Care Home: Ashgrove House

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What the care home does well People who live at the home, and their relatives, told us that Ashgrove House is a pleasant and well cared for environment. One person commented `a nice happy home` and somebody else said `Everyone is kind and helpful`. When we visited Ashgrove House we saw that the environment was homely and the communal areas looked festive prior to Christmas. The home has a well established programme of social activities and provides a varied range of entertainments. Different themes were being chosen during the year to provide a focus for activities and social events that would be of interest to people. In November 2009 for example, the theme was `Remembrance`. People generally spoke favourably about the food. There is a varied menu and we observed people being well supported with their meals. Staff were aware of one person who needed encouragement with eating their lunch. We saw staff talking to this person in a positive way and offering them different items for lunch that they might like. The home was awarded an excellent rating for the standard of the kitchen when last inspected by an environmental health officer. People who gave us their views were very appreciative of the care and support that they receive from staff. Their comments included `The greatest asset is the staff who are all very caring in their individual ways` and `All staff seem to care. They are really kind and loving`. The home expects staff to obtain a relevant qualification, which helps to ensure that people are supported by competent carers who work in a professional manner. National Vocational Qualifications (NVQ) are being well promoted and over 86% of the staff team have achieved the qualification. The home has achieved the `Investors in People` (I.I.P.) standard, which recognises the commitment being shown to improvement and on-going development. People are generally well protected by the arrangements being made for the recruitment of new staff. People`s comments showed that the home`s manager has established good relationships with the people who use the service, and with their relatives. People told us about a happy and friendly atmosphere in the home, which they attributed to the manager`s approach. Their comments included `Nothing is too much trouble` and `All the senior staff are very approachable`. People said that they could discuss things with the manager and relatives told us that that they are made to feel very welcome at the home. What has improved since the last inspection? The home`s garden has been developed during the last year, to include a fountain, pond and raised flower beds with scented plants. The environment has been improved in other ways, for example some windows have been replaced and new furnishings and carpets fitted. Redecoration has taken place in a number of areas, including the lounge and several bedrooms.New activities and facilities are being provided, to give people further choice in their daily routines. More `comedy` related entertainments are taking place, and a second hairdresser now visits the home, in order to provide more modern styles for the younger people at the home. Developments such as these reflect people`s different interests and individual preferences. We have been given information in the AQAA about training that has been provided in new subjects, such as mental capacity. We have also been told about improvements that have been made in the staffing arrangements, for example by increasing staffing levels and the employment of new staff. What the care home could do better: The home needs to ensure that each person who stays at Ashgrove House has received a statement which sets out the terms and conditions for the provision of services and facilities. This is so that there are clear statements about the terms and conditions that have been agreed, and people have the protection that they are entitled to. The statement needs to be in the form of a written contract when a person`s care is being purchased privately. Pre-admission assessments are not always being completed in the right amount of detail, which results in a lack of information about some of people`s care needs. Overall, we found that the standard of care records and plans was inconsistent and people`s individual plans did not always reflect their current needs and conditions. This means that there is a risk that some people`s needs are not being fully met. We have made a number of requirements and recommendations about the care planning arrangements and how information is documented. There is a lack of monitoring and recording in some areas, which means that people may not be receiving support in accordance with their care plans. For example, turn charts are not being used consistently with people in relation to the treatment and prevention of pressure ulcers. The records show that people do not always receive support at the right times and it is difficult to assess the outcome of their treatment. The use of fluid charts also needs to improve to ensure that people`s fluid intake is more carefully monitored and any shortcomings can be quickly identified. People receive support with the safekeeping and administration of medicines. Some changes are needed in these areas to ensure that medicines are better managed and people are better protected as a result. We have made a recommendation about the training that is currently being provided for staff members. The home is generally being kept clean and tidy, although there are areas where hygiene should be improved and the risk of cross-infection reduced. There are other areas in which action needs to be taken to ensure that people`s health and safety is well protected. We saw bedrails that had not been fitted safely and assessments about their use were not being reviewed regularly. As part of the home`s system of quality assurance, a regular audit or check should be carried out in relation to care practice and standards in the home. This is to ensure that procedures, for example in connection with medicines, nursing care, and record keeping, are being followed correctly and are consistent with current guidelines. Key inspection report Care homes for older people Name: Address: Ashgrove House 63 Station Road Purton Wiltshire SN5 4AJ     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: Malcolm Kippax     Date: 0 4 1 2 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 44 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 44 Information about the care home Name of care home: Address: Ashgrove House 63 Station Road Purton Wiltshire SN5 4AJ 01793771449 01793772286 keithtrowbridgecare@ashgrovehouse.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Mary ColletteTrowbridge,Mr Keith Paul Trowbridge care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: No more than 10 persons with a physical disability between the ages of 30 and 64 years may be accommodated at any one time No more than 3 persons may be in receipt of day care at any one time No more than 3 service users with a terminal illness over the age of 30 years may be accommodated at any one time No more than 5 service users with dementia aged 65 and over may be accommodated at any one time The maximum number of service users who may be accommodated in the home at any one time is 34 The staffing levels agreed with Wiltshire Health Authority and set out in the Notice of Staffing dated 11 January 2000 must be met at all times Care Homes for Older People Page 4 of 44 Over 65 5 34 0 3 0 0 10 3 Date of last inspection Brief description of the care home Ashgrove House is a privately run home which provides nursing care to up to 34 people. The home accommodates people with a range of needs, the majority of whom are over 65 years of age. Ashgrove House has a central location in the village of Purton, a few miles from Swindon and the M4 motorway. The home is an older property with a purpose built extension. The accommodation is on two floors with a passenger lift available. There are twenty two single bedrooms and six shared rooms. The bedrooms have ensuite facilities. There is a large open plan communal space which has been arranged to provide a variety of outlooks and sitting areas. Qualified nurses are on duty at all times working alongside a team of carers. Other staff are employed to undertake key tasks, such as catering, cleaning, laundry, maintenance, and administration. The fees range from 713 - 915 pounds per week after the addition of FNC (RNCC). A Statement of Purpose and copies of inspection reports can be obtained from the home. Reports can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Older People Page 5 of 44 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: Before visiting Ashgrove House, we asked the homes manager to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their assessment of how the home was performing. It told us what has happened during the last year and about the plans for the future. We sent surveys to the home, so that they could be given out to the people who use the service, to staff and to healthcare professionals. The people who use the service were also given surveys which they could pass on to a relative. We had surveys back from twenty four people who use the service, seven staff members, seven healthcare professionals and nineteen relatives. They told us what they thought the service did well and what it could do better. We looked at all the information that we have received about Ashgrove House since the last key inspection in November 2006. We had also visited the home for a short Care Homes for Older People Page 6 of 44 inspection (known as a random inspection) in October 2007. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 26th November 2009. We made a second visit to the home on 4th December 2009 in order to complete the inspection. We met with the homes manager, Mrs Mark, and with the joint provider, Mr K. Trowbridge. During the visits we talked with people who use the service, and with staff. We went around the home and looked at a number of records. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Older People Page 7 of 44 What the care home does well: What has improved since the last inspection? The homes garden has been developed during the last year, to include a fountain, pond and raised flower beds with scented plants. The environment has been improved in other ways, for example some windows have been replaced and new furnishings and carpets fitted. Redecoration has taken place in a number of areas, including the lounge and several bedrooms. Care Homes for Older People Page 8 of 44 New activities and facilities are being provided, to give people further choice in their daily routines. More comedy related entertainments are taking place, and a second hairdresser now visits the home, in order to provide more modern styles for the younger people at the home. Developments such as these reflect peoples different interests and individual preferences. We have been given information in the AQAA about training that has been provided in new subjects, such as mental capacity. We have also been told about improvements that have been made in the staffing arrangements, for example by increasing staffing levels and the employment of new staff. What they could do better: The home needs to ensure that each person who stays at Ashgrove House has received a statement which sets out the terms and conditions for the provision of services and facilities. This is so that there are clear statements about the terms and conditions that have been agreed, and people have the protection that they are entitled to. The statement needs to be in the form of a written contract when a persons care is being purchased privately. Pre-admission assessments are not always being completed in the right amount of detail, which results in a lack of information about some of peoples care needs. Overall, we found that the standard of care records and plans was inconsistent and peoples individual plans did not always reflect their current needs and conditions. This means that there is a risk that some peoples needs are not being fully met. We have made a number of requirements and recommendations about the care planning arrangements and how information is documented. There is a lack of monitoring and recording in some areas, which means that people may not be receiving support in accordance with their care plans. For example, turn charts are not being used consistently with people in relation to the treatment and prevention of pressure ulcers. The records show that people do not always receive support at the right times and it is difficult to assess the outcome of their treatment. The use of fluid charts also needs to improve to ensure that peoples fluid intake is more carefully monitored and any shortcomings can be quickly identified. People receive support with the safekeeping and administration of medicines. Some changes are needed in these areas to ensure that medicines are better managed and people are better protected as a result. We have made a recommendation about the training that is currently being provided for staff members. The home is generally being kept clean and tidy, although there are areas where hygiene should be improved and the risk of cross-infection reduced. There are other areas in which action needs to be taken to ensure that peoples health and safety is well protected. We saw bedrails that had not been fitted safely and assessments about their use were not being reviewed regularly. As part of the homes system of quality assurance, a regular audit or check should be carried out in relation to care practice and standards in the home. This is to ensure Care Homes for Older People Page 9 of 44 that procedures, for example in connection with medicines, nursing care, and record keeping, are being followed correctly and are consistent with current guidelines. 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 10 of 44 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 11 of 44 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service had not always issued with a contract, which meant that their rights were not well protected. Action has been taken in connection with this since we visited the home. Peoples needs are assessed before they move into the home. However, the assessments are not always detailed enough, which means that there is a lack of information about some of peoples care needs. Evidence: It was reported in the AQAA that nobody who was privately funded had a written contract with the home. Several people who use the service told us in their surveys that they had not been given written information about the homes terms and conditions. A relative commented in their survey Contracts are not issued. The lack of an agreed contract meant that there could be misunderstandings about the Care Homes for Older People Page 12 of 44 Evidence: terms and conditions that applied, and people did not have the protection that they were entitled to. It was reported in the AQAA that a resident contract had been produced and we were told that one of the things that the home could do better would be to implement this. We received further information from the home after our visits about the issuing of contracts. We were sent a sample contract and told that this contract has been rolled out to all clients and client representatives. We were also told that the contract was available in many of different formats including Large print and a number of foreign languages. We were given information in the AQAA about the arrangements being made for assessing peoples needs before they moved into the home. Assessments were undertaken to ensure that the home could meet a persons needs. We were told that senior members of the team carried out a pre-assessment, and that the completed assessment forms were signed and dated. We looked at examples of pre-admission assessments that had been completed and were being kept on peoples personal files. Three assessments were examined in detail and we saw that there was variation in the completion of these. The assessment records contained a range of useful information, for example about peoples likes and dislikes, allergies, and their current health and mobility. There was information about particular concerns, such as falls, anxiety and difficulties with communication. However, not all relevant factors were being considered and recorded as part of the pre-admission assessment. This included for example, a lack of detailed information in relation to supporting one person with managing their diabetes and about another persons pressure ulcers. A body map had been completed in respect of the person with pressure ulcers, although this had not been completed on the day of admission. It also did not include a record of the pressure ulcers. Nutritional assessments using an appropriate