Care Home: Arden Lodge

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What the care home does well Information is collected about people`s religious beliefs and people are assisted to attend their places of worship. One person told us that this was one of the reasons they chose this home. Care plans and risk assessments are written shortly after people are admitted and this helps to ensure staff have the information they need to provide good care. People spoken to were happy with the care they received and observations showed that staff spent time with them. A person said `I am well looked after and it is not just me they look after everyone.` Food is available at all reasonable times and people have good choices of food available to them. People said that could have a cooked breakfast everyday if they wanted. Care staff have all checks needed before they are employed and have training in important practices such as the moving and handling of people and health and safety. They spend some time observing practice in their first few weeks. This helps to ensure that staff are safe to work with people. The manager is seen as approachable by people that live in the home one person said `She knows what she is doing.` People`s money is managed well and this safeguards people`s interests. What has improved since the last inspection? Since the random inspection in October 2009 there have been improvements in the way information is collected about people`s needs. This means that the home has better information to decide whether they can meet all of a person`s needs before they are admitted. The administration of people`s medication had improved and this helps to ensure that people keep has healthy as possible. There have improvements to the building and the facilities for people living in the home. One of the assisted bathrooms has been refurbished, there is a new laundry and food store and a number of bedrooms have been fully refurbished including the en suites. There is new equipment which has been purchased such as sit on scales, hoists, a new call alarm service and monitoring devices for people that walk at night. There are good systems in place to hand over the responsibility for the building, people`s money and people`s wellbeing from shift to shift. Records generally had improved with clear expectations with how and where information is kept. What the care home could do better: Where risk assessments find a risk, measures are identified but these are not always carried out such as weighing people with the frequency set in the risk assessment or responding to risks they have identified to skin health.People are offered activities but these are not organised in an individual way so activities may not be meaningful for some people. The organisation of the building changes has not been organised to ensure minimum disruption and risk to people. Rooms have not been checked to ensure that all areas have been finished and are safe before they are in use. There are a number of areas throughout the building are unfinished and this can affect people`s risk of gaining chest infections from dust. The manager is not registered with us and this is required to ensure that a determination can be made about their fitness to manage a care home. Key inspection report Care homes for older people Name: Address: Arden Lodge 946 Warwick Road Acocks Green Birmingham West Midlands B27 6QG     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: Jill Brown     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Arden Lodge 946 Warwick Road Acocks Green Birmingham West Midlands B27 6QG 01217067958 01217067958 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lindale Homes Ltd Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 33 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 witin any other category (OP) 33 Date of last inspection Brief description of the care home Arden lodge is a 33-bedded care home for older people. The numbers of people that can be admitted are currently limited as the accommodation on the 2nd floor is currently not in use as it is amidst refurbishment and there is no acceptable fire escape route. Arden Lodge is situated on the Warwick Road, a short distance from the centre of Acocks Green, where there are a range of facilities including shops and recreational Care Homes for Older People Page 4 of 29 Over 65 33 0 Brief description of the care home facilities. The home is on a main bus route and is well served by public transport. The home has single and shared bedrooms with en suites over the two floors in use. The home has a passenger lift. There are three assisted bathrooms one with an assisted shower in as well as an assisted bath, one with an assisted bath and an assisted shower facility on the first two floors. There is a lounge with dining space to the rear of the home. The home has a garden that is accessible to the people living there. The home is currently being refurbished and newly refurbished bedrooms have new furniture, good en suites, televisions and call alarm services. The fees for home are between £322-69 and £363-98. People placed by Birmingham City Council did not have to find a top up. There were extra charges for hairdressing and chiropody services where these are wanted. Care Homes for Older People Page 5 of 29 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: We visited the home unannounced on a day in April 2010. We completed a key inspection which means we inspected the homes performance against most of the National Minimum Standards. We also visited the home to undertake a random inspection in October 2009. The last Key inspection took place in May 2009. The home gave us information in an Annual Quality Assurance Assessment (AQAA) before the inspection. The AQAA shows how the home rates their performance in the areas set out in this report and what improvements to the service they intend to make. During the inspection we case tracked three peoples care. This means we looked at the care records for the person, the administration of their medication and their room. During the inspection we looked at most areas of the building. We also looked at other records about the safety of the building, complaints, accidents Care Homes for Older People Page 6 of 29 and so on. We spoke to 5 people that live in the service and observed practice. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Where risk assessments find a risk, measures are identified but these are not always carried out such as weighing people with the frequency set in the risk assessment or responding to risks they have identified to skin health. Care Homes for Older People Page 8 of 29 People are offered activities but these are not organised in an individual way so activities may not be meaningful for some people. The organisation of the building changes has not been organised to ensure minimum disruption and risk to people. Rooms have not been checked to ensure that all areas have been finished and are safe before they are in use. There are a number of areas throughout the building are unfinished and this can affect peoples risk of gaining chest infections from dust. The manager is not registered with us and this is required to ensure that a determination can be made about their fitness to manage a care home. 