are following safe practice. The amount of medication administered to people who use the service should be documented to inform how much medication the person has had and enable auditing. The homes fire alarm system is not being tested on a regular basis to ensure that it is in good working order and as such does not help to ensure fire safety. Staff working at the home need to attend fire training more often as reccomended by Cleveland Fire Authority. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Allison House Fudan Way, Teesdale Thornaby Stockton-on-Tees TS17 6EN     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: Katherine Acheson     Date: 0 6 0 5 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 28 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 28 Information about the care home Name of care home: Address: Allison House Fudan Way, Teesdale Thornaby Stockton-on-Tees TS17 6EN 01642-675983 01642675985 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) : Cleveland Alzheimers Residential Centre care home 38 Number of places (if applicable): Under 65 Over 65 38 dementia Additional conditions: 0 A maximum of 8 places can be used for people with dementia aged 50 . Date of last inspection Brief description of the care home Allison House is a modern, purpose built facility that is registered to provide personal and nursing care to thirty-eight older people with dementia. The home is single storey and is divided into two units, Aspen and Willow. Each unit has a number of lounge areas and a dining room. There is also an activities room. Bedrooms in the home environment are single in nature and meet the required amount of space. Bedrooms do not have en-suite facilities. Externally there are surrounding grounds and a pleasant enclosed garden/seating area for people who use the service. Car parking is available at the home. The home is on a bus route and close to Stockton town centre Care Homes for Older People Page 4 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 Quality rating for this service is two star. This means that people who use the service experience good quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous inspections reports may have been deleted or carried forward into this report as reccommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. This unannounced key inspection took place on the 6th May 2009 and lasted for almost eight hours. Care Homes for Older People Page 5 of 28 The Manager completed and returned an Annual Quality Assurance Assessment, (AQAA). The AQAA is the services self assessment of how they think they are meeting national minimum standards. This information was received before the inspection and was used as part of the inspection process. The reason for the inspection was to see how good a job the home does in meeting the national minimum standards set by the Government for care homes. Numerous records were examined including care records of people living at the home, medication records, risk assessments, complaints and staff records. It was not possible to have indepth discussion with people that use the service due to their dementia, however brief chats did take place. Some relatives visiting the home on the day of the inspection were spoken to and expressed their views. Staff working at the home were also spoken to. Before the inspection surveys for people that use the service and surveys for staff were sent out to the home for the Manager to distribute accordingly. Surveys sent to people that use the service were asked to comment on care received. Surveys sent to staff were asked to comment on what it was like working at the home and training. We received eight surveys from people that use the service, relatives had helped to complete the surveys. We received five surveys from staff. Comments in surveys received can be read in the main body of the report. The cost of care at the time of the inspection visit was five hundred and fifty two pounds and thirty pence a week. What the care home does well: What has improved since the last inspection? What they could do better: Care plans of people that use the service were inconsistent. Some were better than others and contained detailed information about the person and the help that they needed whilst others only contained basic information. Care plans should be developed to include what the person can do for themselves, assistance needed, likes, dislikes, evidence of personal choice and preferences. This will help to promote independance, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. Risk assessments in relation to bed rails need to be updated to include all of the required information in relation to safe fitting, assessing suitability Care Homes for Older People Page 7 of 28 and ongoing maintenance as detailed in the MHRA device bulletin on Safe use of bed rails The Manager should ensure that staff who are responsible for administering medication have their competency checked on a regular basis to ensure that they are following safe practice. The amount of medication administered to people who use the service should be documented to inform how much medication the person has had and enable auditing. The homes fire alarm system is not being tested on a regular basis to ensure that it is in good working order and as such does not help to ensure fire safety. Staff working at the home need to attend fire training more often as reccomended by Cleveland Fire Authority. 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 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 9 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. Assessments of people who are to use the service are carried out before they move into the home to ensure all needs can be met. Evidence: Before going into Allison House people who are to use the service are assessed by a Social Worker or Health Care Professional. This assessment is forwarded to the home for the Manager to look at to determine if the needs of the person can be met. Once this assessment has been reviewed the Manager said that she visits the person at home or in hospital to introduce herself, answer any questions about the home and carry out a further assessment on the person. People who are to use the service and their relatives are welcome to visit the home, have a look round and meet the staff. Care Homes for Older People Page 10 of 28 Evidence: Comments made by relatives of people who use the service,said that they received enough information about the home before they moved in. One survey received stated, Did a lot of homework, visiting at different times, talking to the residents families and particularly taking notice of how many and where carers were in relation to residents and their attitude toward residents. I still take notice and I am not disappointed. The home does not provide intermediate care. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are well looked after. Some care plans for people who use the service are insufficiently detailed and as such does not help to ensure that the health and personal care that people receive is based on their individual needs and preferences. Evidence: The care files of three people were looked at during the visit. Files contained a detailed assessment of needs for the person, evidence of nutritional screening and moving and handling assessments. Following assessment of the person, plans of care are developed. Plans of care examined during the inspection were inconsistent. The plan of care for one person contained good detail about what they could do for themselves and the help that they needed whilst another contained basic information. An example of this was the person had a care plan for washing and dressing. The plan of care stated, Two staff to attend to hygiene, explain what will happen. The other care file looked at during the visit contained a core care plan. A core care plan is a pre-printed plan of care for a specific problem or need. Core Care plans contain basic Care Homes for Older People Page 12 of 28 Evidence: instructions/guidance on how to assist with the need, and are intended to be added to, to include personal preference and choice. One core care plan looked at during the visit was that of a person who needed help whilst attending to hygiene and stated, On rising from bed wash and dry, use preferred toiletries and keep relatives informed of toiletry shortages. A discussion took place with the Manager regarding care planning and the need for care plans to state what the person can do for themselves and help needed. Care plans should include evidence of likes, dislikes. personal choice and preferences. People who use the service looked well cared for and staff whilst attending to people showed respect in their actions and in the way they spoke. Care files contained evidence that staff at the home had carried out risk assessments to help to ensure the safety of the person. One file looked at during the visit was that of a person that needed bed rails to ensure their safety. This person had a risk assessment on file, however this was insufficiently detailed and did not include evidence that a multidisciplinary team including relatives had been involved in discussion to determine that bed rails were the safest option. The Manager advised that she would look at guidance issued in respect of bed rails and update risk assessments as a matter of urgency. There is clear evidence of the involvement of GPs, District Nurses and other healthcare professionals such as chiropodists. Relatives of people living at the home confirmed that if they were feeling unwell, the GP would be called. People spoken to during the visit and surveys received were complimentary about life in the home and care received. Comments made included, The staff are absolutely fantastic. They take wonderful care of my husband. You only have to ask once and they are there. I cant praise them highly enough The staff are lovely and friendly and the care is great I cant praise the staff enough for the care and attention given to residents, often during trying times, it cant be easy It is not possible to work to hard and fast rules one hundred percent of the time, but this critical path should always point to the welfare of residents and from my observations I truly believe that this is the case. I would like to thank one and all During the inspection arrangements for receiving, storing, administering, recording Care Homes for Older People Page 13 of 28 Evidence: and disposing of medication were observed and examined. In general record keeping was good and medicines were appropriately stored. Staff were recording and using appropriate codes if medication was not given for a particular reason. Examination of records at this inspection highlighted that some people were prescribed medication which could be one or two tablets depending on what was required. Staff sign when they have given the medication, however do not document how many tablets they have given. The amount of medication administered given should be documented to to inform of how much medication the person has had and enable auditing. The Manager said that it is the responsibility of nurses working at the home to give out medication. She said that she had just contacted the homes supplying pharmacy to arrange some medication training updates. A discussion also took place regarding the need to carry out competency checks on nurses at regular intervals to make sure that they are following safe practice. Care Homes for Older People Page 14 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. Appropriate and enjoyable activities do take place. Food provided is varied and enjoyed by people who use the service and as such promotes wellbeing. Evidence: The Manager said that activities, outings and entertainment are planned a month in advance. She said that three of the care staff who work at the home who are responsible for carrying out the activities on a day to day basis. Activities taking place on a daily basis include, sing a longs, baking, and watching and listening to the homes portable sensory lighting and music machine. On the day of the inspection visit, staff, relatives and people who use the service were celebrating the birthday of a person who uses the service. A singer had been organised to come into the home and entertain. Everyone was observed to be enjoying the afternoon of entertainment with some people joining in the singing and eating birthday cake. The Manager said that she has tried hard to improve activities for people that use the service. On the day of the inspection a good sized plastic green house was being put up in the homes enclosed garden area. Two vegetable plots had been dug for a number of Care Homes for Older People Page 15 of 28 Evidence: people who use the service to take an interest and help with the growing of vegetables. The Manager said that two people who use the service had been to Strikes Garden Centre for