Care Home: Anchorage Nursing Home

What the care home does well Some of the care plans had been well written and gave details of the individual, their care needs, and how their needs should be met. There were good monthly reviews and evaluations of the care plans and evidence that residents had visits from their doctor and other health professionals including dietician, physiotherapist, tissue viability nurse as required. Medicines are well managed. Comments made on surveys carried out by the home earlier in 2009 showed that people are generally satisfied with the care provided. A GP wrote `Staff are organised and clearly operate in a common sense approach to patient care`. Other GP commented `excellent service, conscientious staff`. A chiropodist wrote `excellent team of staff, quick to help, staff are very well managed and motivated by Helen, who demands the staff provide each individual patient the highest form of care available while respecting each patient`s dignity and privacy.` A relative commented on `the caring and patience of all the staff, the very friendly atmosphere at all times` and another wrote `all the staff are kind and friendly and always ready to help`. Another relative commented `I am very impressed with the professionalism of your staff and their caring attitude`. The home employs two activities co-ordinators and a variety of social activities are arranged throughout the week. Some residents particularly enjoy the garden, which has a greenhouse and a vegetable plot. A varied menu is offered and the day`s menu is written on a board in the dining room. There is always a choice of meal and the cook goes round each day to ask people what they would like. We found that the home continues to be cleaned to a high standard and in a satisfaction survey a number of people commented on the cleanliness of the home. There are enough staff to meet the needs of the people currently living at the home. Most of the care staff have achieved a national vocational qualification in care. This shows that staff are qualified to carry out their role. Records showed that staff training is on-going and that all staff have received mandatory training in key subjects. This means that staff have the skills to promote people`s health and welfare. What has improved since the last inspection? Some of the nurses are now writing care plans in a person-centred way to reflect the needs and preferences of the individual. Monthly reviews and evaluations of the care plans were improved and showed that the nurse had looked at any changes that had taken place over the last month. We saw evidence that residents had visits from their doctor and other health professionals was needed and the wound care records for a very frail person with several pressure sores were much more detailed than we had seen previously. There is a new clinical room which is great improvement, giving much more storage and space to move. Risk assessments have now been carried out and action taken to reduce the risk of fire caused by people smoking in their bedrooms. The owners of the home have produced a refurbishment plan that includes updating of bathrooms and toilets, re-decoration of corridors and communal areas, upgrading of bedrooms as they become vacant, and work to ensure that TVs are able to receive digital signal. We could see that this was in progress. Work was going on in a first floor bathroom and there were tiles and fixtures waiting to be fitted in other bathrooms. Some bedrooms have already been decorated and have new furniture. The manager now has her own small office so no longer has to share an office with the administrator. The manager said that she feels more supported now that the owners are taking an active role in running the home. They have been living overseas for the last few years but have recently returned to the UK. We have been concerned that requirements made at our previous inspections have not been actioned and the responsible individual for the home has failed to communicate with us as agreed. The home owners assured us that this would improve. At our last visit we found that the fire risk assessment for the home did not accurately reflect arrangements for residents who smoke and this has now been updated by a safety consultant. What the care home could do better: Two of the care plans we looked at had been completed in full but were not personalised to reflect the person and gave little information about their individual needs and preferences or how that staff should provide care for them. We found that a considerable number of residents had bed rails in use. There were risk assessments in their care plans but these were not fully completed and did not adequately explain why the individual was considered to be at risk of falling out of bed, or whether any alternative ways of keeping them safe had been considered. The records did not show that the risk of entrapment had been fully explored for each person. The complaints procedure needs to be updated to show the name of the home manager, the name and contact details of the home owners, and contact details for the Care Quality Commission, so that people know who to contact if they have any complaints or concerns. Since our last inspection a survey of the windows has been carried out, but work has not yet started to carry out the repairs and replacements identified as necessary. Staff and relatives have reported that some areas of the home are cold. The management need to identify where the problems are occurring and take appropriate action to address this. We have made previous requirements about fitting bathrooms and toilets with privacy locks and using signage to identify bathrooms and toilets. Very little progress has been made so far, but the home owners have now