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 29 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 29 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 living in this home can be assured that enough information is collected about their health and social care needs for these to be met. Evidence: The homes Annual Quality Assurance Assessment (AQAA) stated that people receive a copy of a contract and we saw copies of the agreements with local social services contracts. We were also told that the service user guide, that gives information to people, had been updated and is available in a large print version. We visited the home on a random inspection in October 2009 following concerns about the assessment of people before admission and shortfalls were found. At this inspection we looked (April 2010) at the information collected for 2 people before they were admitted to the home. We found the home has its own pre-admission assessment forms as well as receiving information from professionals working with the person. The manager at the home had completed the assessments for both people. Care Homes for Older People Page 11 of 29 Evidence: There was good information contained in the records which included details of peoples health conditions, the help the person needs and their lifestyle. Records also indicate peoples religious beliefs and cultural heritage are detailed. A person told us that they chose this home because of these considerations. During our visit we observed arrangements for a person to attend their church. Detailed assessments help the home develop care plans for the person. A number of people have been admitted into the home on an emergency basis, the home has ensured that they have sufficient information to give care to people but some people were unable to have an admission visit. Care Homes for Older People Page 12 of 29 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 can be assured that are plans are written in a timely way to inform staff how their needs are to be met. Peoples health and medication needs are met well and this helps people remain healthy. Evidence: People living in the home have care plans and risk management plans. Some care plans do not have a date to say when they are written. Dates on care plans determine when a person needs have changed and when the plan was changed to meet those needs. Care plans have information about what personal care the person can manage themselves such as washing and dressing and use of the call alarm system. This information helps staff to preserve the abilities and skills people have. Care files contained information about unusual health conditions to inform staff how these may affect the person. When people are admitted there are checks to ensure that the person is as well as Care Homes for Older People Page 13 of 29 Evidence: they can be. This includes checking for injuries which are followed up to see if there is an explanation for them and this helps to ensure people remain safe. Other checks include weight and nutrition, dental health, mobility and skin health. We found that people were referred to dentists, chiropodists and dieticians where needed. There was good risk assessment documentation but the plans made are not always followed. One person had an assessment that indicated that they were at high risk of developing pressure areas. The plan indicated that specialist equipment was needed for skin health and these were not in place and the person spent a long time on a dining room chair which could have affected their skin. Some people were required to have weekly weights taken and these were not done. However people that have a tendency to walk at night have equipment in their rooms to inform night staff that they are out of bed and this helps to keep them and other people safe. We found that the service worked well with local health services and tried to ensure that peoples health needs were met. Records indicated that when people became ill assistance was requested from health professionals quickly and we were informed of these incidents. We looked at the medication records for two people. The medication was stored securely in the office. Copies of the current prescription are kept and this helps to ensure that the medication dispensed from the chemist is as prescribed. In front of the medication administration records (MAR) there is a photograph of the person and this is an extra check to ensure the right medication. The checks of administration and the stocks of medication of the two people were correct indicating that medication was given as prescribed. We observed staff administer medication and there was good interaction whilst this task was being undertaken staff described what medication was being given. For example we heard staff say I have your mouthwash can you swish it around your mouth and then swallow. This helps people with sight loss know what is happening. We observed the interactions between staff and people and found these to be good. For example where staff did could not get agreement from a person to get up out of bed the staff member asked another member of staff try again a little later. People were attended to when they asked for assistance. Staff were observed having conversations about their lives and the lives of the person they were assisting and this helps to ensure people feel valued and involved. People told us that I am well looked after and it is not just me they look after everyone. Its ok but Im not staying. One person, although they are independent, felt that staff needed to ensure they checked how the person was managing because it took a lot of effort to remain independent Care Homes for Older People Page 14 of 29 Evidence: and they may not be able to manage by themselves one day. Not all shared bedrooms had screening to ensure privacy when needed. Care Homes for Older People Page 15 of 29 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 in the service have activities arranged but these may not reflect their interests or history. People living in the service have nutritional food available when ever they wish. Evidence: Although care plans are in place they need to be more individualised to ensure that people have activities that are relevant to them. Some people are able to say what they would like to do and this is arranged others are not. People are to be given assistance to go to church or go to the local shops or have a pub lunch. However more needs to be done to try and engage people that have difficulty saying what they would like to do. The home has a hairdresser that attends the home and was visiting during the inspection. Massages are available and there is