Care Home: Astley Hall Nursing Home

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What the care home does well The focus of this inspection was to check if requirements had been met. Because of this, we did not look at all aspects of the service and may not, therefore, have identified some positive things about the home. Medication practices within the home have improved which means that people are protected by from harm. Medication administration and management will continue to check when we next complete a visit to the home as part of our regulatory activity to ensure consistency is maintained. People were generally well presented, with clothing appropriate for the weather. There was an open visiting policy and people were welcomed, so people living at the home were able to maintain important friendships and relationships. Staff training matrix is now in place so that training can be arranged, planned and booked. What the care home could do better: Care plans must be accurate, up to date and give clear guidance about how to meet the needs of each person in the home to ensure consistency in staff practices even when individuals needs change. It is important that when a person is identified as losing weight and or nutritionally compromised due to a medical/health need then staff practices must be improved in the area of recording each person`s nutritional intake in a precise and adequate manner. This will make certain that individuals are not left at risk from their health and or wellbeing deteriorating due to inappropriate monitoring and reviewing tools. To make certain that there is a system in place so that all nutirional supplements can be accounted for and therefore we are assured that people are receiving their nutirional supplements as directed. Ensure that there is continued monitoring and checks on medicines so that medication practices within the home are consistently audited to proect people from harm. Staff recordings must reflect what is happening in practice specifically in the area of staff practices when a person requires bed rails and bumpers in place so that risks to individual are minimised. Social stimulation and the provision of activities need improvement to make certain that it is meeting individual`s needs particularly as people who live in this home have varying levels of dementia. This should include more opportunities for people to access the community and `one to one` stimulation. Infection control procedures in the home must be put into practice with daily cleaning and audits to monitor this area of staff practices so that people are safeguarded from the risks of infections.The environment must meet the individual needs of people who live in this home and as stated in the statement of purpose. This is specifically in the area of providing orientation aids for people. Thorough employment checks and supervision arrangements must be put in place to make sure the people are suitable to work with vulnerable people living at the home. Action must be taken to demonstrate that all staff are competent in their work practice. The quality assurance audits must be more robust so that failings are recognised with appropriate actions taken to improve the service. Any adverse event affecting people living at the home must be notified to us and the local authorities safeguarding procedures followed without delay to show that people are safeguarded. Records must be more rigorously monitored and improved so that risks are recognised and controlled. This must include all accidents that occur including any subsequent action taken. Random inspection report Care homes for older people Name: Address: Astley Hall Nursing Home Astley Hall Church Lane Astley Stourport-on-Severn Worcestershire DY13 0RW zero star poor service 13/04/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Seel Date: 3 1 0 8 2 0 1 0 Information about the care home Name of care home: Address: Astley Hall Nursing Home Astley Hall Church Lane Astley Stourport-on-Severn Worcestershire DY13 0RW 01299827020 F/P01299827020 Carisastley@aol.com None Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Kailash Jayantilal Patel,Mr Jayantilal James Bhikhabhai Patel Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 48 Number of places (if applicable): Under 65 Over 65 0 48 0 dementia old age, not falling within any other category physical disability Conditions of registration: 29 0 48 The maximum number of service users to be accommodated is 48. The registered person may provide the following category of service only: Care Home with Nursing (Code N) to service users of the following gender Either Whose primary care needs on admission to the home are withi the followng categories: Old age not falling within any other category (OP) 48 Physical Disability (PD) Age 50 years and over 48 Dementia (DE) Age 50 year and over 29 Care Homes for Older People Page 2 of 18 Date of last inspection Brief description of the care home 1 7 0 6 2 0 1 0 Astley Hall Nursing Home, Church Lane, Astley, is a three storey, Grade II listed building, set in 20 acres of parkland and situated two miles outside Stourport-onSevern. Astley village is a short travelling distance away. Astley Hall is registered to accommodate up to 48 residents who require nursing and/or personal care needs relating to old age and physical disabilities. A maximum of 29 residents of the 48 may have dementia illnesses and 2 people with a physical disability may be between 