bought suitable locks which will be fitted. Also, there are no names on bedrooms doors and this may make it difficult for residents to find their own bedrooms. A door outside the laundry does not close properly. At the last inspection we were concerned about the cellar being used for storage. We were informed that all combustible material had been moved from the boiler area, but when we visited we found that combustible material was again being stored in the boiler area and one of the home owners had this removed immediately. The manager needs to have more time allocated for management and monitoring so that the home can continue to improve. There are some auditing systems in use, but we considered that checks of care plans and of health and safety arrangements need to be more thorough so that shortcomings are identified and addressed. Health and safety procedures were in a file dated 1994, which suggests that an update should be carried out as soon as possible. Key inspection report Care homes for older people Name: Address: Anchorage Nursing Home 17 Queens Road Hoylake Wirral CH47 2AQ     The quality rating for this care home is:   one star adequate 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: Wendy Smith     Date: 2 4 1 1 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 25 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 25 Information about the care home Name of care home: Address: Anchorage Nursing Home 17 Queens Road Hoylake Wirral CH47 2AQ 01516324504 01516320367 rolfields@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rolfields Limited care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home is within the following category: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 35 Date of last inspection Brief description of the care home The Anchorage nursing home is a three storey mature building in Hoylake. The home is registered to provide nursing care for up to 35 people over 65 years of age. It is privately owned by Rolfields Ltd and the registered manager is Helen Devaney. 0 Over 65 35 Care Homes for Older People Page 4 of 25 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: The quality rating for this service is one star. This means that the people who use this service experience adequate quality outcomes. Two inspectors from the Care Quality Commission visited Anchorage unannounced on 24 November 2009 as part of this inspection. During the visit we spoke briefly with residents and staff. We walked round the building to see all the communal areas and some of the bedrooms. We checked records kept at the home and spent time talking with the manager and the home owners. We also looked at any information that we had received about Anchorage since our last inspection there in May 2009. Before the inspection the manager was asked to complete a questionnaire to give us up to date information about the service. Care Homes for Older People Page 5 of 25 Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? Some of the nurses are now writing care plans in a person-centred way to reflect the needs and preferences of the individual. Monthly reviews and evaluations of the care plans were improved and showed that the nurse had looked at any changes that had taken place over the last month. We saw evidence that residents had visits from their doctor and other health professionals was needed and the wound care records for a very frail person with several pressure sores were much more detailed than we had seen previously. There is a new clinical room which is great improvement, giving much more storage and space to move. Risk assessments have now been carried out and action taken to reduce the risk of fire Care Homes for Older People Page 7 of 25 caused by people smoking in their bedrooms. The owners of the home have produced a refurbishment plan that includes updating of bathrooms and toilets, re-decoration of corridors and communal areas, upgrading of bedrooms as they become vacant, and work to ensure that TVs are able to receive digital signal. We could see that this was in progress. Work was going on in a first floor bathroom and there were tiles and fixtures waiting to be fitted in other bathrooms. Some bedrooms have already been decorated and have new furniture. The manager now has her own small office so no longer has to share an office with the administrator. The manager said that she feels more supported now that the owners are taking an active role in running the home. They have been living overseas for the last few years but have recently returned to the UK. We have been concerned that requirements made at our previous inspections have not been actioned and the responsible individual for the home has failed to communicate with us as agreed. The home owners assured us that this would improve. At our last visit we found that the fire risk assessment for the home did not accurately reflect arrangements for residents who smoke and this has now been updated by a safety consultant. What they could do better: Two of the care plans we looked at had been completed in full but were not personalised to reflect the person and gave little information about their individual needs and preferences or how that staff should provide care for them. We found that a considerable number of residents had bed rails in use. There were risk assessments in their care plans but these were not fully completed and did not adequately explain why the individual was considered to be at risk of falling out of bed, or whether any alternative ways of keeping them safe had been considered. The records did not show that the risk of entrapment had been fully explored for each person. The complaints procedure needs to be updated to show the name of the home manager, the name and contact details of