tool had not been undertaken at the time of admission. During the random inspection in October 2007, we had looked at the documentation and records in relation to a person who was admitted for respite care. We had found shortcomings in the assessment process and there had been no formal reassessment of the persons needs on admission to the home. This had meant that the home did not have an up to date record of the condition of the persons skin, which had been of concern at the time. Care Homes for Older People Page 13 of 44 Evidence: The assessment process appeared not to have been reviewed since the random inspection and developed in the light of current guidance. The format did not highlight dependency and risk ratings, which would provide an accurate baseline at the time of admission. The home was not following guidelines from NICE (National Institute for Health and Clinical Excellence) for assessing the risk of pressure ulceration. These state that in clinical settings this should be done within six hours of admission. The assessment forms did not state the source of some information and the documentation was not being dated consistently. This could lead to misunderstandings about the accuracy of the information and how up to date it was. We read in the minutes of a team meeting in November 2009 that staff had been reminded about the need to complete the paperwork for new residents. Training had also been offered to staff in relation to the admission paperwork. Care Homes for Older People Page 14 of 44 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. People appreciate the way in which they are treated by staff and the care that they receive. Care plans and assessments do not always reflect peoples current needs and physical conditions. This means that there is a risk that some peoples needs are not being fully met. There is a lack of monitoring and recording in some areas, which means that people may not be receiving support in accordance with their care plans. People receive support with the safekeeping and administration of medicines. Some changes are needed in these areas to ensure that medicines are better managed and people are better protected as a result. Evidence: We were given information in the AQAA about the arrangements being made for supporting people with their health and personal care. In addition to care plans, a range of records were being kept concerning the nursing and health care that people received on a day to day basis. These included for example, risk assessments, monitoring charts, and records of appointments with healthcare professionals. Care Homes for Older People Page 15 of 44 Evidence: We looked at examples of peoples records and saw that each person had an individual care plan. We selected five care plans and associated records to look at in detail. Overall, we found that peoples needs were mostly being identified, although there were a number of shortcomings in the care planning arrangements and in how peoples care was being monitored. We saw examples of individual plans where areas of need were well described and clearly recorded. These covered a variety of areas, such as social care, communication, memory loss and the use of topical creams. However these standards were not being maintained consistently. We saw three peoples records where the information in their care plan did not cover all areas of need, or there was not sufficient detail. For example, there was a lack of information in relation to support with eating, and about pressure ulceration and its prevention. This concerned people who required a high level of support throughout the day. There were occasions when risks, for example in relation to falls and swallowing difficulties had been identified in the pre-admission assessments, but not later identified in a care plan or risk assessment. There was also a lack of detail in relation to continence assessments and the type of pads that people used. We received further information after our visits about the assessment of continence and the use of pads. We were told that the pads were colour coded; staff were aware of the size and type of pad to use with people; and an assessment tool was in place to assess an individuals continence needs on admission. Sometimes, a standard form of care plan was being used, which meant that particular factors, for example about the use of a catheter, were not individualised to the person. Peoples weight was being recorded, although the records did not show that this was being considered as a factor when air mattresses were being used in relation to the prevention and treatment of pressure ulcers. On occasions, the language used in the care plans was not precise. This included phrases such as normal limits, regular position change and as necessary, which did not show how often a particular task or intervention should occur. We also saw occasions when the information in care plans did not reflect what was happening in practice, indicating that the plans were either not up to date or were not being followed correctly. We read for example that one person used a zimmer frame to help with mobility, although we saw that they had a wheelchair, which they used by paddling with their feet. Another persons care plan referred to the application of splints, although these were not being used. Care Homes for Older People Page 16 of 44 Evidence: The completion of care plans and other documentation was not confirming to NICE (National Institute for Health and Clinical Excellence) guidelines in relation to pressure ulceration. One persons records included information about their treatment for a pressure ulcer. This included repositioning every four hours, although a record or turn chart was not in use to show when changes in position had taken place. This meant that there could be misunderstandings about whether the person had received support at the right times and it would be difficult to assess the outcome. Another person had a turn chart in use, however their records in relation to the treatment of pressure ulcers were not being completed consistently. We saw other monitoring forms that were not being consistently completed. These included records in relation to monitoring diabetes, bowel movements, and to food and fluid intake, where people needed support with eating and drinking. We looked at the fluid charts for one person and saw that on some days their daily intake had been recorded, while on other days it had not. The records did not show whether the person had received the recommended amount of fluid each day this information would help to ensure that any shortcomings were quickly identified and the persons fluid intake more carefully monitored. We had also found that there were shortcomings in the planning and recording of a persons care when we visited the home for the random inspection in October 2007. We saw reports on peoples individual records of their contact with GPs and other healthcare professionals. There was also evidence of appointments with health specialists outside the home. One person commented in their survey that the provision of a physiotherapist had meant that their family member in the home was continually improving. We asked the healthcare professionals in their surveys, whether the home sought advice and acted on it to meet peoples social and health care needs and to improve their well being. Four people responded Always and two people Usually. In their surveys, we asked the people who use the service Do you receive the care and support you need. Nineteen people responded Always to this question and five Usually. Several people who use the service, and their relatives, commented very positively in their surveys about how staff approached their caring duties, and the care that they provided. Their comments included The greatest asset is the staff who are all very caring in their individual ways and All staff seem to care. They are really kind and loving. Care Homes for Older People Page 17 of 44 Evidence: One relative commented in the survey Staff do not patronise or talk down to the residents. During our visits we observed staff working with people in a helpful and informal way. We noted that people were not always called by their own names and generic terms of affection were used instead, for example my love, lovely, gorgeous, darlin and good girl. Although these terms may have been used in a friendly and familiar way, it should not be assumed that everybody is