50 and 65 years of age. Accommodation is provided on all three floors of the home, and access to all floors is gained via stairs or a central passenger lift. Mr and Mrs Patel are the registered providers. The current charges for living at this home can be obtained by interested parties by contactiing the home direct. Information regarding the home was available from the reception area in the Statement of Purpose, the Service Users Guide and the most recent Inspection report. Copies of these documents are given to each new resident or their relatives. Care Homes for Older People Page 3 of 18 What we found: We, the Care Quality Commission (CQC) undertook this random inspection visit to monitor requirements issued at the key unannounced inspection on the 12th and 13th April 2010. These requirements were relating to the safety and well being of people living at the home. This was because the service received a poor, zero star quality rating as a result of our key inspection. The home has also had a history of management instability and a number of incidents reported as safeguarding referrals. The registered manager resigned from their post on the day and the new manager was on their induction on the day we completed our key inspection on the 18th November 2009. This manager also left their employment with the home and a member of staff became the acting manager in the interim until a new manager was recruited in August 2010. This random inspection was unannounced, which meant the home was not given notice of our visit. Three inspectors spent ten hours at the home and the pharmacist inspector arrived at the home at 12:00 to inspect medications. We were told that there were thirty-three people living in the home on the day we visited. There is currently an agreed voluntary suspension with the proprietor and the local authority in relation to new admissions to the home. We were told that there have been no new admissions to the home since we last visited in June 2010. Where appropriate we talked with some people living at the home and staff which included the proprietor of Astley Hall, the manager designate and a manager from one of the proprietors other homes. We did not inspect all of the standards at the time of this visit. At the key inspection on the 12th and 14th April 2010 we issued a requirement that each person must have appropriate and accurate care plans, risk assessments and health care screening assessments to maintain their health and well being. The organisation provided us with an improvement plan, which told us compliance would be in place, within the timescale identified. We are aware that care plans were in the process of being rewritten into new formats. This process has been ongoing since our last key inspection on the 12th and 14th April 2010. At this key inspection we saw some instances where care plans had not been written so that staff had instructions to guide them whilst assisting and supporting people to meet their needs. For example, managing individuals continence needs, falls, expressing sexuality, eating and drinking and taking medications. At the random inspection on the 17th June 2010 we found that one person was noted to have a skin tear. We would have expected to see a clear audit trail of wound care, such as, descriptions, measurements or photographs. This would give important information about the healing or deterioration of the wound but this was not the case which resulted in insufficient monitoring to assess whether the wound was healing or deteriorating. This was to the detriment of this person as on the 14th June 2010 it was noted that this persons wound had deteriorated and they had been prescribed antibiotics as their wound had become infected. We were also told that staff observed there to be a maggot in this persons wound area. Care Homes for Older People Page 4 of 18 At this random inspection we looked at four peoples care records and one other persons partially. These are our findings:Health and Personal Care It was concerning to find that there continues to be inconsistency in the recording of peoples needs and how staff should meet these. For example, we looked at the care records for a person who was at risk of bruising and skin tears. We saw that the Waterlow assessment for this person indicated that they were at very high risk. We saw that care records guide staff to what creams/lotions need to be applied but records do not state how often staff should apply these. We also looked at the body map in the care records and found that three wounds were recorded on the 25th August 2010. We were advised that this person has been referred to the STAR project which is for people who are prone to skin tears. However, the actual plan for the wounds which guides staff in relation to their practices reflects unclear information in relation to the frequency and monitoring of wounds. We also looked at the care records for a person who was experiencing redness of both of their eyes. We looked to see if there was a care plan in place for staff to follow. We saw that there was an entry under wound care which confirmed that this person had a sore left eye, conjunctivitis. However, the hygiene records failed to provide information about the care of this persons red eyes so that staff are able to follow this to provide consistency of care. In another persons care records we saw that on the 30th July 2010 this person had a 1 cm split to their great left toe, the cause