Care Home: Amber House

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What the care home does well The staff team is cohesive, supportive, helpful and kind. People who use the service spoke well of staff team and expressed: "Pleasant staff." "They let me make all my own choices." "They listen" "Very caring." The home gathers good information about people`s personal care and health needs before they move in. This helps to assure people that the home is able to meet their needs. There are enough staff available in the home to meet people`s needs. People living at Amber House find the lifestyle they experience, matches their expectations and preferences and the staff spend time with them engaging in activities of their choice. This is in addition to the activities which are planned and implemented by the activities coordinator. People told us that they liked the meals provided by the home and we saw there was a good food supply and choices are available. Amber House offers the people who live there a safe, clean, homely and well maintained environment. What has improved since the last inspection? The home has met the requirements made at the last inspection and completed the improvement plan we asked for. This means better outcomes for the people who use the service. The home has introduced new person centred care plans which means they look at the needs of the people on an individual basis. The home has improved the outdoor facilities for people and have provided a summerhouse. Ongoing refurbishment is evident. Activities have improved , an activities coordinator visits twice weekly and the stimulation required for people is looked at on a one to one basis. What the care home could do better: We made the responsible individual aware of a number of areas in medication administration and recording which should be improved. We need assurance that everyone living at the home receives their medicines as prescribed. All staff need to receive suitable training in the protection of vulnerable adults to give them the knowledge and skills to keep people safe. The home needs policies and procedures on the Deprivation of Liberty Safe Guards, (DOLS). This means staff have clear information to establish whether the home needs to make an application to request a deprivation of liberty from the appropriate professionals. The home needs to publish their results following their quality assurance. This will show people what they do well, identify shortfalls in the service provided and offer a plan for any necessary improvement. Information within the home should be tailored to meet the needs of the people who live there. We recommend the home promotes pictorial and easy read literature. The home is run in the best interests of the people who use it but more written evidence would help to validate the managers statements. Key inspection report Care homes for older people Name: Address: Amber House 7/8 Needwood Street Burton On Trent Staffordshire DE14 2EN     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: Rachel Davis     Date: 1 5 0 7 2 0 0 9 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 31 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) 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. 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: Amber House 7/8 Needwood Street Burton On Trent Staffordshire DE14 2EN 01283562674 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: amberhousecare@aol.com Michael Shaw,Mrs Karen Marie Shaw care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care Home Only (Code 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) 18 Dementia - Over 65 years of age - (DE(E)) 5 Date of last inspection Brief description of the care home Amber House is a large Victorian detached house that can provide personal care support to 18 older people. Amber House can accommodate five people who have dementia care needs, it is owned and managed by Mrs Karen Shaw. The home provides accommodation on two floors, there are two shared rooms. Communal areas are sited on the ground floor, there are two lounges and a dining room. The home is located in Burton upon Trent and is convenient for shops, amenities and public transport. The fees are recorded in the Service User Guide but could not be accessed Care Homes for Older People Page 4 of 31 Over 65 5 18 0 0 Brief description of the care home due to a computer error on the day of inspection. For up to date fees please contact the provider directly. 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: 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 focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who use the services and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We ask managers to fill in a questionnaire called an Annual Quality Assurance Assessment, which tells us how well their service provides for the people who use it and how they intend to improve their service. We received this back from the manager within the required timescale and we used the information it provided us with to assist in planning our visit and deciding what areas to look at. We also reviewed all the information we have received about the service since we last visited in September 2008 and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking which involves us selecting a number of people who use the service and looking at the quality of the care they receive by speaking with them, observation, reading records and asking staff Care Homes for Older People Page 6 of 31 about their needs. We also sent Have your say surveys to a random selection of people who use the service, some relatives, staff members and health care professionals. The information provided in the replies we received is also a contributory factor in the focus of our inspection visit. We spoke with four staff on duty, the manager, five people who use the service and two relatives to form an opinion about the quality of the service being provided. We also read documents, and medication administration was observed. All this helps us to form an opinion about the health and safety and welfare for the people who use the service. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: We made the responsible individual aware of a number of areas in medication administration and recording which should be improved. We need assurance that everyone living at the home receives their medicines as prescribed. All staff need to receive suitable training in the protection of vulnerable adults to give them the knowledge and skills to keep people safe. The home needs policies and procedures on the Deprivation of Liberty Safe Guards, Care Homes for Older People Page 8 of 31 (DOLS). This means staff have clear information to establish whether the home needs to make an application to request a deprivation of liberty from the appropriate professionals. The home needs to publish their results following their quality assurance. This will show people what they do well, identify shortfalls in the service provided and offer a plan for any necessary improvement. Information within the home should be tailored to meet the needs of the people who live there. We recommend the home promotes pictorial and easy read literature. The home is run in the best interests of the people who use it but more written evidence would help to validate the managers statements. 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. 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 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to live at the service have a pre-admission assessment completed to ensure their needs can be met. People are given accurate information about the service provided. Evidence: The information provided to us by the manager told us; We have a revised service user guide and statement of purpose , it contains the information required on fees and it is also available in large print. These new documents were stored on the homes laptop and unobtainable but were e mailed to us after the inspection. It is recommended that people using the service are informed that the Statement of Purpose and Service User Guide could be made available in a format appropriate to the people who use the service, their individual capacity and language. The home may also wish to consider an audio or pictorial version. Care Homes for Older People Page 11 of 31 Evidence: People living in the home are assessed by the manager from the home prior to moving in, this helps to ensure peoples individual needs can be met. Paperwork available and discussion with the staff told us that a full assessment before admission to the home is taken seriously and fully considered. Areas such as health care needs and social needs are discussed along with the individuals ability to live with the current group of people living at the home. As part of our case tracking process, we looked at files for three people who live at the home, all contained pre-admission assessments. We looked closely at the information on the most recent person who had moved into Amber House and were able to speak with them also. It was evident the manager visited people at home and spoke with their family members one visitor told us: Karen was great she came and saw us at home and reassured us we also had all the information we needed. We sent questionnaires to eight people who live at the service and six were completed and returned to us. These told us that four people did feel they had been given all the information they needed to enable them to make a choice about where to live, one did not know, and one said no, they did not feel they had received sufficient information. There is no intermediate care provision at this service. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and healthcare needs are assessed and provided for in a way which shows respect for the privacy and dignity of people who live at the service. Medication administration practices require some attention to make sure that safe practice is always followed; not doing so leaves vulnerable people at risk. Evidence: All people living at Amber House have an assessment of their needs from which a plan of care is developed. We found plans of care and care records have improved and are person centred, this means they are developed with the person and are individualised. Plans fully identify all the persons care needs and these are clearly reviewed. Other professional support is requested when needed and records evidence this. Visiting professionals who completed questionnaires reported: I have used Amber House to place service users and feedback from them is they are able to meet their needs well. It also provides a homely environment and freedom for service users to access community resources. Service users have also said their social Care Homes for Older People Page 13 of 31 Evidence: needs are met well in cases where they experienced social exclusion at home. The provider meets needs of people experiencing confusion or disorientation well. Records showed us that people were receiving in-put and support from external health providers including Doctors, District Nurses, Chiropodist etc. Risk assessments were also completed as required. In the questionnaires we sent to people living at the service, we asked Do you receive the medical support you need? Five replied always and one replied sometimes. Relatives we spoke with on the day of the inspection visit told us, They treat my relative with respect and dignity