comfortable with this. We looked at how peoples medicines were being managed and administered in the home. There were mostly suitable arrangements in place for the storage of medicines. A trolley system was being used, which enabled the medicines to be taken round the home. Other medicines were being kept in a cupboard under a sink. We discussed the location and contents of this cupboard, which contained various items including unnamed enemas. There were also boxes of suppositories, which were in somebodys name although there was no current prescription for these. A fridge was available for the storage of particular medicines. However, these medicines were less secure than those kept elsewhere, as the fridge was not kept locked, and the room where it was located was also not locked. The temperature of the fridge was being checked and recorded, to ensure that this was being maintained at an appropriate level. Controlled drugs were being kept in a separate cupboard. The size of the cupboard meant that it would be difficult to store more drugs than those currently being prescribed. We made a check of the controlled drugs stocks and found that these were being correctly recorded. Regular audits of the controlled drugs were being undertaken. During our visit on 26th November 2009 we observed staff when they were administering medicines. Staff were very supportive and helpful to people when giving them their medicines. We saw some areas where practice could be improved. A nurse carried the homes phone with her when doing the drugs round and was observed answering this on three occasions. They told us that relatives often came to talk when the medicines were being administered. Errors can occur if a person is distracted when administering medicines and the nurse did not wear a tabard to indicate that they should not be disturbed. When we visited the home again on 4th December 2009 we were told that a system to address this had been set up. We also saw occasions when medicines were prepared, although not given to people Care Homes for Older People Page 18 of 44 Evidence: straight away, and signed for before they had been administered. This was contrary to the homes own procedure for administering medicines. We observed the preparation of medicines for administration to people who used feeding tubes. Their care plans did not cover the use of medication with feeding tubes and we recommended that guidance is obtained about this. We also discussed the need to ensure that the testing of blood sugar levels in relation to diabetes is carried out in accordance with current guidelines. There were suitable arrangements in place for the recording of medicines received into the home, and of their administration to people. Hand written amendments to the administration of medicine forms were being countersigned. We saw two matters in relation to record keeping that were in need of attention. Medication that had been refused was being kept in an old tablet container, prior to its disposal through the pharmacy. However, no date was recorded on the bottle to show when it was first used, which meant that its contents could not be cross-referenced to other records. We saw that antibiotics were being dated on opening, although eye drops were being used and the date of opening had not been recorded. Care Homes for Older People Page 19 of 44 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 benefit from a well established programme of social events and the homes approach to finding new activities and ways of doing things. People maintain contact with their relatives, who are welcomed into the home. People generally enjoy their meals at the home and receive the individual attention that they need. Evidence: Information was displayed on notice boards in the home about the regular activities and one-off entertainments that were taking place. We read about a number of special events that had been arranged. One person had recently celebrated their 100th birthday, which included a visit from a string quartet. Another person had celebrated a 90th birthday with a singing group. A number of activities were being arranged each month around a specific theme. In November 2009, the theme was Rememberance. There were other activities which took place on a regular basis. This included a weekly visit from volunteers from the Pets As Therapy charity. We were given information in the AQAA about activities, such as exercise, reminiscence and aromatherapy sessions that were being held in the Care Homes for Older People Page 20 of 44 Evidence: home. We were told that the home participated in the villages social activities. Two staff members were employed to co-ordinate the homes activities and to provide practical support to people. In their survey, one relative described these staff as patient and dedicated. Transport from the home was available for trips out and to assist people with attending their regular activities in the community. We met with one person who attended a club on a weekday evening and they were getting ready for this during one of our visits. One person who completed a survey commented that their friend at the home was taken to concerts and outings on a regular basis, which keeps her mind active and in touch with the outside world. During our visits, some people were spending time in their own rooms and involved in their own activities, such as watching television and reading. One person told us I prefer to spend most of my time in my room and they let me do this. One person we met received support with looking after their own pet dog. They were very pleased to have been able to bring their dog with them when moving into the home We saw staff supporting people with some one to one activities, such as manicures and art sessions. The communal areas were arranged in a way that meant that a range of individual activities could take place at the same time. There was a separate hairdressing salon. We were given information in the AQAA about a number of improvements that had been made during the last year. These included organising a regular mens club session and providing more comedy activities. A second hairdresser was now visiting the home to provide more modern styles. We were told that a new social form had been implemented, so that more could be found out about peoples interests and what they liked to do. In their surveys, we asked the people who use the service whether the home arranged activities that they could take part in if they wanted to. Of the people who answered this question, thirteen people responded Always and five Usually. One person commented The home does a lot of activities, something going on everyday more or less. Details of peoples family backgrounds and significant relationships were recorded in their personal records. We saw information displayed in the home which would be of interest to relatives. In their surveys, several relatives mentioned that they visited the home regularly and commented positively about a friendly and welcoming Care Homes for Older People Page 21 of 44 Evidence: atmosphere. We observed the lunch arrangements during our visit on 24th November 2009. There was a dining area where most people had their meals. Some people had meals taken to their rooms, which we were told was their choice. Other people stayed in the main sitting areas and received individual support with eating their meals. Peoples views about the food were generally positive. In their surveys, we asked the people who use the service whether they like the meals at the home. Of the people who answered this question, seven people responded Always, seven Usually and two Sometimes. During our visits, different views were expressed about the choices and range of meals that were available. The homes menus showed a choice of dishes and we overheard a member of staff explaining the menu and asking people what they would like to eat. We observed people being well supported with their meals. For example, staff were aware of one person who needed encouragement with eating their lunch. We saw staff talking to this person in a positive way and offering them different items for lunch that they might like. After some initial reluctance, the person was offered a dish that they enjoyed eating. The meals for people who ate in their own rooms were taken to them in a trolley via the lift. Meals were plated up, with covers placed over the plates. Peoples puddings for the second course were taken to them at the