an evening event of Gardening for the older generation. The homes AQAA states that, We have received a silver gilt from Northumbria in Bloom Summer 2008. Some of the men at the home like to go to the local pub for a pint and a sandwich, whilst others have enjoyed trips out in the homes minibus to Teeside Park. Both staff and relatives accompany people on trips out. The Manager said that the home regularly has afternoon teas. She said that people that use the service like to sit round nicely set tables eating sandwiches and cakes that have been bough from Marks and Spencers and drinking tea from china cups. The Manager said that those people who want to are supported and encouraged to practice their religion. The Manager said that the home benefits from regular visits from the Priest and Special Ministers of the Roman Catholic church. One relative spoken to on the day of the visit said, My mum really enjoys receiving a blessing. She is still able to understand and join her hands in prayer. People that use the service were unable to comment on the activities and outings planned by the home due to their dementia, however relatives spoken to and surveys received made the following comments, The staff at Allison House try very hard with activities. The Bonfire night party was enjoyed by all and when I came in on Valentines day staff had helped her/him to make a valentines day card for me More one to one contact would/should be available. Activities are centred around hairdressing, nail care e.t.c., rarely around individual needs. Staff are not encouraged to take part and do not have enough time to do so. An employee trained specifically in this area would be beneficial The garden area is beautiful and in the nice weather we can all sit outside and enjoy the sun Familys and friends are made to feel welcome at any time. One relative spoken to during the visit said, I have got my life back on track as I have confidence in the care that they provide another said, I feel that I am a part of the family here and, I am always made to feel welcome. There is always a nice smile and a nice greeting. Care Homes for Older People Page 16 of 28 Evidence: The home has a two week menu plan that has two choices at each meal time. On the day of the inspection the lunchtime menu of the day was, liver casserole with carrots, peas and mashed potato or black bean spring roll, broccoli, potato grattan and peas. The lunchtime of people that use the service was observed. Lunchtime was generally relaxed with people enjoying the food provided. Those people who required assistance with feeding were being attended to, however it was observed that staff were stood up whilst feeding two people and as such not making meal time as pleasant as it could be. This was pointed out to the Manager at the time of the visit. The home had an unannounced visit from Environmental Health on the day of our inspection. The purpose of the visit from Environmental Health was to carry out their routine inspection of the homes kitchen. General discussion took place with the Inspector from Environmental Health at the end of his visit. The Inspector said that it had been a good inspection and that the kitchen was clean. Family and friends are able to have a meal at the home. Comments made in respect of the food provided included, The food is quite good. I have been invited to stay for meals and always enjoyed them I was invited to spend Christmas day with my husband. The dinner was absolutely beautiful with all the trimmings From what I have seen and smelt they are lovely. All home made and dad is happy plus homemade cakes and snacks at tea breaks Tea and cakes and sandwiches are always nice, Have never seen any of the main meals so cant comment Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are encouraged and supported to make any complaint they feel necessary. Adult protection procedures are in place which helps to protect people from abuse. Evidence: The home has a complaint procedure which informs people of who to contact and timescales for action. People spoken to during the inspection said that they would have no hesitation in approaching the Manager or any member of staff to raise any concern that they may have. The home have received four complaints in the last twelve months. The home has an adult protection procedure which informs staff of who to contact if abuse is suspected. The Manager said that staff receive adult protection training when they start working at the home and on a regular basis there after. 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 standard of the environment is good providing people that live there with an attractive, homely and comfortable place to live. Evidence: The home is a modern, purpose built facility that is registered to provide personal and nursing care to thirty eight people with dementia. The home is single storey and divided into two units, Aspen and Willow. Each unit has a number of lounge and a dining area. There is also an activities room. Bedrooms in the home are single, they do not have ensuite facilities, but they do have a sink. There is a beautiful enclosed garden area for people to use. The Inspector walked around the home with the Manager. Since last inspection corridor areas have been painted. The Manager said that corridors are soon to benefit from new carpets. Two lounge areas have been redecorated and both have had new fireplaces and one of which had a new large screen television. Some new chairs have been purchased for lounge areas. The Manager pointed out new signage in corridor areas that was printed in bold in either red or blue. Signage pointed to toilet areas. She said research had shown that using bold colours helped people with dementia and that the new signs had been very successful. She said that a number of people who use the service have been able to find the toilet areas more easily. Care Homes for Older People Page 19 of 28 Evidence: Bedrooms looked at on the day of the visit were personalised and contained appropriate furniture. The home has a beautiful enclosed garden area for people to use. There are lots of benches in the garden for people to sit and enjoy the large selection of plants and flowers that fill the garden borders. At the time of the inspection visit an area of the garden was being used to develop a sensory garden. On the day of the inspection the home was clean and tidy. Appropriate laundry facilities were in place. 