Care Home: Avery Lodge

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What the care home does well Residents and relatives we spoke to were happy with the care they received. One resident told us, "They understand me and look after me." Another said, "I don`t know what I would do without them." The staff made sure that residents had access to health care services either for check ups or for treatment if they were not well. Several residents told us that their health had improved since being at Avery Lodge. One said, "I wasn`t well when I came in but my goodness me they helped me to get better." Residents were encouraged to make choices and decisions about their daily routines. One resident told us, "There are no restrictions on what you do or where you go." Those we spoke to were happy living at Avery Lodge. One said, "It feels like being in your own home, I don`t think you could fault it." Most residents told us there were enough organised activities to suit them. There was open visiting which helped people to stay in touch. Everyone we spoke to liked the meals, which were described by various residents as, "great," "excellent," and "brilliant." Residents told us that they did not have any complaints but they knew who to speak to if they did. Staff had training and written guidance in adult protection. They understood their responsibility to report any suspected incidents to ensure they would be investigated. The staffing levels were flexible to make sure there were always enough staff. One resident told us, "Everyone gets their fair share of care and attention." Most of the staff had worked at the home for a number of years and knew the residents very well. All the residents and visitors we spoke to made positive comments about the staff. Various people described them as "friendly, brilliant, welcoming and kind." What has improved since the last inspection? The manager had written a new and detailed service user`s guide. This gave anyone thinking of moving into the home good information about the service and helped them to make a decision about whether Avery Lodge was right for them. After our last visit we made a requirement that all residents must have up to date care plans and risk assessments. Although this had been met, further improvements must be made to ensure that staff have enough written instructions to provide safe, appropriate care that matches residents` wishes. Since our last inspection the manager had drawn up a procedure to guide staff on the safe management of medicines. A number of areas had been redecorated and had new furnishings. Residents told us they were warm and comfortable and they liked their bedrooms. One person commented on the new TV and said that it made it easier for people to see and hear the television. There had also been improvements in the hygiene in the home. The visitors we spoke with all remarked that the home was clean. There were more opportunities for staff training, which helped to ensure that staff had the knowledge and skills to understand and meet the needs of the residents. Almost all of the staff held an NVQ in health and social care. Following a previous requirement the manager had put into place a system to monitor the quality of the service. Questionnaires were being sent out to residents, staff and visitors to find out if there were any ways the service could be improved. This had only just started and needed to be further developed in order to make it a useful exercise. What the care home could do better: The assessment that the manager carries out with people thinking of moving into Avery Lodge should be more detailed. This would help to make sure that staff have a clear picture of what the person was able, and liked to do, and what they needed help with. The risk assessment for unguarded radiators must be more robust to ensure that it takes into account the needs of people who are at risk of falling and burning themselves on hot surfaces. Key inspection report Care homes for older people Name: Address: Avery Lodge 93 Southtown Road Great Yarmouth Norfolk NR31 0JX     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: Jane Craig     Date: 1 2 1 0 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 29 Information about the care home Name of care home: Address: Avery Lodge 93 Southtown Road Great Yarmouth Norfolk NR31 0JX 01493652566 01493603627 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: avery.lodge@btconnect.com Mrs Sheryl Anne Hodgins,Mr Karl Michael Hodgins care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 13 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category Code OP Date of last inspection Brief description of the care home Avery Lodge is a detached property situated in a central location between Great Yarmouth and Gorleston. It is owned by Mr and managed by Mrs Hodgins. It is registered as a care home to accommodate 13 older people. The home is a three storey building with bedrooms situated on the ground and first floors. The accommodation is spacious and has 11 single and 1-shared bedrooms; nine of the bedrooms have en-suite facilities. The communal areas consist of three lounges and Care Homes for Older People Page 4 of 29 Over 65 13 0 0 5 0 5 2 0 0 9 Brief description of the care home one dining room, all on the ground floor. Access to the first floor can be via a chair or shaft lift. The front garden has been landscaped and has a seating area overlooking the pond and flowerbeds and the rear has a small car parking area, both enable wheelchair access. Information about the home, including the last inspection report is available on request. The weekly fees ranged between 300 to 342 pounds. The fees did not include toiletries, hairdressing and chiropody. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 5th May 2009. We also did a random inspection on 20th August 2009 to check on the progress the service had made to meet outstanding requirements for improvement. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. This visit was carried out on 12th October 2009 by one regulatory inspector. At the time of the visit there were 12 people resident in the home. We met with some of them and asked about their views of Avery Lodge. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the registered manager, visitors to the home and members of the staff team. We looked around the home and viewed a Care Homes for Older People Page 6 of 29 number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The manager had written a new and detailed service users guide. This gave anyone thinking of moving into the home good information about the service and helped them to make a decision about whether Avery Lodge was right for them. After our last visit we made a requirement that all residents must have up to date care plans and risk assessments. Although this had been met, further improvements must be made to ensure that staff have enough written instructions to provide safe, appropriate care that matches residents wishes. Since our last inspection the manager had drawn up a procedure to guide staff on the safe management of medicines. A number of areas had been redecorated and had new furnishings. Residents told us they were warm and comfortable and they liked their bedrooms. One person commented on the new TV and said that it made it easier for people to see and hear the television. There had also been improvements in the hygiene in the home. The visitors we spoke with all remarked that the home was clean. There were more opportunities for staff training, which helped to ensure that staff had the knowledge and skills to understand and meet the needs of the residents. Almost all of the staff held an NVQ in health and social care. Following a previous requirement the manager had put into place a system to monitor Care Homes for Older People Page 8 of 29 the quality of the service. Questionnaires were being sent out to residents, staff and visitors to find out if there were any ways the service could be improved. This had only just started and needed to be further developed in order to make it a useful exercise. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure was not thorough enough to ensure that staff had sufficient relevant information about a new resident on which to base their care plan. Evidence: Since the last inspection the manager had written a new service users guide. It provided comprehensive information about the home and the service people could expect. She was in the process of condensing the most useful information to be included in a brochure, which will be more accessible to people thinking of moving in to Avery Lodge. The manager obtained health and social care assessments for anyone referred to Avery Lodge but we were told that these were not always available until after the person moved in. The manager also carried out her own assessment, which helped to ensure that she understood the persons needs and could meet them at Avery Lodge. However, the assessments we saw did not include enough information about the Care Homes for Older People Page 11 of 29 Evidence: persons abilities, preferences or daily routines. This meant that staff would not always have a complete picture of the person on which to base their initial care plan. Despite this, staff told us that there were good systems for verbally communicating information between team members and the annual quality assurance assessment (AQAA) indicated that there had been no placements breakdowns in the past year. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in care records could result in residents needs not always being understood and met. Evidence: There had been improvements in the care records since the last inspection. Everyone had an up to date, daily care plan. These were accounts which told staff what care the resident needed and how they preferred to spend their day. Some people had other care plans to expand on the information contained in the daily plans. However, these were not sufficiently detailed. They did not always direct staff to provide care to help residents to maintain their independence or to take account of their preferences. There were also a number of gaps in the care plans. For example, separate members of staff told us exactly how they supported a particular resident when she was low in mood. The resident confirmed how the staff helped her when she was not feeling, 100 , and that this usually worked. However, these directions were not written in the care plan, which meant that new or temporary staff might not be aware of how to respond. Care Homes for Older People Page 13 of 29 Evidence: The care files we saw had all been signed by the resident or their relative to show their agreement with the plans. It was not clear whether there was an ongoing process for consultation and involvement in care planning. Family members we spoke to said they were always kept informed of any serious issues affecting their relative. We heard from residents, relatives and staff that the health care at the home was very good. The AQAA told us that the service was good at ensuring that residents had access to health care professionals and the records we saw confirmed that. A resident told us, They know what help everyone needs, they know what we can do and what we cant do. We were also given examples of how treatment and health care advice were incorporated into residents daily care. However, there were still some shortfalls in the care plans and other records relating to health care issues. The falls risk assessments were not detailed enough to assist staff to write meaningful plans to control the identified risks. The nutritional assessments had not been completed because staff were waiting for training to use the tool. There had been improvements in the moving and handling assessments and, following a re-assessment, there were no bed rails in use in the home. Residents and visitors told us that they were happy with the care at the home. Several said that their health had improved since being at Avery Lodge. One resident said, The longer I stay here the better I feel, and another commented, I have come off a lot of tablets since I have been here because I am so much better. One visitor told us their relative was, warm and clean and well looked after. Another said, I have no concerns when I go away, and a third told us that they had seen a big improvement in their relative since being at Avery Lodge. Following a previous requirement, the manager had drawn up a new medication policy. Staff with responsibility for handling medication had read it, and one told us, It is just what we do but it is always good to refresh your memory. Staff had received recent training in medicines management. None of the residents managed their own medicines but one told us, If I am going away for the weekend the staff get my tablets ready. Medicines were stored safely and there was no excess stock. There was a safe system for ordering medicines. There were complete records of medicines received, disposed of and of any stocks of medicines carried over from the previous month. These records contributed to the audit trail and helped to minimise any risk of mishandling. There were no gaps on medication administration record (MAR) charts and the tablets in the monitored dose Care Homes for Older People Page 14 of 29 