the home owners, and contact details for the Care Quality Commission, so that people know who to contact if they have any complaints or concerns. Since our last inspection a survey of the windows has been carried out, but work has not yet started to carry out the repairs and replacements identified as necessary. Staff and relatives have reported that some areas of the home are cold. The management need to identify where the problems are occurring and take appropriate action to address this. We have made previous requirements about fitting bathrooms and toilets with privacy locks and using signage to identify bathrooms and toilets. Very little progress has been made so far, but the home owners have now bought suitable locks which will be fitted. Also, there are no names on bedrooms doors and this may make it difficult for residents to find their own bedrooms. Care Homes for Older People Page 8 of 25 A door outside the laundry does not close properly. At the last inspection we were concerned about the cellar being used for storage. We were informed that all combustible material had been moved from the boiler area, but when we visited we found that combustible material was again being stored in the boiler area and one of the home owners had this removed immediately. The manager needs to have more time allocated for management and monitoring so that the home can continue to improve. There are some auditing systems in use, but we considered that checks of care plans and of health and safety arrangements need to be more thorough so that shortcomings are identified and addressed. Health and safety procedures were in a file dated 1994, which suggests that an update should be carried out as soon as possible. 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 25 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 25 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. Peoples needs are assessed before they go to live at Anchorage to ensure that it will be the right home for them. Evidence: The manager told us that two people have come to live at the home since our last visit. We looked at their care plans and they showed that the home manager had visited them and assessed their needs before they moved to live at Anchorage. Information about their care had also been received from hospital staff. For one of the people, we considered that the pre-admission assessment could have been more detailed to ensure that the homes staff have as much information about the person before they move in. Care Homes for Older People Page 11 of 25 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. Overall, the health and personal care needs of people living at the home are met, but there remains room for improvement in the way that individual needs and preferences are identified and recorded. Evidence: Everyone who lives at the home has a care plan. We have continued to monitor the care plans since our inspection in May 2008 when we found that they had not been completed to an acceptable standard. The homes management were served a statutory requirement notice regarding care plans on 8 June 2009 because they had not improved, and this required that the care plans must be improved by 30 June 2009. During a short visit on 26 June, we found that significant improvements had been made to the care plans. During this visit we looked at care plans for four people and these were chosen as two people who had moved to live at the home this year, and two people who were frail and needing a considerable amount of day to day care. We considered that two of the care plans had been well written and gave details of the individual, their care needs, Care Homes for Older People Page 12 of 25 Evidence: and how their needs should be met. The other two had been completed in full but were not personalised to reflect the individual. For example, the care plan for nutrition (written 13/11/09) for a person who has lived at Anchorage since 2006 included instructions to assess her likes and dislikes, find out where she likes to dine, and assess type of diet. The care plan for continence included regular toileting, but with no explanation of how often the person needs to be assisted to the toilet or whether she is able to use a WC or commode. The plan instructed staff to maintain privacy and dignity, but with no details of how this should be achieved for this person. The care plan stated that she has a twice weekly bath, but the daily living form recorded that she has a daily bed bath. Similarly for the second person, the care plan for continence included regular toileting and ensure adequate fluid intake, but with no detail of how often he needs assistance to the toilet or how much he needs to drink, what he likes to drink, or what assistance he needs. The hygiene care plan for this person included c/o hair, nails, teeth etc daily, but gave no information about his individual needs and preferences. We saw good monthly reviews and evaluations of the care plans. We saw evidence that residents had visits from their doctor and other health professionals including dietician, physiotherapist, tissue viability nurse as required. The wound care records for a very frail person with several pressure sores were much more detailed than we had seen previously. We found that a considerable number of residents had bed rails in use. There were risk assessments in their care plans but these were not fully completed and did not adequately explain why the individual was considered to be at risk of falling out of bed, or whether any alternative ways of keeping them safe had been considered. The records did not show that the risk of entrapment had been fully explored for each person. We looked at medicines management and found this to be satisfactory. There is a new