for this injury was not recorded. The plan showed the dressing to be used which was to be applied and reviewed daily. We saw that daily reviews were undertaken on three separate occasions but could not find any further reporting that would inform us about the progress of this injury. We observed that staff practices are not always reflecting what is written down in care planning information. Also as at previous inspections reviewing processes are not robust to make certain people are receiving the correct care to meet their individual health needs. For example, in one persons care records we saw that they were highly dependant and had a low weight. We also saw that this person had experienced skin tears in the past and had been seen by the tissue viability nurse. The dependency assessment for this person had not been updated since the 25th May 2010. Therefore it failed to show the deterioration in this persons condition. The nutritional assessment for this person was not accurate as the scoring on it was 14 which alerts staff to the fact that this person is at risk whereby it should have shown a score of 18 plus very high risk. We would have expected this person to have been referred to a dietician and have frequent weight monitoring more frequently. On the hygiene records of this person it states, X to have a new mouth care tray every day and carers are to give mouth care after every meal or as require. We found that this was not being completed and no mouth tray was seen in this persons bedroom. It was also noted, offer her drink every half hour. We saw on two occasions at 12:30 and 13:40 hours that this persons food and fluid records showed that they had had no lunch and no record of fluid since 12:20. Therefore the information on this persons record was not being put into practice as there was no record of fluid from 12:30 hours until 14:30 hours. At 14:30 hours we saw that this persons fluid balance chart had been completed Care Homes for Older People Page 5 of 18 at 13:30 hours Fortisip 200, half lunch, half yoghurt. The contents of the jug of orange and glass by the side of this persons bed were the same as at our last visit. We asked this person how they were as their mouth looked very dry, the person asked for a cup of tea and a biscuit. We used the call bell to summon a member of staff to assist this person. We checked with a nurse how they ensured that this person had their nutritional supplements? The member of staff told us that when they are on duty the nutritional supplements are put out for the care staff and then charts are signed. The nurse was unsure how staff monitor nutritional supplements which means we cannot be confident that each person who is having supplements are receiving them as directed. The recording of another persons weight was looked at and we saw that the person had an eating and drinking plan which confirms that the person required access to finger food throughout the day. We also saw another entry which stated to offer prescribed supplements and any problem report to the nurse in charge. The food and fluid intake chart told us that the prescribed supplements are not being given to this person. We saw that this persons weight was recorded in December 2009 as 44.5kgs and then no weight recordings until June 2010 where it was recorded 44.3kgs. The manager was asked about the lack of weight recordings but they could not explain the reasons why this persons weight check had not been done. In another persons weight records we saw that they had 10kg weight loss in four months. The care plan records for eating and drinking on the 11th August 2010 states slight decrease and to weigh weekly. There was no evidence that weekly weighing had been taking place. Although we did see documented that on two occasions it was noted that this person declined to be weighed. We would expect to see that the staff have recorded that this has been discussed with external medical professionals in the best interests of the person. The pharmacist inspector noted that the Medication Administration Records (MAR) reflect that this person was not having their prescribed nutritional supplements as instructed. One person at 09:15 asked us if they could have their teeth so that they could put these in their mouth. Whilst undertaking this task we noticed that this persons cooked breakfast and drink were on their side table untouched. The person said that they did not want their breakfast and or drink but would like to be helped to get out up. We pressed the call bell and waited for five minutes for a member of staff who said that they thought it was another room and had gone there first. We looked at this persons care records which told us that this person needed encouragement to drink and eat. Staff were directed to monitor the persons fluid intake daily and the care plans told us that the person was prone to urinary tract infections. However, on looking at the food intake chart later in the day it was noted that the person had had cooked breakfast and toast. The fluid balance chart stated that the person had had a drink of tea with the amount documented as part of the monitoring of this persons fluids. It was confirmed to the management team that this was not a true account as we had saw this persons cold breakfast and drink that morning untouched. We were told that this person has a diagnosis of dementia which affects their memory recall and therefore is reliant upon staff to ensure they are