and I am always made welcome. People who use the service recorded in questionnaires: I am very pleased with the way the staff always listen if I bring anything to their attention. The staff are very caring both to myself and my family. The home does lots of things well, I am very happy here. The home has a key worker system which enables staff to establish special relationships and work on a one to one basis. We heard from a number of staff who told us they really liked working at the home and they felt they have sufficient time to spend with each person. We observed medication practices during our inspection and noted there is room for improvement. We evidenced that on some medication administration records medication was prescribed to be given once or twice, and sometimes had been changed to as and when medication known as PRN. There is no protocol or record for if they had been administered with one or two tablets, nor a written record to confirm if the medication could now be given as and when required. Staff must not make these judgments and must follow the advice of the General Practitioner, if they feel changes need to be made to a persons medication then a referral should be undertaken. We also saw one tablet being signed for prior to administration and noticed gaps on some medication administration records; these are poor practice issues and need to be addressed. Care Homes for Older People Page 14 of 31 Evidence: The storage of medication does not comply with the law. The manager has ordered the correct storage devise which will be in place within the next three weeks. In the meantime we have asked for a risk assessment is put into place to ensure people involved with medication follow a clear procedure and are aware of the risks. 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. People living at the service experience a flexible lifestyle which is in accordance with their needs and abilities. Evidence: The manager told us in the written information she provided: We have changed our activity programme completely since our last inspection to try and stimulate all of the residents. This is reviewed by the activities coordinator every 12 weeks formally with the residents and open informal discussions also take place as to how they find the activities and what they would like. Friends and family also join in if they wish. We discussed the activities that people are offered. There are opportunities to take part in games, music, quizzes and art and craft sessions. There are a variety of other activities organized by the staff which take place on a more spontaneous basis according to the wishes of the people living at the service. We discussed the recording of activities and a record is in place however this could contain further information to support the manager when collating information to improve the outcomes for the people who live there. For example recording the spontaneous activities. Care Homes for Older People Page 16 of 31 Evidence: The completed surveys we received told us three people said there are usually activities, two always, and one said sometimes. Five people responded they usually enjoy the food that is provided, and one said they always enjoyed the food. Relatives we spoke with told us that they are welcome to visit at any time and never feel restricted. A monthly church service is also provided. The menu is displayed on each table the meals for the day. We observed people having lunch and staff assisting people where necessary in a discreet, caring and supportive manner. We consider clearer information could be displayed as a number of people we asked were unsure of what was for lunch. Pictorial support for those with more complex needs may also prove useful. People we spoke with said The food is good Ive really enjoyed my dinner Relatives we spoke with said they were aware of choices being offered and thought the food was good. One visitor said they regularly saw the food and it was always lovely. Another said Amber House smelt of home cooking. Care Homes for Older People Page 17 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. People are able to raise their concerns freely. There are adult safeguarding policies and procedures in place but these need to be developed to comply with new legislation. Evidence: People can access the complaints procedure because it is written in the Service User Guide and displayed in the hall. We have recommended the complaints procedure is placed in a more prominent position as a few people said they were unaware of the policy. It describes the procedure for people should they have any concerns and it is clearly written, easy to understand and explains what the procedure is and how long the process will take. In the questionnaires we sent to people who use the service we ask Do you know who to speak to if you are not happy? Six people replied and they all said yes. To the question Do you know how to make a formal complaint? Two of the six said No People we spoke with told us that they would tell the manager or the staff if they were unhappy or worried about anything and felt happy to do so. We checked the complaints records and can confirm that complaints, actions and Care Homes for Older People Page 18 of 31 Evidence: outcomes are recorded. The AQAA tells us the home has not received any complaints, however there are four logged in the complaints book. The service should ensure the information within the AQAA is correct. There is a comments book available within the home should people wish to raise informal comments or concerns. All records have been changed to reflect the new Care Quality Commission (CQC came into being April 1st 2009), rather than the Commission for Social Care Inspection (CSCI). The manager needs to ensure staff are made aware of The Mental Capacity Act Deprivation of Liberty Safeguards. They must be aware of their responsibilities and ensure there are no other less restrictive ways of keeping people safe and well if liberty is deprived. Decisions must always be in the persons best interests and assessments and questions must be satisfactorily answered. We have asked the home to follow this through and ensure records are in place. We have made a requirement that the home drafts appropriate policies and procedures. There have been no safeguarding referrals made since the last inspection. Suitable safeguarding of adults policies and procedures are in place. Some staff still require training in this field but training has been sourced and dates made available. Safeguarding Adults is a process of identifying and reporting suspected or potential abuse to vulnerable people and provides a framework of consistency to protect those individuals who are at risk. Eight staff completed questionnaires and all said that they knew what to do if anyone raises any concerns. Care Homes for Older People Page 19 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. People live in a clean, safe and comfortable home which is well maintained and is suitable to meet their needs. Evidence: We looked at some bedrooms, bathrooms, communal areas and the kitchen. All areas of the home are clean, tidy and hygienic. People we spoke with said the home is always clean and fresh and the relatives we spoke with confirmed this. Records we looked at including the AQAA showed us that all necessary Health and Safety checks on services and equipment are up to date. Some refurbishment has taken place since the last inspection and further improvements are planned. The home is having a new kitchen and utility area which should be completed within the next three weeks. Questionnaires revealed the following under what could the service do better? The carpets and furnishings could be improved upon. Decorate, update the home. The decor has much improved but carpets still need to be replaced in communal Care Homes for Older People Page 20 of 31 Evidence: areas. The manager has an ongoing plan for redecoration and it has been clear that when people have requested new mattresses, beds etc these are provided promptly. The AQAA tells us: We have a continuing maintenance plan, we have a lovely summerhouse now and the garden is better utilized. We have purchased a better washing machine and have refurbished the hall and dining room. We have a 5 star rating from environmental health and have not had any infection outbreaks. We plan to refit our utility room. We checked to see if the home had provided a lock on the downstairs bathroom door, this was seen. We can also confirm all pipework and radiators are suitably guarded. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff meet the needs of people living at the home. Recruitment and training needs to be improved to fully safeguard vulnerable people. Evidence: During the time we spent at Amber House we spoke to a number of staff and observed or heard them supporting people. We found there were very positive and engaging interactions between those people living at the home and the staff members. Duty rotas were not checked on this visit but we saw enough staff on duty to meet the needs of people who use the service and we can confirm the home has a consistent staff group. The AQAA also tells us we have a low turnover which allows us to give consistent and quality care. A number of staff have been working at the home for many years and know the people and their families well. As part of our case tracking process we looked at the files for two members of staff including the last person to be recruited. The new file contained two written references, identification, a Criminal Record Bureau disclosure and Protection of Vulnerable Adults checks. However, the dates concluded that the worker was in the home on induction prior to the POVA First check and this does not comply with law. Care Homes for Older People Page 22 of 31 Evidence: This means vulnerable people are not suitably protected. We discussed this with the manager at the time. There is also no written evidence to confirm if the worker was supervised. We were able to speak with this person who confirmed they were not left alone with vulnerable people. This assures us that the home had taken appropriate steps, but had failed to document their procedures. The other staff file contained minimal information, this worker has been employed for ten years and inherited from the previous owner. We have asked the manager to ensure all the necessary information with regards to CRB information is in place and suitably stored. Presently some staff have a CRB number but no date of issue. The files also contained evidence of training that has been completed, this included mandatory training and additional training to support the needs of the service. Not all training is up to date but the home has ensured this will be rectified in a timely way as they have sourced a local training company to provide all the necessary courses. We also spoke with other staff who confirmed that the manager is always available and there to support them if needed. Staff feel valued and respect their manager. The home does not undertake formal team meetings and we recommend this is added to their repertoire. Staff confirmed these would prove useful. Eight staff questionnaires were returned and all said they feel supported. Here are some of their comments: Amber House has a very good relationship with service users and their families. Amber House entitles service users to make their own choices about menus activities