clinical room which is great improvement, giving much more storage and space to move. Storage and recording of medicines, including controlled drugs, was good. We looked at comments that had been made on surveys carried out by the home earlier in 2009. A GP wrote Staff are organised and clearly operate in a common sense approach to patient care. Other GP commented excellent service, conscientious staff. A chiropodist wrote excellent team of staff, quick to help, staff are very well managed and motivated by Helen, who demands the staff provide each individual patient the highest form of care available while respecting each patients dignity and Care Homes for Older People Page 13 of 25 Evidence: privacy. A relative commented on the caring and patience of all the staff, the very friendly atmosphere at all times and another wrote all the staff are kind and friendly and always ready to help, but added I would like to see J dressed in her own clothes. I cant understand why she has to wear other peoples clothes. Another relative commented I am very impressed with the professionalism of your staff and their caring attitude. Care Homes for Older People Page 14 of 25 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 who live at the home enjoy a wide range of social activities and a good choice of meals. Evidence: The home employs two activities co-ordinators and a variety of social activities are arranged throughout the week. Some residents particularly enjoy the garden, which has a greenhouse and a vegetable plot. Photographs record events that had taken place. The home has two budgies which are very tame and there were photos of people who live in the home holding them. A varied menu is offered and the days menu is written on a board in the dining room. There is always a choice of meal and the cook goes round each day to ask people what they would like. People we spoke with at previous inspections have always been satisfied with their meals. One of the people who completed a survey form commented on the friendliness of the staff and the welcome we always receive, and good consultation with the family keeping us informed of problems. Care Homes for Older People Page 15 of 25 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 living at the home are protected from abuse. Evidence: The manager told us that no complaints have been made to the home since our last visit. The home has a complaints procedure which is on the notice board in the entrance hall. The complaints procedure does not have the correct name of the home manager because she has married and changed her name since it was written. The complaints procedure should also inform people of the name and contact details of the home owners so that they know who they should go to if they are not satisfied with the way that the manager has addressed their complaint, or if they wish to make a complaint about the manager. The complaints procedure also needs updating with the contact details for the Care Quality Commission. Training records showed that all staff have received training about safeguarding people from abuse and, at the time we visited, this training was being updated to make sure that it is fresh in peoples minds. An allegation of abuse was made earlier this year and this was reported and dealt with in the correct way by the home manager. Care Homes for Older People Page 16 of 25 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are in progress to ensure that the environment is safe and comfortable. Evidence: Over recent visits we have identified a number of issues in the environment that need to be addressed to ensure a safe and comfortable place for people to live. The owners of the home have produced a refurbishment plan that includes updating of bathrooms and toilets, re-decoration of corridors and communal areas, upgrading of bedrooms as they become vacant, and work to ensure that TVs are able to receive digital signal. We could see that this was in progress. Work was going on in a first floor bathroom and there were tiles and fixtures waiting to be fitted in other bathrooms. Some bedrooms have already been decorated and have new furniture. The improvement plan also needs to include repair and/or replacement of windows as needed and a full assessment of the central heating system. Since our last inspection a survey of the windows has been carried out, but work has not yet started to carry out the repairs and replacements identified as necessary. A number of bedrooms have portable electric heaters and staff and relatives have reported that some areas of the home are cold. The home owners said that they have had an inspection of the boilers and they have been told that these are in good working order. (We had previously been informed that new boilers were to be installed.) There was no information about Care Homes for Older People Page 17 of 25 Evidence: which parts of the home are not adequately heated and we suggested that thermometers might be put in bedrooms and staff, in particular night staff, asked to identify where the problems were occurring. We have made previous requirements about fitting bathrooms and toilets with privacy locks and using signage to identify bathrooms and toilets. Very little progress has been made so far, but the home owners have now bought suitable locks which will be fitted. Also, there are no names on bedrooms doors and this may make it difficult for residents to find their own bedrooms. During our last visit we identified some concerns with regard to fire safety and we discussed these with a fire officer, who visited the home and made recommendations for improvement. One issue was with a door outside the laundry that did not close properly, and we found that it still did not close properly. Another issue was