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 homes recruitment procedure is good, which helps to ensure that people are protected. Mandatory training and other training relevant to the job staff do is provided ensuring that staff are knowledgeable and experienced to meet the needs of people using the service. Evidence: Duty rotas looked at during the visit informed that Aspen unit, which accommodates up to eighteen people, but had an occupancy of seventeen on the day of the inspection had four care staff on duty on a morning, afternoon and evening. Willow unit which can accommodate twenty people and was fully occupied at the time of the visit had six staff on duty on a morning and seven on an afternoon and evening, however two of the staff were allocated to people who use the service and require one to one. To cover both units there are two nurses on duty in a morning and afternoon and from 4pm there is one nurse on duty. The Manager of the home who is also a nurse works five days a week two to three of which are supernumerary. On night duty there is one nurse on duty and three care staff to cover both units. Duty rotas looked at showed that at times there was a large number of agency care Care Homes for Older People Page 21 of 28 Evidence: staff being used. The Manager said that at the present time the home were struggling to cover the duty rota with staff that were employed by the home due to sickness and other reasons. She said that she was using the same agency to cover the duty rota and as such the agency were providing her with the same care staff to ensure continuity. Eighty seven percent of care staff working at the home have achieved a minimum qualification of NVQ level 2 in care. Records were available to confirm that good recruitment procedures are followed. Three files of staff working at the home were examined. Appropriate references were on file as was evidence of Criminal Record Bureau checks. Records were available to confirm that staff working at the home receive induction training. Staff files examined during the visit contained certificates to confirm that staff had recently attended training in Moving and handling, fire, dementia and adult protection. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the interest of people that use the service. The fire alarm system is not tested as often as it should be and as such does not help to to ensure fire safety. Evidence: The Manager is both experienced and qualified. The Manager is a Registered Psychiatric Nurse who has achieved a management qualification. The Manager has attended lots of training during the last twelve month to develop her skills and to keep herself up to date. The home is well run with a Manager who communicates and demonstrates a clear sense of leadership. Comments made in respect of the Manager included, This home is extremely well run. The Manager is always there to talk to and, The Manager is wonderful and so approachable. We know any issues, that are issues to us that we can talk to her and she will sort it out. You cannot ask for a better Manager. Care Homes for Older People Page 23 of 28 Evidence: Appropriate quality assurance monitoring systems are in place. Surveys are sent out to relatives on a yearly basis to make sure that they are happy with the home and the care that is receive. Regular meetings are held for people who use the service and their relatives. The Manager said that people that use the service are not able to manager their own finances due to their dementia. Those people who want a small amount of change in their pocket, wallet or purse do so. The home does not handle personal allowance for people that use the service, relatives, representatives or Social Services maintain control. A sample of health and safety records were examined. Records were available to confirm that the homes fire extinguishers, hard wiring and gas boilers had been serviced in the last twelve months. Records were available to confirm that weekly testing of water temperatures is carried out to ensure that water is a safe temperature to use. The last inspection of the service highlighted the need for weekly testing of the fire alarm system to ensure that this was in good working order. Records examined during the visit showed that weekly testing of the fire alarm system was not happening and that the last actual test of the fire alarm system was 6th April 2009. Cleveland Fire Authority had visited the home in January 2009 and highlighted a number of areas that needed to be addressed. One area being the need for staff at the home to receive more fire training than they have been receiving. The Fire Authority have recommended that day staff receive fire training every six months and that night staff receive fire training every three months. Some other areas in relation to fire safety were also highlighted as needing improvement. The Fire Authority have said that they plan to make a return visit on or after the 1st of June 2009 Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 38 23 The Registered Person must 09/05/2007 ensure that testing of the fire alarm system is carried out on a regular basis 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 38 23 The Registered Person must give consideration to the recommendations made by Cleveland Fire Authority following their visit on 14th January 2009 and take the appropriate action. To ensure safety 01/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should be developed to include what the person can do for themselves, assistance needed, likes, dislikes, evidence of personal choice and preferences. This will help to promote Independence, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. The Manager should ensure that risk assessments in relation to bed rails are updated to include all of the required information in relation to safe fitting, assessing suitability and ongoing maintenance as detailed in the MHRA device bulletin on Safe use of bed rails The Manager should ensure that staff who are responsible Page 26 of 28 2 7 3 9 Care Homes for Older People for administering medication have their competency checked on a regular basis to ensure that they are following safe practice. 4 9 The amount of medication administered to people who use the service should be documented to inform how much medication the person has had and enable auditing. Care Homes for Older People Page 27 of 28 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. 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