receiving a nutritional diet and if not, what intervention is required. We observed one person in bed with the bed rails in place but no protective bed bumpers in use. We looked at this persons care records and saw that an assessment dated the 2nd July 2010 had been completed indicating that bed rails were required to minimise the risk of this person falling out of bed. However, we saw that the bed rails assessment had not Care Homes for Older People Page 6 of 18 been agreed with this persons relatives and or representatives. Also we could not find any care plan in place for the use of bed rails and therefore no evaluation of the bed rails for this person. The assessment stated that protective bed bumpers must be used at all times when the bed rails are in use. A nurse told us that this persons bed rails and protective bed bumpers are always in place when this person is in bed. The manager told us that safety checks on bed rails are completed but we could find no records to substantiate this. We looked at this persons daily progress reports and not that they had an accident on the 18th August 2010 and were found sitting on the floor with no apparent injuries. We requested the accident report from the manager as we could not find this in the care records or central file. We were not provided with this. We also saw that this person was at high risk from falls and we found that reviews in their regard had been completed but we could not find any indication that this person had been referred to their doctor, physiotherapist and or falls co-ordinator for an assessment. It was concerning to note that there is some inconsistency in relation to reporting unexplained marks on a persons body. For example, in one persons care records we found a body map had been completed and discovered through speaking with staff that an extensive bruise to this persons left shoulder was unexplained. However, we saw no documentary information that would show us that staff alerted the local authoritys safeguarding team as an investigation was required to try to find the cause of the bruising. The manager said that they would now do this as we cannot be confident that staff are following procedures to ensure peoples safety is promoted and maintained. We discussed our findings in relation to health and personal care with the management of the service and informed them that the evidence did not demonstrate compliance with requirement issued at the key inspection or with their improvement plan. We highlighted that the care plans would not be effective unless there were consistent actions taken by staff to meet individuals needs and changing needs. We copied documents under Code B of the Police and Criminal Evidence Act and informed the acting manager and registered proprietor that the commission may consider enforcement action. Medications At the key inspection on the 12th and 13th April 2010 we issued five immediate requirements in relation to some medication practices which were potentially unsafe and told the proprietor that the storage, administration practices and records must be improved. We found that these requirements had not been met at the random inspection on the 17th April 2010. Therefore we copied documentary evidence which may be used in enforcement action. We served one Statutory Requirement Notice on the organisation in relation to the administration of peoples medications. These were used as part of enforcement action to secure improvements and keep people safe. The pharmacist inspector visited the home on 31st August 2010 to check the management and control of medicines within the service. The purpose of this inspection was to check compliance with a Statutory Requirement Notice (SRN) relating to medicines. We looked at medication storage and medication administration record (MAR) charts. We found that there was good documentation and recording of medicine records. We Care Homes for Older People Page 7 of 18 looked at four MAR charts, two from each floor and overall found that they were documented with a signature for administration or a reason was recorded if medication was not given. Medicines were available in the service to give to people. For example, One person was prescribed four different medicines. Another person was prescribed eight different medicines. All of the checks made for both peoples medicines were correct, which showed that they had been given their medicines as prescribed. We were told by a nurse that a detailed check had recently been made on all peoples medicines. We were shown a copy of this audit dated 24/8/2010, which had been completed by the Care Services Quality Team Officer who is from the local authority. Every MAR chart had been checked and detailed comprehensive comments made. These issues had been dealt with by the service. This means that there had been positive action taken by the service to ensure that safe arrangements were in place for medicine management. We found that there had been improvements in the management of medicines to ensure that medicines are given to people safely and as prescribed. We gave feedback to the Manager and explained that the service had complied with the SRN relating to medicines. Daily Life and Social Activities At the key inspection on the 12th and 13th April 2010 it was found that activities available need to be improved so that people can lead interesting and stimulating lifestyles that reflect their gender, personal taste and interest. At