and day to day living. Amber House works well with health care professionals to help meet service users care plans. Very good care home, one of the best it is a homely place. The home continues to meet the care needs of all residents whilst maintaining that all care plans and other documentation is up to date. The majority of staff have NVQ2. Care Homes for Older People Page 23 of 31 Evidence: Homely friendly atmosphere. All service users have a choice of activity meals and care. Service users take part in menus and care plan reviews. Visitors often comment we are like one big happy family and feel made welcome. Amber House meets the residents care needs we all get on well staff visitors and residents. Helps residents feel safe in a homely environment. Amber House is a friendly place theres activities done every day. Care Homes for Older People Page 24 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. The home is well managed and being run in the best interests of the people who live there. Evidence: The manager was available during this key inspection and has the required qualifications and experience necessary to run the home. The Annual Quality Assurance Assessment was completed by the service provider, Karen Shaw and it was returned to us within the required timescale. Staff we spoke with told us Karen was approachable and provides support to the staff team. Relatives we spoke with also said that they feel they can go to the management with any problem and will be listened to. Staff meetings and resident meetings do not take place but relatives are asked to contribute any suggestions they have about the running of the service. Care Homes for Older People Page 25 of 31 Evidence: We looked at the outcomes of some of the quality audits that have been completed by the service and this told us that people are given a number of opportunities to make their opinions known and this information is collated and acted upon. We have asked the home to ensure their finding are published and made available to the people who live there. Here are some of their comments : Rate friendliness care comfort good impressions of home and activities. Our family are very happy your staff are friendly and happy we are made to feel welcome and questions are answered straight away. Our relative is fortunate living in such a cosy, comfortable, caring home, we have peace of mind knowing she is so well looked after. We received confirmation from the manager stating no finances or personal allowances are held for people who use the servicer by the home. The manager confirmed fire risk assessments for people who use the service are not in place, we have asked her to contact the fire officer to seek clarity on this matter. Care Homes for Older People Page 26 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 27 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 9 13 Regulation 13(2) You must ensure medication is stored in a secure and suitable way. This means medication is kept safe and protects the people who live at the home. 17/08/2009 2 18 12 Regulation 12 (3) 31/08/2009 To make sure people are safeguarded the service must ensure there are policies and procedures in place in regard to The Mental Capacity Act deprivation of liberty safeguards. This is to make sure staff know what course of action to take, understand the assessment processes and are clear of their legal responsibilities. Regulation 19(1)(b) The registered manager must 31/08/2009 3 29 19 Care Homes for Older People Page 28 of 31 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 ensure recruitment procedures follow safe practice. This means vulnerable people are suitably protected. 4 29 18 Regulation 31/08/2009 18(1)(c) (i) To make sure people are supported appropriately all the staff team require training on the protection of vulnerable adults. This is to ensure everyone is safe. 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 1 It is recommended that information is made available to confirm that the Statement of Purpose and Service User Guide are available in a format appropriate to the people who use the service, individual capacity and language. Medication instruction on administration should be clear, where it says take one or two there should be a clear protocol as to what constitutes the decision making process i.e. when is it one and when are two necessary. This will ensure medication is administered consistently. The records of administration for the people who use the service need to be accurate to demonstrate that all medication is administered as prescribed. This is to ensure people are kept safe and records tally with actions. 2 9 3 9 Care Homes for Older People Page 29 of 31 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 4 15 You should consider offering daily menus produced in appropriate formats, such as large print or pictorial, suitable for people with dementia care needs or sensory impairments to assist their understanding and help them make realistic choices. Consider placing the complaints procedure in a more prominent position. This means people can access the information easily. Ensure all documentation regarding criminal record bureau checks (CRB) is stored with the date of issue, name of staff member and the CRB disclosure number. Consider introducing team meetings, this means the staff group have an open forum to discuss their views. Speak with the fire officer to confirm the need for individualised fire risk assessments for the people who use the service. This means people will be suitably protected. 5 16 6 29 7 8 30 38 Care Homes for Older People Page 30 of 31 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. 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