same time. The bowls were not covered, which meant that the puddings could not stay as warm. We also thought that if the puddings were taken to people after their main course, then there would be an opportunity for staff to talk to them about their meal and what they would like to follow. We met with the homes cook, who said that she talked to people about their choice of meals. There was an emphasis on home cooking, with items such as soups being homemade. We were told that dieticians had been involved with specific individuals. Care Homes for Older People Page 22 of 44 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. Peoples concerns and complaints are being followed up. The home has procedures in place which help to protect people from harm and abuse, although these should be further developed. Evidence: The home had a written complaints procedure which was on display in the home. Most people who completed surveys confirmed that they knew how to make a complaint and who to talk to if not happy with something. In the surveys for healthcare professionals, we asked Has the care service responded appropriately if you, a person using the service, or another person have raised any concerns? Five people responded Always and one person Usually. Another person responded Not applicable to this question. It was reported in the AQAA that all complaints, except one, had been adequately dealt with at floor level, which had meant that no official complaints, except for one had been necessary. We were told that the one formal complaint had been resolved within 28 days. The home had kept a record of the complaint and we saw that a letter had been sent to the complainant confirming the outcome. One person commented in their survey: any queries or questions we want to know we have only to ask a member of staff - we both have no complaints. Another people Care Homes for Older People Page 23 of 44 Evidence: also commented that they had not had reason to complain. There was a policy on whistle blowing. We were given information in the AQAA about a range of procedures that were in place to ensure that people were protected from harm. These included for example, procedures for staff recruitment, carrying out risk assessments, and for dealing with peoples money and financial affairs. People could receive support with their personal money, so that it would be kept safely for them when not needed. We met with the homes administrator, whose duties included maintaining accounts in relation to peoples money and any items that were purchased on their behalf. We saw that records were being kept of transactions with receipts obtained, and peoples money was being kept securely on an individual basis. We also saw that some items and small amounts of cash were being kept more informally for people, without being dealt with and accounted for by the homes administrator. This was being kept in one of the medication cabinets. Notes had been written about some of the items received, although some cash had not been accounted for in a written record. See Management and administration section. It was reported in the AQAA that senior staff had been trained in DoLS (Deprivation of Liberty Safeguards) and that many staff had been trained in mental capacity. We were told that the home had started to use documentation in relation to mental capacity and DoLS, and that there were plans to complete mental capacity assessments, where necessary. Abuse awareness was included in the induction for new staff and the homes on-going programme of mandatory training. The home had copies of the local authoritys procedures for safeguarding vulnerable adults and its own policy for protecting people from abuse. Staff members told us in their surveys that they knew what to do if somebody had concerns about the home. The home has had experience of dealing with an allegation of suspected abuse. One incident at the time of last inspection was dealt with promptly and appropriately by the home. At this inspection we were told about action that had been taken in relation to an allegation about financial abuse affecting a person who uses the service. We also talked about the recent admission of a person who had moved in from hospital with a number of pressure ulcers. The extent and history of these ulcers had not been clearly Care Homes for Older People Page 24 of 44 Evidence: established at the time of admission. There had also been no action taken in relation to a safeguarding adult referral, which could have provided the opportunity for the circumstances of the pressure ulcers to be investigated with other agencies. The existence of pressure ulcers can be a sign of neglect or poor care, and people are at risk if the circumstances are not followed up. A safeguarding referral has subsequently been made following our discussions about this. Care Homes for Older People Page 25 of 44 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 homely surroundings and have accommodation that meets their needs. The home is generally being kept clean and tidy. However, there are ways in which hygiene could be improved and further action needs to be taken so that the risk of cross-infection is reduced. Evidence: Ashgrove House has a central location in the village of Purton. The home is an older property with a purpose built extension. The accommodation is on two floors with a passenger lift available. There were twenty two single bedrooms and six shared rooms. The bedrooms had en-suite facilities. There was a large open plan communal space, with a dining area. We were told in the AQAA that the homes garden had been developed during the last year, to include a fountain, pond and raised flower beds. Other improvements had included replacement of some windows and the fitting of new carpets and furnishings. Further improvements had been identified for the year ahead, including the redecoration of some areas. Day to day maintenance items were being identified and recorded for the attention of those employees who carried out repairs and work in the home. It was reported in the AQAA that the home had been awarded an excellent rating for Care Homes for Older People Page 26 of 44 Evidence: the standard of the kitchen when last inspected by an environmental health officer. We looked around the home. The communal space was furnished and decorated in a homely way and had been arranged to provide a variety of outlooks and sitting areas. We discussed a change of location for some maintenance records and clinical information that was on display, so that they would be less intrusive visually when in the communal areas. In between our two visits, the communal areas had been decorated prior to Christmas and looked very festive. It was reported in the AQAA that there were plans to find a cover for the difficult radiator in the front hall, and that all the other radiators in the home were covered. We saw that another radiator in a ground floor toilet was also uncovered and we were told that the location of this radiator meant that is was also difficult to fit a cover. The radiator was not in use, so it was not a hazard to people; however this meant that the room was unheated by the radiator. We talked to Mrs Mark about making an alternative arrangement for heating this room. There were various aids and handrails around the home to assist people when moving around the accommodation. We saw that a portable hoist was being used regularly. It was reported in the AQAA that new hoist slings had been bought so that each person who needed to be hoisted had two slings each. We were told when going around the home that people had individual slings in their rooms. We also saw that a number of items were being kept on a handrail in one of the corridors. From our conversation with Mrs Mark at the time, we believed that these were slings for people to use during the day. Since visiting the home, we have been told that these items were lifting belts; we have questioned whether a corridor handrail is the appropriate place to keep such items. We saw one person sitting on a sling when seated in the lounge after using the hoist. We received further information about this after our visits. We were told that this was a specialist sling which had been purchased for its specific use in this capacity and had been agreed for use in this way by the homes physiotherapist. In their surveys, we asked the people who use the service whether the home was fresh and clean. Of the people who answered