this random inspection we did not fully inspect social activities but we are aware and the management team are that this is an area that needs to continue to improve. Although we did not inspect all of the standards we did observe the lunchtime meal. We saw that tables were laid with paper table cloths which did not appear to fit the tables correctly and knives and forks. We did not see any condiments, napkins and or drinks were offered. The mealtime routine appeared to be disorganised with a sense that staff were preoccupied with completing tasks which meant that there was little engagement with people apart from one staff member. We saw one member of staff remove plates when people had finished eating and asking whether people wanted a yogurt. There was no mention of the alternative choice which was on the menu for that day. We observed that there were no trays or trolleys used which included a heated facility to ensure meals remain warm. These observations reflect that mealtimes require improving so that there are sociable and pleasant experiences for people. Environment At the key inspection on the 12th and 13th April 2010 we found that there was a lack of orientation aids, such as, different colour schemes for varying areas of the home and appropriate signage. This would assist people who experience confusion, memory loss or dementia can more easily orientate themselves around the home and maintain their independence. Also the homes environment requires some redecoration work this should ensure that people live in a home that is well maintained and pleasant. We saw that there continues to be a lack of orientation aids and this concerns us as it is stated that that this home is able to meet the needs of people with dementia. We saw names missing from peoples doors and there were names on some doors of people who were not in that particular room. We were made aware that some people have moved to other rooms but Care Homes for Older People Page 8 of 18 nonetheless this just adds to the confusion for people who live in this home and any visitors. It was a concern to find that a commode that we looked at had brown coloured soiling to under seat and extensive brown soiling to under seat part of frame when upturned. We found that this soiling could be easily removed with a damp cloth. This was pointed out to the manager as it shows that daily cleaning of equipment is not being done as it should which means that the homes infection control procedures are not always being carried out to protect people who are living in the home from infections. This was also the case when we looked at a pressure relieving cushion on one armchair. When the cover was unzipped there were brown stains on the inner cover of the cushion and a malodour evident from inside. We pointed out to the management team that the curtains that are used as dividers in bedrooms to afford people some privacy were very thin and had dirty marks on them. Also in a communal toilet area there were no paper towels for people to use. In the first floor lounge area we saw broken windows. There was evidence of offensive malodours in parts of the home and as at previous inspection the general decoration of the home looks tired which does not make a pleasant environment for people to live in. This was pointed out to the proprietor and management team at the time of our visit. Due to our concerns about infection control practices we issued an immediate requirement. This requirement tells the proprietor about the things they must do immediately so that people are not placed at risk from infections. At the previous inspection there were concerns raised about wardrobes that were not secured and were therefore a risk to people as they could fall. We saw that there were fittings to fix the wardrobes but some were not fixed to these. We also saw a wardrobe that was inappropriately secured to the wall and had exposed metal tacks used to secure the back panel of the wardrobe This was mentioned to the management team and we were told that wardrobes would be secured to walls immediately to ensure that people living at the home are not placed at risk from injuries caused by hazards around the homes environment. It was positive to see that there were no cardboard boxes obstructing corridor areas as was the case at the key inspection on the 12th and 13th April 2010. We were concerned about the ceiling in a persons bedroom which had suffered from a leak coming from the roof area of the home. This is the second time this has happened and we did ask the proprietor if a structural report had been done but were told this is not required. Staffing We looked at the personnel file of all of the nurses who work at the home. As at the random inspection on the 17th June 2010 we saw that the files are being organised by the receptionist/administrator and there were indexes to follow which is an improvement. However, the recruitment process was not robust for two nurses that have been recruited and or the new manager as they did not provide safeguards for people living at the home. One nurse had been employed and their reference from previous employer highlighted some issues that would require a degree of supervision in place. We looked at Care Homes for Older People Page 9 of 18 the staffing rotas and found that this nurse had completed weekend shifts without any supervision and would be effectively be the nurse in charge of the home as the proprietor has made the decision