about the cellar being used for storage. We were informed that all combustible material had been moved from the boiler area, but when we visited we found that combustible material was again being stored in the boiler area and one of the home owners had this removed immediately. The third issue was regarding residents smoking in their bedrooms. Risk assessments have now been carried out and action taken to reduce the risk of fire. We found that the home continues to be cleaned to a high standard and in a satisfaction survey a number of people commented on the cleanliness of the home. Care Homes for Older People Page 18 of 25 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. Enough qualified and experienced staff are employed to ensure that peoples needs can be met. Evidence: We looked at staff rotas and spoke with the manager who confirmed that there are enough staff to meet the needs of the people currently living at the home. The numbers are two nurses and four carers between 8am and 4pm, one nurse and four carers in an evening, and a nurse with two carers at night. Most of the care staff have achieved a national vocational qualification in care. This shows that staff are qualified to carry out their role. There have been no new staff since our last visit. Records showed that staff training is on-going and that all staff have received mandatory training in key subjects. This means that staff have the skills to promote peoples health and welfare. We recommend that infection control is added as a compulsory training subject for all staff. Care Homes for Older People Page 19 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and the home owners are committed to improving the service provided for the benefit of the people who live at the home. Evidence: The manager is an experienced nurse and has been registered with CQC (previously CSCI); she also has a management qualification. The manager spends most of her time working as a nurse on the shop floor and we discussed with the manager and the owner that the manager needs to have more time allocated for management and monitoring so that the home can continue to improve. The manager now has her own small office so no longer has to share an office with the administrator. The manager said that she feels more supported now that the owners are taking an active role in running the home. They have been living overseas for the last few years but have recently returned to the UK. We have been concerned that requirements made at our previous inspections have not been actioned and the responsible individual for the home has failed to communicate with us as agreed. The home Care Homes for Older People Page 20 of 25 Evidence: owners assured us that this would improve. There are some auditing systems in use, but we considered that checks of care plans and of health and safety arrangements need to be more thorough so that shortcomings are identified and addressed. Health and safety procedures were in a file dated 1994, which suggests that an update should be carried out as soon as possible. A customer satisfaction survey was sent out in April 2009 and we were given copies of all the replies, which contained mainly positive comments. Staff expressed their concerns about the future of the home at a staff meeting held on 21 October 2009. The AQAA told us that all the required safety certificates were in place. At our last visit we found that the fire risk assessment for the home did not accurately reflect arrangements for residents who smoke and this has now been updated by a safety consultant. We saw evidence that staff have received fire safety training but this failed to prevent combustible material being stored in the boiler room. There were records of fire drills being held in May, June, September and November 2009 and the names of staff attending. Care Homes for Older People Page 21 of 25 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 7 15 (2)(b, c & d) Ensure that each service user 30/06/2009 has a written service user plan identifying all their needs in respect of health and welfare and detailing instructions for staff on what action they must take to meet those needs. 2 8 23 The toilet and bathroom 30/06/2009 doors in the home must be identified so that people who live in the home are aware of where the facilities are. Care Homes for Older People Page 22 of 25 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 7 13 Whenever bed rails are used 31/12/2009 there must be a full risk assessment to show why this restraint is necessary to keep the person safe. So that people are not put at risk from the indiscriminate use of bed rails 2 19 23 Confirm whether the door outside the laundry is a fire door and fit the appropriate closing device if required. To ensure that people are kept safe. 31/12/2009 3 19 23 Ensure that all parts of the building are adequately heated. So that residents are kept warm. 31/12/2009 4 19 23 Repair or replace windows as identified in the homes survey. 30/04/2010 Care Homes for Older People Page 23 of 25 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 To ensure that the building is in a good state of repair. 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 16 Update the complaints procedure so that people have details about who to contact if they wish to make a complaint. Fit privacy locks to all shared bathrooms and toilets. All staff should attend training about infection control so that residents are protected from the spread of infection. Ensure that the manager is allocated sufficient time to carry out management and monitoring tasks to identify where the service can improve and check on progress. 2 3 4 19 30 31 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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