this question, sixteen people responded Always and three Usually. The home looked clean and there were no unpleasant odours at the time of our visits. Anti-bacterial hand gel was available for people to use in the homes entrance hall. At the last key inspection we had made a recommendation about installing another Care Homes for Older People Page 27 of 44 Evidence: bedpan sterilising unit on the first floor of the home. Mrs Mark said that it had not been possible to do this. We were told that night staff carried out regular sterilising of commode buckets, although there was no documented system for ensuring that this took place on a regular basis. The condition of the commode chairs and buckets varied and looked like they may need to be replaced. Mop heads were being used, which we were told were disposed of when necessary. There was no system in place for ensuring that the mop heads were regularly laundered and stored dry, which would help to reduce the risk of cross-infection. Bed linen was laundered by an external contractor, and personal laundry was carried out in-house. Staff in the laundry told us about the procedure in place for managing infected and potentially infected laundry. There was a clear system for the marking of peoples clothes to ensure that they were easily identifiable. We saw that the concrete plinth for the washing machine and dryer in the laundry was not sealed and had become stained as a result. This was an infection control risk, as was the dust and debris that had accumulated behind the machines. We were told in the AQAA that storage in the home could be improved. When going around the accommodation we saw that the home was short of appropriate storage areas. Trays of cleaning materials were being kept in the en-suite areas of bedrooms, which took up space and was not a safe arrangement. Mrs Mark said that some trolleys were on order, and the cleaning items would be stored separately away from peoples accommodation in a secure area. Continence pads were being kept in bathrooms where they were readily available, but could be affected by moisture and be less effective as a result. We received further information about this after our visits. We were told that the continence pads were never present in the bathroom when a person was bathed; they were kept in their plastic bags; and the supplier had advised that if this is the case then they are not likely to be affected by moisture. Staff told us that there was a good supply of sterile gloves to use when undertaking personal care and dressings. We saw that some of the topical creams in use were not named, which meant that there was a risk of cross-infection through shared use. Care Homes for Older People Page 28 of 44 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 feel that they are well supported by the staff team, with a sufficient number of staff available to meet their needs. Staff members have the opportunity to obtain a relevant qualification and to undertake relevant training. This helps to ensure that people are supported by competent staff who are developing their skills and knoweldge. People are generally well protected by the arrangements being made for the recruitment of new staff. Evidence: In their surveys, we asked the people who use the service whether staff were available when they needed them. Of the people who answered this question, fifteen responded Always, three people Usually, and one person Sometimes. Staff members told us in their surveys that there were always or usually enough staff to meet the needs of the people who use the service. We looked at the deployment of staff when we arrived at the home on 26th November 2009. There were three nurses and seven carers working at the time. We were told that the number of carers varied, but could be as many as eleven or twelve on busy days. Other staff were employed to undertake key tasks, such as cooking, Care Homes for Older People Page 29 of 44 Evidence: housekeeping, cleaning, laundry and maintenance. Staff rosters were being maintained and we looked at examples of these. It was reported in the AQAA that staffing levels had improved during the last year. In the surveys for relatives we asked whether the homes care workers had the right skills and experience to look after people properly. Twelve people responded Always and three people Usually. Their comments included there are lots of very friendly, efficient and capable staff around and friendly, skilled and approachable staff. We asked the healthcare professionals in their surveys, whether the homes managers and staff had the right skills and experience to support peoples health and care needs. Four people responded Always and three people Usually. The home had achieved the Investors in People (I.I.P.) award. This recognises the commitment being shown to improvement and on-going development. The homes I.I.P. status was last confirmed in March 2009 following a review. We were told in the AQAA that all the permanent carers had completed induction training, as described and recommended by Skills for Care. Mrs Mark told us about the induction that new staff received when starting in the home. There was a written induction programme which included a three-day period when the new staff member got to know the homes procedures and received training in subjects such as fire, abuse awareness, core values and moving and handling. In their surveys, we asked staff members whether their induction had covered everything that they needed to know when starting the job. Four staff members responded Very well, two Mostly and one person Partly. We also asked staff members in the surveys about the training that they received. Five staff members said that the training they received gave them enough knowledge about health care and medication. Two staff members said that it didnt. All except one staff member confirmed that the training kept them up to date with new ways of working. We were told in the AQAA that 26 of the homes 30 permanent carers had a NVQ (National Vocational Qualification) at level 2 or above. We were told that two carers were also undertaking their NVQ. During our visits we met with staff who told us about the training that they had received. Two nurses told us that there were enough nurses trained in male catheterisation, suprapubic catheterisation and syringe drivers to support people on each shift. A carer told us about the training that they had received in dementia care. One carer commented: they always send you for training, training, training. Care Homes for Older People Page 30 of 44 Evidence: Records of induction were included on staff members training and employment files. We looked at the training records for eight staff members, including nurses and carers. Staff members had received training relating to health and safety and specialist areas of care. However the records showed that courses were not being attended consistently, and there were gaps in the records where staff members had not attended training in particular subjects. We were told about difficulties that had arisen with a training provider, which had also meant that some records in relation to training were not available in the home. We have received further information after our visits about the arrangements being made for staff training. This included a number of records relating to training that we did not see, or were not available, at the time of our visits. The information we received included an audit of mandatory training, a training plan for individual needs - 2010 and some new training documention that was due to be brought into use. This gave us more detailed information about the arrangements being made for staff training and the homes plans for the future. The training plan for 2010 focussed on specialist subjects that were to be covered in addition to the mandatory training. The plan included a varied range of subjects, for example diabetes, wound care, and end of life care. Other areas of training, for example in relation to learning disabilities and brain injury, were not included in the plan, although these were relevant subjects, given the individual needs of people who used the service. We saw from the 2010 plan that training was to be provided in Safety side application re: HSE guidelines, which reflected one of the shortcomings that we found during the inspection. We looked at the recruitment records for four staff members who had started their employment since the last