to decrease nurses to one at weekends. Another nurses reference indicated on it that a referral had been made to Nursing and Midwifery Council (NMC) and Independent Safeguarding Authority (ISA) which has been created to help prevent unsuitable people from working with adults and children. We saw no information that would confirm the reasons for these organisations to be noted on the reference and or if any risk assessments had been completed. This nurse had also worked weekend shifts without appropriate supervision in place. Due to our concerns we issued an immediate requirement instructing that all documentation stored on staff members recruitment files is in place ensuring that people living in the home are safeguarded by the homes recruitment procedures. There is a staff training schedule in place but the management team now need to ensure that all staff members training is consistently done in a timely manner as we have seen this lapse at previous inspections. We did see copies of the staffing rotas but at times it shows that only five care staff are on duty as opposed to six. We are also seriously concerned about the decrease to one nurse at weekends as opposed to two. In the week there are two nurses on duty. The proprietor is aware of our concerns. Management and Administration We saw that the managers reference from their former employer provided no information about their competency and or suitably for a management role. The second reference was from a past employer where the manager had worked some time ago. We looked to see if any further information had been sought but could not find any. We were told by the provider that the manager had done well at their interview. We found no interview notes and no information particularly in relation to the skills that would support the providers decisions in appointing the new manager to a home that needs improving to make certain that the home is run in their best interests of people who live at Astley hall. We saw that staff supervision is now being completed and staff that we spoke with confirmed that this was now the case. However the supervision records show that practice in this area could be improved upon as the documented information is very brief in detail. The manager recognises this as an area for improvement and confirmed that although they have had discussions with the manager from one of the providers other homes this is not documented anywhere. Therefore supervision practice within the home is a concern and must be improved in order to monitor staff competence and training needs. Gas and electrical certificates are now in place so that people can be assured that to show that the premises were maintained in a safe condition, There were records of unannounced visits by the person who the organisation has chosen to be their representative in compliance of Regulation 26, to monitor the management and running of the home. The reports highlighted some good practice improvements and some areas, which needed to be improved but in practice these, are not consistently being carried out to ensure that there is compliance with previous requirements and the homes improvement plan. Care Homes for Older People Page 10 of 18 What the care home does well: What they could do better: Care plans must be accurate, up to date and give clear guidance about how to meet the needs of each person in the home to ensure consistency in staff practices even when individuals needs change. It is important that when a person is identified as losing weight and or nutritionally compromised due to a medical/health need then staff practices must be improved in the area of recording each persons nutritional intake in a precise and adequate manner. This will make certain that individuals are not left at risk from their health and or wellbeing deteriorating due to inappropriate monitoring and reviewing tools. To make certain that there is a system in place so that all nutirional supplements can be accounted for and therefore we are assured that people are receiving their nutirional supplements as directed. Ensure that there is continued monitoring and checks on medicines so that medication practices within the home are consistently audited to proect people from harm. Staff recordings must reflect what is happening in practice specifically in the area of staff practices when a person requires bed rails and bumpers in place so that risks to individual are minimised. Social stimulation and the provision of activities need improvement to make certain that it is meeting individuals needs particularly as people who live in this home have varying levels of dementia. This should include more opportunities for people to access the community and one to one stimulation. Infection control procedures in the home must be put into practice with daily cleaning and audits to monitor this area of staff practices so that people are safeguarded from the risks of infections. Care Homes for Older People Page 11 of 18 The environment must meet the individual needs of people who live in this home and as stated in the statement of purpose. This is specifically in the area of providing orientation aids for people. Thorough employment checks and supervision arrangements must be put in place to make sure the people are suitable to work with vulnerable people living at the home. Action must be taken to demonstrate that all staff are competent in their work practice. The quality assurance audits must be more robust so that failings are recognised with appropriate actions taken to improve the service. Any adverse event affecting people living at the home must be notified to us and the local authorities safeguarding procedures followed without delay to show that people are safeguarded. Records must be more rigorously monitored and improved so that risks are recognised and controlled. This must include all accidents that occur including any subsequent action taken. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 12 of 18 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must be in sufficient detail so that staff have the instructions and guidance to meet each persons needs. This will ensure to ensure risks to individuals health and wellbeing is minimised. 18/06/2010 2 7 12 All care plans must be 18/06/2010 accessible to staff delivering the care and be a reflection of the care given and be reviewed and amended at the point where a persons needs change or routinely all staff must be aware of these changes. This will enable all staff to meet individuals needs at all times to make sure peoples health and safety is fully promoted and met at all times. 3 7 13 Risk assessments must be in 18/06/2010 place for all identified areas of risks to a persons health and wellbeing which must inform staff practices. This will help to maintain peoples safety at all times. Care Homes for Older People Page 13 of 18 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 4 8 12 To ensure that people with 18/06/2010 poor nutritional intake and or weight loss are monitored using a recognised screening tool as frequently as required by their risk assessment and care plan. This will ensure that staff takes required actions to promote peoples health and well being. 5 8 15 Action must be taken to 18/06/2010 ensure that all aspects of risk assessments identify and provide guidance for all areas of risk and reflect all changes to each persons health and needs, including short term care needs. This will make certain staff understand and review peoples specific needs so that they are not placed at risk of harm through neglect of care. 6 15 13 Arrangements must be 18/06/2010 consistently in place so that the quantity of food eaten by people who use the home is being assessed, monitored and reviewed. This should ensure that staff take appropriate action if people are not eating enough to maintain their health and well being. 7 18 13 All staff must receive appropriate safeguarding 18/06/2010 Care Homes for Older People Page 14 of 18 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action training and the homes procedures to protect vulnerable people must be implemented and followed diligently at all times. This is to safeguard all persons living at the home from risks of harm. 8 30 18 The competency of the registered nurses must be reviewed. This is to to ensure they have the skills and knowledge to identify and meet the residents care needs. 18/06/2010 Care Homes for Older People Page 15 of 18 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 1 19 13 Action must be taken to 31/08/2010 ensure that staff recruitment processes in the home are robust with required measures in place which must include risk assessments and supervision when on duty in the home. This will ensure that people who live at Astley Hall are fully protected. 2 26 13 Audits must take place to make certain that staff are following infection control practices in relation to daily cleaning which must include the environment and equipment. This should make certain that people who live at Astley Hall are protected from all risks of infection. 31/08/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Care Homes for Older People Page 16 of 18 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 13 People should have opportunities to access the local community with staff on a regular basis so that they are supported to lead interesting and meaningful lives. People should be offered a choice of meals daily and if individuals are unable to participate in this process their relatives and representatives should be involved. This will ensure peoples personal and dietary preferences are met. A pictorial menu may assist as an aid to this task. The planned programme of redecoration must continue so that people live in a pleasant environment. Continued improvements must be continued to meet the specific needs of individuals who experience dementia so that peoples privacy, dignity, rights, choices and independence is fully promoted. This will make sure that the environment not only meets individuals specific needs but is in line with homes are for living in. The management team must continue to review and audit the suitability of the premises against recognised national guidance such as Alzheimers 50 Point Action Plan and the needs of current people who live in the home. Staff should be clear on their roles, be supervised at least six times a year, and have meaningful regular appraisals of their knowledge, performance, and development needs. We recommend audits of safe working practices and quality of care as well as observed practice is used to confirm competences. 2 15 3 4 19 19 5 22 6 36 Care Homes for Older People Page 17 of 18 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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 noncommercial 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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