a regular visit from an external entertainer. People are able to receive their care in their rooms if they wish, or spend a part of their day there. People have the ability to move around most areas of the home. Care Homes for Older People Page 16 of 29 Evidence: On arrival to the home people were being assisted with breakfast. People were asked what they were liked as they came down from their bedrooms so they did not have to wait for their first meal. People could have cereals and or toast, or a cooked breakfast. Several people told the inspector that they had cooked breakfast most days others said they had cereals and toast. We tasted a sample of both main meals, which was corned beef hash and lamb chops and these were well cooked and presented. People could also have the option of a baked potato. People spoken to thought the food was good. One person thought that they needed to have more vegetables and fresh fruit available as this is what they were used to before admission and that they preferred their food to be softer. We asked about the homes arrangements for providing culturally appropriate food for two people and this was not in place at the time of the inspection. A person spoken to said that they would like some Jamaican food. People are asked about the menus and activities in resident meetings. There are records of the options people have for meals and what they have chosen or if they have refused. People are given options and have food supplied at least at breakfast lunch tea and supper times each day.These arrangements help to ensure that people are happy with the service receive. Care Homes for Older People Page 17 of 29 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. Staff are aware of the policies and procedures to keep people safe and this means that people are safeguarded. People are able to raise concerns with the manager but small issues are not recorded and this may mean that themes of dissatisfaction are not identified. Evidence: The service had no complaints logged at the time of the inspection and none were recorded on the homes Annual Quality Assurance Assessment (AQAA). We have received no complaints about the service. The home had not sent surveys to people or their relatives to find out their views of the service. There are no systems in place for visitors to record any minor dissatisfactions with the home and this information may help the home move forward. People do have the opportunity to attend residents meetings. People told us they were able to talk to the manager and that she was good, kind, and knows whats shes doing . The home has had some safeguarding issues since the last key inspection in May 2009. Action was taken on all issues that arose; a number of these were issues that were not about the homes practice and the appropriate agencies were contacted to follow up concerns. The management has demonstrated that they have a clear understanding of safeguarding practice and procedures and this helps to keep people safe. Staff newly recruited have training on safeguarding vulnerable people and this Care Homes for Older People Page 18 of 29 Evidence: helps to ensure that people are kept safe. Care Homes for Older People Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the environment is improving the control of building works is not sufficient to ensure that the home is safe and comfortable to live in. Evidence: Since the home has been acquired by the current owners a lot of work has been undertaken. The standards of safety and cleanliness in the home have improved. However the refurbishment of the home is not being organised enough to ensure the minimum impact on the people living in the home. A large number of areas in the home are being worked on at once and this means that other safety concerns are being raised. (See Management and Administration outcome area) We found a new bathroom was being used despite the bath panel not being fitted and the pipe work not being boxed in. This poses risks of skin tears or burns to people. We gained assurances that the bath panel would be in place the next day and the pipe work was boxed in by the end of the inspection. There was a new bath hoist in place and being used as the ground floor the bath hoist in the communal bathroom was being repaired. However risk assessments were not in place for the use of the new hoist with individual people and this may be put people at risk. We found that a room was being used without the ventilation fan being installed in the en suite leaving a hole in the wall. The home did not have a system in place to ensure Care Homes for Older People Page 20 of 29 Evidence: that areas are signed off as fully finished and safe for use. There was an increase in the numbers of people having chest infections which was an indication that dust in the air may be an issue. The building work was in evidence on all floors of the building and in most areas. The second floor was not completed and no people were accommodated there. The first floor had some rooms that have been refurbished but others were not. The same was true of the ground floor. On the first floor bedroom doors do not have locks and it is difficult for people to identify what is behind each door. For example the fire exit door and the bathroom doors are new and of the same construction and colour as the refurbished bedroom doors. There are other doors on that floor that are different but they lead on to bedrooms that have not been refurbished and this can be confusing to people. Where areas have been refurbished such as individual bedrooms, the laundry and the communal bathroom these have been done well and provide better facilities than people have had previously. There is a new call alarm system in place that enables management to monitor the staff response times to calls for help and that agreed night time checks have been undertaken. Where necessary extra equipment is needed it is in place. We saw several rooms where pressure alarms were in place to alert staff to a person getting up during the night where this was an issue. We were told in the AQAA that a new hoist and sit on scales has been purchased and these purchases improve the care of people. The home has had a health and safety inspection and this indicated problems with the food storage areas but this has been refurbished since this inspection. We became aware that an extra room had been created and that number that the ground floor and the first floor can accommodate in now 26 people. We have asked for the plans to ensure that the new areas meet with the current regulations. Care Homes for Older People Page 21 of 29 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. People living in this home have enough staff that are recruited and trained to give the care needed. Evidence: We looked at the staffing levels in the home. The rotas showed us that there was 1 senior carer and 3 carers on duty on each of the morning and afternoon shifts. These staff were supported by the manager