inspection. The recruitment procedure included Criminal Record Bureau (CRB) and Protection of Vulnerable Adults list (POVA) checks. Written references, proof of the applicants identities, and their authority to work, had been obtained. The staff members had completed application forms, which included questions about their health, convictions and their employment history. We saw on one nurses application form that they had given their previous employer as a referee. Two references had been obtained, however this did not include one from the previous employer. In normal circumstances, a reference must be obtained from an applicants previous employer, although it was not clear from the records why this had not happened in this case. Care Homes for Older People Page 31 of 44 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 home is well run in particular areas. However, attention is needed to ensure that appropriate standards are maintained in relation to care and to health and safety, so that people are well protected. Evidence: Mrs Mark, the homes manager, is a registered nurse and has previous experience in care home management. Mrs Mark has completed the Registered Managers Award since the homes last inspection. Comments were made in the surveys and during our visits which showed that Mrs Mark has established good relationships with the people who use the service, and with their relatives. People told us about a happy and friendly atmosphere in the home, which they attributed to the managers approach. Their comments included Everyone is kind and helpful, Nothing is too much trouble and All the senior staff are very approachable. People said that they could discuss things with the manager and generally felt that communication with the home was well established. Care Homes for Older People Page 32 of 44 Evidence: Some people also suggested improvements that could be made, such as in relation to contracts and the sharing of information. People also mentioned a lack of space, for storage and for activities, and in the garden. Since our visits we have received further information from the home about the arrangements being made for storage. We were told We have learnt to make the best use of the space we have. We are very innovative on how we make the most use of the space we have. There is no current problem over space and clients are not inconvenienced by this either. We still have plenty of storage space, in the attics for instance which has lots of capacity. We were also told The garden is small at the front and rear but there is more seating and space than will ever be needed. Further information was provided about the arrangements being made to ensure that people could go out regularly. One person mentioned in their survey that there was a tendency for personal possessions and clothing to migrate. Since visiting the home, we have received a response to this from the home, which included We do not currently have a problem in this area. Occasionally laundry items are mislaid or end up in the wrong room despite proper labelling. Things always turn up however. Occasionally clothes are damaged in the laundry, when this is brought to my attention we will normally treat the individual to a free shopping trip ... The home had a policy for quality assurance, which included the use of surveys to obtain the views of the people who use the service and of their relatives. Mrs Mark said that the surveys had last been used in October 2008 and were due to be sent out again. The surveys from 2008 had been analysed and reported on. Since visiting the home, we have been told that the report for 2009 was now ready and the findings were being acted on. We talked to Mrs Mark about other arrangements that were in place in relation to quality assurance and improvement. We had been given a lot of information in the AQAA about what the home does well, how it has improved, and what could be done better. This inspection identified that, although the home did well in certain areas, there were concerns about significant aspects. These included for example, care planning and how peoples personal and nursing care needs were being responded to and monitored. In some areas the appropriate procedures were not being followed consistently. There was evidence that the home has not kept up to date with practice guidelines, or the management was not adequately checking, through audits or otherwise, whether standards were being maintained. Care Homes for Older People Page 33 of 44 Evidence: Some of the shortcomings that we found at this inspection in relation to care, had also been discussed at the random inspection in 2007. We also found at this inspection that records relating to peoples nursing and personal care were not being maintained consistently. It is important that records are completed appropriately; if they are not then there can be misunderstandings about the care that people have received, and an accurate assessment cannot be made of the outcome of care and of peoples conditions. There were also shortcomings in the way in which records were being written. For example, records were not always being signed and dated, and some records were completed in red, rather than black ink. As reported under Complaints and Protection some items and small amounts of cash were being looked after for people, but not being recorded appropriately. The home had written policies and procedures in relation to the health and safety of the people who use the service, visitors and the staff. During our visits we saw a health and safety file. This contained the records of risk assessments that had had been undertaken in connection with the environment and facilities. There was also a health and safety checklist, which was being completed annually, although a more frequent timescale could be useful in identifying any areas of concern. It was indicated on the most recent checklist that there was adequate storage in the home, although we found that there were shortcomings in this area. We saw records in relation to the servicing of the lift and the hoists. We were told in the AQAA that water was temperature controlled; temperatures were being recorded. When we went around the home Mrs Mark told us that staff checked the temperature of the hot water when supporting people with baths. There were books for recording these checks, although the records showed that the checks were not being carried out on each occasion. This was brought to Mrs Marks attention. We were told in the AQAA that yearly PAT testing took place. A fire risk assessment had been undertaken in 2009. We were told in the AQAA that new fire regulations were being met following recommendations that had been made at a fire officers visit. There was an evacuation plan which included the names of people at the home. Mrs Mark said that she checked the plan on a weekly basis. We discussed this and it was agreed that the plan also needed to be amended at other times, to ensure that the list of names was updated straight away when there was a change in the homes occupancy. Care Homes for Older People Page 34 of 44 Evidence: Some people at the home were using bedrails. We looked at a number of these and at the assessments that had been carried out about their use. The assessments identified the need to Fit safety rails correctly, although we saw examples where the fitting of the rails did not comply with current guidelines about their safe use. The assessments were not being reviewed regularly and did not take into account all the relevant factors. When in the communal room we observed two carers moving a person by holding them under their arms and lifting. Lifting belts were readily available but not being used, and this was not commented on by other staff who were working in the area. Since our visits, we have received information from the home about this: The illegal lifting manoeuvre observed by the inspector was performed by two of our most senior and experienced carers and was not actually a lifting manoeuvre. The lady in question stands and walks unaided; she also has memory problems and needs to be reminded at frequent intervals when she is getting up to move to the dining room for instance. The carers concerned believed, that by employing gentle pressure under her arms that she would concentrate on standing while being invited to do so, that this was satisfactory. They learnt a valuable lesson here, in that this action could be confused with lifting by the