Evidence: system matched the records, which indicated that residents received those medicines appropriately. However, there were minor discrepancies in the stock and records of one person who was taking tablets in a changeable dose. This could be a consequence of staff not carrying out robust checks when administering medicines and the lack of medication audits meant it had not been identified by the staff and could have continued indefinitely. Some residents were prescribed medicines to be given when required. There were no care plans or instructions to ensure that staff had guidance as to when individual residents needed this medicine. This is especially important if residents are not able to verbally communicate their need, for example, for pain relief. When the instructions on the MAR chart indicated a variable dose, staff recorded the amount given. This helped them to be able to track how much medicine the resident was having and whether the dose was effective. Controlled drugs were stored, recorded and administered in accordance with the policy. Residents we spoke to confirmed that staff were polite and respectful to them. The interactions we observed showed that staff treated residents as individuals and helped them to maintain their dignity and independence. Visitors we spoke to, who were not family members, told us that staff would tell them if the person they were visiting was not very well but would not say more than that in order to protect their privacy and maintain confidentiality. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service met the expectations of the residents, who were happy with the lifestyle at Avery Lodge. Evidence: The care records we looked at included information about the residents past social and family history and their preferred daily routines. When talking to staff it was apparent that they knew the residents very well. One told us, We know pretty much everyones routines and they usually like to stick to one. Throughout the course of our visit we observed that residents were given choices in all aspects of their daily lives. The people we spoke to confirmed this. One told us, There are no restrictions on what you do or where you go. Another said, If I want to stay in bed they tell me it is my choice. There were no care plans to support residents to meet their social and recreational needs. However, most residents we spoke to said that there were usually enough activities in the home. They told us there was a range of games, quizzes and entertainment they could join if they wished. A relative also said, They have been well entertained all summer, with something almost every day. Several residents mentioned how much they enjoyed the regular parties at the home and the outside Care Homes for Older People Page 16 of 29 Evidence: entertainer. Both lounges contained a selection of books, games and DVDs, which residents said they could help themselves to. All the residents and relatives we spoke to said they were happy with the home and it matched their expectations. One commented that they chose Avery Lodge because it was more, normal and homely. Another told us, It feels like being in your own home, I dont think you could fault it. Residents and relatives were satisfied with the visiting arrangements. Visitors said they were made to feel welcome and were always offered refreshments. Some residents went out with family members and staff. Several residents were able to go out on their own. There was a risk strategy in place for one person who was assessed as being vulnerable when going out without an escort. All the residents we spoke to said they were satisfied with the meals. They said they had plenty of choice and if there was nothing on the menu they wanted they could have something else. One resident told us, At the moment I feel I need to diet and they are helping me. Another said, The food is brilliant, no-one could fault it. On the day of the inspection the meals looked appetising and nutritious. There were two sittings for the main meal at lunchtime to ensure that people who wished to get up late had a suitable gap between breakfast and lunch. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the complaints and safeguarding procedures in the home. Evidence: The complaints procedure had been amended since the last inspection. Although there was a copy of the procedure in the service users guide, it was not on display in the home. This meant that not all visitors would have access to the procedure. Residents we spoke to said they could talk to relatives or could approach staff if they were unhappy about anything at the home. One said, If I have any problems I talk to whoever is on duty and I can guarantee it will be sorted. The AQAA showed there had been no formal complaints in the last year and none had been received by the Commission. The manager told us that she made sure she responded to any minor grumbles, which helped to ensure they did not escalate into complaints. All staff had recent training in safeguarding adults. There was also a copy of the local social services guidance, including the contact procedure, for staff to refer to. Staff we spoke to were confident they would be able to recognise abuse. They understood their role in dealing with suspected abuse and knew who to report to. The manager was also clear about her role and there were procedures in the home to assist in minimising the risk of abuse. The manager had received training in the Mental Capacity Act and other staff were Care Homes for Older People Page 18 of 29 Evidence: booked on a course next month. The training will help to ensure that residents rights are understood and protected. The manager told us that there was no-one currently living at the home who would be affected by the legislation. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the environment helped to make the home comfortable but the lack of thorough risk assessments for unguarded radiators may put people living at the home at risk. Evidence: There had been several improvements to the environment since the last inspection. There were new chairs in the lounge, which a resident told us were, Much better than the old ones, which were looking old. Another resident told us that the new flat screen TV in the second lounge, Makes it easier for people to see and hear. A new kitchen had been installed and several bedrooms had been redecorated; some had new flooring. The manager had a plan for ongoing redecoration and renewal to bring all areas up to the same standard. None of the radiators in the home were guarded. There was a general risk assessment, which indicated that none of the residents were at risk from heated surfaces. However, the assessment did not look at the needs of individual residents, for example, those with poor mobility who may be at risk of falls. Residents we spoke to were happy with their rooms. One said, I have a lovely room, it overlooks the ships, I have a great view. All the bedrooms we saw were personalised. Staff helped residents without families to make their rooms how they Care Homes for Older People Page 20 of 29 Evidence: wanted. The cleanliness in the home had improved since our last visit and all areas were fresh smelling. One resident told us the home was always clean and said, Your could eat your dinner off the floor. Some senior staff had attended infection control training and were cascading it to the others. A member of staff we spoke to said that all staff were aware of the importance of hand washing and had hand gel and paper towels around the home, in addition to gloves and aprons. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff, with appropriate training, to meet the needs of people using the service. Evidence: Residents we spoke to told us there were always enough staff to help them. One said, Everyone gets their fair share of attention. Rosters showed that the staffing levels were flexible. For example, extra staff were rostered throughout the previous week to meet one residents increased needs and ensure that the other residents still received their usual level of care. We received positive feedback from residents and relatives about the staff. One commented, The staff are brilliant; all of them. Another told us, You can have a laugh with them, none of them are stuck up. Others commented that staff were always there if they needed help, and that they did not know what they would do without them. The AQQA told us that the service was good at retaining staff and most had been at the home for a number of years. No new staff had been recruited since before the last inspection. The manager was aware of the need for a robust recruitment procedure to provide safeguards for residents. She told us she would not consider employing anyone without doing the appropriate pre-employment checks. Care Homes for Older People Page 22 of 29 Evidence: Staff training had improved. We saw evidence that staff had received training in most of the mandatory topics, such as health and safety, moving and handling and food hygiene. Other courses included, dementia care, supporting people with challenging behaviour and awareness of the mental capacity act. A number of other courses were booked for the remainder of the year. The AQAA showed that 91 of the care staff had an NVQ at level 2 or above. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was run in the best interests of the people living there. Evidence: There had been a consistent management presence since our last inspection. The manager had also nominated a senior member of staff to assist with administration and take the lead on updating and maintaining care records. The deputy manager continued to take the lead in practical care issues. These measures had led to some improvements in the day to day running of the home. Staff, residents and visitors we spoke to said the home was well managed. The manager had started a new system for monitoring the quality of the service, which included seeking the views of residents, relatives, staff and other stakeholders. Surveys were being distributed at the time of our visit. The manager discussed how she had made sure that the questions, especially those for residents, were meaningful and asked about issues that were important to them. She had plans to carry out audits of environment, systems and procedures. She had started with a full audit of Care Homes for Older People Page 24 of 29 Evidence: the kitchen and there was an informal action plan in place. On speaking with the manager she was clear about how she wanted the service to develop and improve. However, there was no written development plan and the AQAA did not provide enough clear information about the improvements planned for the next year. Several residents managed their own money, others were supported by family or other representatives. The manager did not hold any money or valuables on behalf of people using the service. Secure facilities were available if needed in an emergency. Staff had received fire safety training within a recent health and safety course. There was a fire risk assessment and servicing and maintenance of fire systems and equipment were up to date. However, the internal tests of fire alarms and emergency lighting were not carried out on a regular basis, which meant that minor faults may not be identified. The AQQA told us that maintenance and servicing of other installations and equipment was up to date. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must contain sufficient direction about how staff are to meet residents health, personal and social care needs. To ensure that residents receive the care they need in the way they prefer. 31/12/2009 2 7 13 Risk assessments and risk 31/12/2009 management strategies must be further developed. They must identify the potential risks associated with falls and nutrition and plans should contain sufficient direction to help to control the risk. This is to promote residents health and safety. 3 19 13 Risk assessments carried out 30/11/2009 in respect of uncovered radiators must take into account the needs of individuals living in the home. Any radiators deemed Page 27 of 29 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to be high risk must be guarded. This is to protect residents health and safety. 4 33 24 The planned systems for monitoring and improving the quality of the service must be fully implemented. This is to ensure that any shortfalls in the quality of the service are identified and addressed. 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 31/01/2010 1 3 In order to ensure that the prospective residents needs are understood, the pre-admission assessment should be more detailed. There should be clear criteria to help to guide staff when they should administer medication prescribed to be given when required. There should be regular medication audits to ensure that minor errors are identified and action taken to prevent them happening again. To ensure that all visitors are made aware of how to make a formal complaint, the procedure should be displayed in the home. There should be regular in-house testing of fire alarms and emergency lighting to ensure that they are always in good working order. 2 9 3 9 4 16 5 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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