Monday to Friday however we also evidenced through the homes notifications to us that the manager also came into the home at other times if needed. There is a cook available each day and housekeeping hours throughout the week. There are two staff on waking night duty and management on call. All of the care staff are female one care record indicated that they would prefer a male member of staff to help him with his personal care. The homes Annual Quality Assurance Assessment indicated that 56 percent of staff have the National Vocational Qualification level 2 in care (NVQ2). This is recognised qualification for staff providing personal care to people. We looked at the recruitment records of two staff and found that staff had appropriate checks undertaken before they were employed. Staff completed an application form, made declarations as to their health and any criminal convictions, references were obtained and checks were completed with the Criminal Records Bureau. Staff have Care Homes for Older People Page 22 of 29 Evidence: training shortly after starting at the home in key areas such as first aid, safeguarding, fire safety and moving and handling. Rotas indicated that new staff have a period of time observing practice and getting to know people living in the home before they become one of the staffing numbers for a shift. Staff have a skills for care induction which is recognised by us. These measures help to keep people safe. Staff that have worked in the service for some time have completed the majority of mandatory training recently. Care Homes for Older People Page 23 of 29 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. Systems are in place for the effective management of the service some health and safety issues need to be managed so that the service received by people living in the home is consistently good and safe. Evidence: There is no registered manager for the home. The acting manager has worked at the home in a senior position for a number of years and is currently working on a National Vocational Qualification level 4 in care and will be undertaking the Registered Managers Award when this is completed. We have not received an application for the manager to be registered with us and this may affect the smooth transition of the services re registration under the Health and Social Care Act. We looked at the management systems in place and found the following. There are clear systems in place to handover the management responsibilities from senior to senior member of staff. There is a handover of the care needed for each person living in the home and allocation of work record. These records help to ensure that routine Care Homes for Older People Page 24 of 29 Evidence: safety checks, information about peoples wellbeing is passed from shift to shift. We found that the managers were auditing health concerns such as infections, challenging behaviour for each person and this was helping to look any patterns so that they could intervene early. Rotas indicated that staff meetings at all levels were in place. We also saw records of meetings held with people living in the home. Although there was not a clear Quality Assurance system in place that resulted in a report and an action plan it was clear that measures were in place to assess the service. The risk audits with the Annual Quality Assurance Assessment could be used to develop this Quality Assurance system. There was one person living in the home that was having a best interest assessment and the service was supporting this assessment. This means the person is having an assessment to determine their ability to make specific decisions under the Mental Capacity Act. These assessments protect peoples rights to make their own decisions where ever possible. We looked at the arrangements for the management for three peoples personal allowance money. We found that the cash held for people matched the record. There were two staff signatures for every transaction. There were clear systems for the transfer of responsibility for the money from staff member to staff member, audits of the money held were completed regularly and receipts were obtained for any spending. These measures help to keep peoples money safe. We looked at the health and safety records for the home. The fire officers had been to the home but were going to continue to visit because of the changes to the environment. There were certificates indicating that fire safety equipment had been checked and staff had received appropriate training. The service had certificate for gas safety. There was a certificate in place for electrical safety however changes in the homes environment may mean that this should be completed more often. As stated in the environment outcome area the management of the refurbishment was not coordinated enough to ensure that health and safety risks to people were appropriately minimised. Care Homes for Older People Page 25 of 29 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 26 of 29 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 19 13 (4)(c) Areas of the home that have been refurbished must be completed and assessed as safe before put in use. This is to minimise the risk of injury to people living in the home. 31/05/2010 2 19 13 (3) Plans must be put into 31/05/2010 place to minimise the dust in all areas that people have access to. This is to ensure to minimise any risk of ill health to people living in the home. 3 31 10 An application must be made to register a manager for this home. This is to ensure that the manager is accountable for the service provided. 11/06/2010 Care Homes for Older People Page 27 of 29 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 have dates on when they are written and when any detail on them is changed to ensure that changes can be tracked. Where risks to people are identified plans must be put in place and action taken. All shared rooms should have scrrening to ensure that peoples dignity is maintained whilst personal care is given or if they are unwell. Activities provided should be more individual to the person and reflect their: - current and past interests, culture and abilities. Meals should be available to reflect peoples culture and lifestyle before admission. Positive and negative comments from people living in the home and other stakeholders should be recorded so that themes of dissatisfaction and approval are identified. Consideration should be given to improving the signage in the building to assist people identifying their bedrooms, fire exits, toilets and so on. Risk assessments should be put in place before the use of any new equipment. The home should develop a Quality Assurance system that looks all areas of the service, involves people living in the home and stake holders views and results in an annual plan. 2 3 8 10 4 12 5 6 15 16 7 22 8 9 22 33 Care Homes for Older People Page 28 of 29 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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