armpits. We have made our trainer and our physiotherapist aware of this so that they can use it in our future training sessions that it should not be done as it can appear to be an illegal manoeuvre. Care Homes for Older People Page 35 of 44 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 1 The registered person is 01/11/2007 required to ensure that a written plan as to how the service users needs in respect to health and welfare are to be met is in place for all service users, including those admitted for respite care. The registered person shall 01/11/2007 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. In respect of: * The recording of positional changes *The recording of mouth care *The recording of skin condition on admission 2 8 12 1 Care Homes for Older People Page 36 of 44 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Pre-admission assessments must be completed in full and in sufficient detail. This is to ensure that good information is available about peoples needs at the time of admission. Accurate assessments of peoples needs will ensure that care plans can be drawn up to direct staff on how the persons needs are to be met. 31/01/2010 2 7 15 Evaluations of care plans must include all relevant information about the person. The evaluations must take place when a persons condition changes. If care plans are not evaluated, reviewed and changed when necessary, staff will not be fully directed on how to meet peoples individual needs. 31/01/2010 Care Homes for Older People Page 37 of 44 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 3 7 15 If a person who uses the 31/01/2010 service has a need or a risk, a care plan must always be put in place to direct staff on how that need is to be met, or the risk is to be reduced. Care plans must be written in measurable language and must conform to research based evidence unless it can be demonstrated that this is not in the best interests of the person who uses the service. Care plans are needed to ensure that all staff know the actions to perform and are able to meet a persons care needs in a consistent way. 4 8 17 Full monitoring records must 31/01/2010 be in place to show that peoples individual needs are being met and they are protected from risk. These records must be reviewed regularly to ensure that care is being provided to people in accordance with their care plans. If the relevant records are not in place, then there is a risk that peoples needs are not being met in accordance with their care plans. Care Homes for Older People Page 38 of 44 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 5 9 13 Suitable arrangements must be made for the recording, handling, safekeeping, and safe administration of medicines received into the home. This includes ensuring that all medicines are kept securely and that appropriate procedures are being complied with in relation to their administration and recording. This is to ensure that peoples medicines are being safely managed on their behalf and they are protected because the medicines are being administered in accordance with the appropriate procedures. guidelines. 31/01/2010 6 16 13 Action must be taken to ensure that there is a good understanding of all the circumstances in which a safeguarding adults referral should be made. This is so that people at the home can feel confident that concerns are being appropriately followed up on their behalf. 30/01/2010 7 26 23 The plinth to the washing machine must be wipeable 31/01/2010 Care Homes for Older People Page 39 of 44 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 and clean, and all debris behind the washing machine and dryer must be regularly removed. This is to reduce the risk of cross-infection and ensure that good standards are maintained in relation to housekeeping. 8 26 23 A system must be in place which ensures that the mop heads are regularly laundered and stored dry. This is to reduce the risk of cross-infection. 9 29 19 Where applicable, a written reference relating to an applicants last period of employment must be obtained as part of the recruitment process. This is to so that the people who use the service are not being supported by staff who may be unsuitable to work with vulnerable people. 10 35 17 A full record and audit trail must be completed when people hand in money or other items for safekeeping in the home. This is to ensure that peoples finances are being 31/01/2010 31/01/2010 31/01/2010 Care Homes for Older People Page 40 of 44 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 safely managed and the risk of financial abuse is reduced. 11 37 17 All relevant nursing and care 31/01/2010 documentation must be in place and completed to the appropriate standard. This is to ensure that the home is complying with current professional guidelines. 12 38 13 Bed rails must not be used 31/01/2010 unless they are in a safe condition. Full risk assessments, in accordance with directives from the HSE and MHRA, must be undertaken in connection with their use. The assessments must be regularly evaluated. There is a large body of research based evidence which highlights the risks associated with bed rails. They must only be used if they are safe and if the risks associated with their use have been assessed appropriately. Care Homes for Older People Page 41 of 44 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 3 That the arrangements being made for undertaking preadmission assessment process are reviewed. This is to ensure that the assessments are more detailed, show who has contributed, and provide better information about peoples needs at the time of admission. That the use of standard care plans is avoided. This is to help ensure that there is an individual and person centred approach to describing a persons needs and the support that they require. That the quantity of fluid as recorded on peoples fluid charts is totalled every 24 hours. This is so that an assessment can be made of the whether people have received the required amount of fluid on a daily basis. That the settings on air mattresses are documented in peoples individual records. That the clinical indicator for the use of a urinary catheter is always documented. That the type of continence aid used is always documented. That all staff members are advised or reminded of the appropriate procedures to follow concerning the use of medication with feeding tubes and about the testing of blood sugar levels in relation to diabetes. Guidance in relation to feeding tubes can be found on www.swallowingdifficulties.com That the way in which medicines are stored is reviewed. This is to ensure that there is no risk of items going out of date and to prevent the use of unprescribed items. An alternative to storing medicines in a cupboard under the sink should also be looked at, as should the need for a larger controlled drugs cabinet. That a date is recorded on the tablet container marked refused medication to show when the bottle was first used and its contents can be cross-referenced to other records. That, in normal circumstances, the people who use the service are addressed by their own names. Other forms of address should only be used on occasions when this is known to be the persons preference, and this has been recorded as such. That the practice of taking the main and second courses at Page 42 of 44 2 7 3 8 4 5 6 7 8 8 8 8 8 9 9 9 10 10 11 15 Care Homes for Older People 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 the same time to those people who eat in their own rooms, is reviewed. 12 26 That the condition of commode chairs and buckets is reviewed and any which are no longer intact or wipeable should be disposed of and replaced. That all containers of topical creams are named, to ensure that they are only used with the appropriate individual. That the content of the training plan 2010 is reviewed to ensure that it reflects the needs of people who are currently using the service and the shortcomings that were found during the inspection. That care practice and standards in the home are audited or checked on a regular basis as part of the homes system for quality assurance. This is to ensure that procedures, for example in relation to medicines, nursing care, and record keeping, are being followed correctly and are consistent with current guidelines. 13 14 26 30 15 33 Care Homes for Older People Page 43 of 44 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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