Care Home: Bankfield Premier Care

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What the care home does well Bankfield Premier Care care home provides an adequate standard of personal care to people living there. Most contact with them and their families was very complimentary about the manner in which they were cared for. One daughter described the home as "lovely" and another husband said it was "very good". However, comments were also received about the greater disabilities of people living there and the detrimental effect this was having on the home`s ability to care for them. The home has a good understanding of the particular needs of people living there and through a care planning process sets goals to enable them to be met. It has good policies and procedures to ensure a good standard of care and is particularly good in documenting their needs and wishes so that these can be followed. The home provides a good standard of meals and activities to ensure an enjoyable stay for those accommodated. Staff in the home receive a full induction and subsequent mandatory training to ensure they are well suited for their role. Although there has been a large turnover in staff the manager is managing to integrate the present staff team so that it works effectively. The manager herself, with the support of her deputy and senior care workers, provides a full management structure to provide support for care workers in the home. Bankfield Premier Care has full policies and procedures to ensure that people living there are safe and secure. What has improved since the last inspection? Since the last key inspection there have been a number of improvements to ensure that care is provided to an acceptable standard. The Statement of Purpose and Service User Guide have been updated to reflect the current position of the home. Risk assessments have been extended so that staff are aware of the specific risks associated with people living there. There has been improved activities so that people living in the home can be occupied positively. The premises have been significantly upgraded with the addition of new bathing, showering and hairdressing facilities. In addition, although further refurbishment is required, a start has been made to this process with the result that the upper floor is of a significantly improved appearance. The home has improved the training of staff so that they are more prepared for their role. What the care home could do better: Although the activities have been extended they need to be better publicised for the information of people living there and their families. Equally, the redecoration needs to be completed and, most importantly, an extra hoist provided so that staff can speedily assist residents when required. The home must introduce a quality assurance system so that continual improvement is encouraged. In addition, the home should have on site policies on the deprivation of liberty safeguards so that this information is readily available. Equally, although the home is a safe environment, this would be improved with an annual risk assessment so that any hazard can be systematically recorded and addressed.It is noticeable that people living in the home are increasingly ageing and infirm which is increasing the pressure on staff. The home should reconsider its registration conditions to reflect its new population and complete its staff complement so that people living there can be cared for more effectively. In this context, staff training in the field of dementia care is required so that they are fully equipped to meet the needs of people accommodated. Although the manager is well trained and experienced to undertake this role, she requires support through a line manager so that she can be assisted in progressing the home. Key inspection report Care homes for older people Name: Address: Bankfield Premier Care Gigg Lane Bury Lancs BL9 9HQ     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: John Mullen     Date: 1 3 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 27 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 27 Information about the care home Name of care home: Address: Bankfield Premier Care Gigg Lane Bury Lancs BL9 9HQ 01617648552 01617613689 deniserimmer@bankfield.org www.bankfield.org Mr David Arthur Hopkins care home 47 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home is registered for a maximum of 47 service users to include:- *Up to 47 service users in the category of OP (old age not falling within any other category). Date of last inspection Brief description of the care home Bankfield Premier Care is a care home providing personal care for older people over 65 years of age. It is privately owned and has not at present a registered manager in place although the current manager is expected to make an application for registration in the near future. It is a large purpose-built detached home situated in a residential area of Bury. It is close to main bus routes and is approximately 3 miles away from Bury town centre. There is limited parking to the front of the home for the use of staff and visitors. There is a large enclosed courtyard at the back of the home. The home is registered to care for 47 residents and provides accommodation on the ground and first floor. Most of the bedrooms are single rooms and 22 of the single rooms have an en-suite facility of toilet and wash hand basin. The bedrooms on the first floor are reached either by stairs Care Homes for Older People Page 4 of 27 Over 65 47 0 1 3 0 1 2 0 0 9 Brief description of the care home or a passenger lift. The home charges 415 pounds per week for private users and from 378 pounds for council referrals depending on an assessment of individual means. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced inspection of Bankfield Premier Care Care Home which included a visit to the service. All key standards were assessed as well as an additional standard. The inspection included information received since the last key inspection, including a random inspection on 13th January 2009 and the Annual Service Review on 12th May 2009. In addition it also encompassed information provided by the home through its Annual Quality Assurance Assessment document (AQAA). The AQAA gives an overall picture of the performance of the home as well as factual information about the service. Care Homes for Older People Page 6 of 27 Interviews took place with the manager, the deputy manager, the activity coordinator, a care worker, the cook and two domestic staff. Four users of the service were case tracked; that is their care examined in detail and members of their families were contacted where possible. People living in the home were spoken to and observed and any relatives visiting the home were also spoken to. Surveys were sent to staff and people living in the home. The premises were inspected and a large amount of documentation examined. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Although the activities have been extended they need to be better publicised for the information of people living there and their families. Equally, the redecoration needs to be completed and, most importantly, an extra hoist provided so that staff can speedily assist residents when required. The home must introduce a quality assurance system so that continual improvement is encouraged. In addition, the home should have on site policies on the deprivation of liberty safeguards so that this information is readily available. Equally, although the home is a safe environment, this would be improved with an annual risk assessment so that any hazard can be systematically recorded and addressed. Care Homes for Older People Page 8 of 27 It is noticeable that people living in the home are increasingly ageing and infirm which is increasing the pressure on staff. The home should reconsider its registration conditions to reflect its new population and complete its staff complement so that people living there can be cared for more effectively. In this context, staff training in the field of dementia care is required so that they are fully equipped to meet the needs of people accommodated. Although the manager is well trained and experienced to undertake this role, she requires support through a line manager so that she can be assisted in progressing the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is provided based on an assessment of need so that it is relevant to the individual person accommodated. Evidence: The manager stated that the home completes an assessment of people prior to admission so that their needs are known. In addition, the home receives information from Bury Council when appropriate for the same reason. Three of the four people who were case tracked had care needs assessments within their files which showed that these are completed to direct staff. Interviews with staff confirmed a good knowledge of the individual needs of people living there so that care can be given in an appropriate and individualised fashion. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are treated in an individualised and caring manner to promote their wellbeing. Evidence: Neither the recent inspections of this home nor the Annual Service Review revealed any concern about the care planning process which confirmed that it is conducted individually and thoroughly. A visit to the home and an examination of the files of people living there showed this remained the case. Each file contained an up to date care plan with appropriate goals so that the needs of people living there are identified and met. The care plans had been reviewed regularly to confirm their relevance and had been changed when necessary to show that the plans are a working document. Interviews with care workers, people living in the home and their relatives all revealed that individual needs were known and were being met. The last key inspection found that there was a need to improve some areas relating to meeting the health needs of people living in the home. This inspection found that this had been done and that health needs were both identified and being met Care Homes for Older People Page 12 of 27 Evidence: systematically. One daughter interviewed whose mother has complex health needs described the home as really caring and one hundred per cent effective. Examinations of files of people living in the home found full documentation of healthcare needs and recording of how these were met. The manager stated that the home has good relationships with providers of healthcare services and that they can be called upon easily when required. The AQAA stated that the home had full policies and procedures to ensure the correct administration of medicines. This was confirmed by a visit to the home which found a medication policy, updated in September 2007, which gave detailed guidance to staff on correct procedures. In addition, a tour of the premises revealed that there was appropriate facilities to store medicines, including controlled drugs, for the protection of people living there. Examination of documents found that medicines were being correctly recorded both in the case of controlled drugs and other medicines. Examination of training documents found that staff responsible for the administration of medicines had received recent training in this subject to confirm their competence. Contact with families and people living in the home during this inspection has been very favourable towards the manner in which staff provide personal care. Comments from families included they are really caring and the care is brilliant. Comments from people living in the home were equally positive about their care and included they are very good. An interview with the manager, confirmed by documentation seen, showed that all staff receive a full induction which includes training on the correct provision of personal care. In addition, an interview with the manager, confirmed by training documents seen showed that there are a high proportion of trained staff in the home and that practice is underpinned by correct principles. Observations during the visit to the home showed that staff interacted with residents in a pleasant and friendly manner and in accordance with good practice. Care Homes for Older People Page 13 of 27 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 home provides an appropriate range of activities for people living there within the context of their abilities so that they can be actively occupied. Evidence: Recent inspections of this home have commented on the need for a dedicated activities organiser and more activities. The AQAA stated that these had been addressed so that people living in the home can be stimulated more. An interview with the activities organiser found that she was under pressure to divide her time between this home and another and she was advised that this was not best practice in the interests of the people she supports. The interview showed that the activities coordinator had a good understanding of the particular needs of people living in the home, particularly the limitations of age and disability. She revealed an innovative approach to her work and that individual requests could be met. The activities are not being publicised within the home which would be preferable as providing full information to people living there and their families. The manager stated that the home has an open door policy so that people living there can be visited frequently at their convenience and that of their relatives. Contact with families confirmed this was the case and that they were welcome and informed when Care Homes for Older People Page 14 of 27 Evidence: they visited the home. Observations on the day of the visit showed that easy access was being given to relatives including one who takes his wife out of the home on a daily basis. A tour of the premises found there were a number of discrete areas where families could meet relatives privately. An interview with the manager revealed that the number of people living in the home who could either manage their own finances or are self medicating is nil so that these have to be managed on their behalf. The age of people living in the home and their physical disability continues to increase and that their ability to manage independently reduces. This was confirmed by a tour of the premises and meeting people living there which showed that there is a particular increase in the level of dependence which restricts their ability to act independently. Within that context, discussions with staff and observations during the visit revealed that the home does respect individual wishes when they are expressed. A tour of the premises included an inspection of the kitchen facilities and an interview with a cook to assess the standard of meals being served. The kitchen was of a good standard and was well equipped to provide the number and quality of meals required. The home provides a four week menu with choices at every meal so that individual preferences can be met. Observations of a lunch time meal showed that people were being effectively assisted to eat where necessary. Their comments included the food is very good and is decent. Care Homes for Older People Page 15 of 27 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. The homes policies and procedures are devised to safeguard people living there. Evidence: A review of evidence found only one complaint that had been notified to us and the manager stated that this had not been proven. The manager also stated that the complaints procedure had been updated with our address and that this information is contained in each bedroom for easy access. A tour of the premises found this to be the case. An examination of the complaints book found that there was a full complaints procedure in place which commits the home to the speedy resolution of any such issue so that people can be reassured quickly about any concern. An examination of the book recording complaints found two complaints which were fully recorded and actioned, with dates, so that the home could clearly show it had managed these matters correctly. No complaint was received during the course of this inspection from any person contacted confirming the other evidence of a good service. A review of evidence found that there had been one safeguarding issue which has been correctly referred to us so that the matter can be fully dealt with. On the day of the visit to the home this matter was being progressed by the police so that the matter can be resolved. The manager stated that this has had a profound effect on both herself and other care workers because of the implications of this. However, all other evidence has found no other matter which has questioned the integrity of the home or the staff working there. The home has Bury Councils safeguarding policy to Care Homes for Older People Page 16 of 27 Evidence: direct staff. An interview with the deputy manager found that she was fully conversant with the actions to be taken in the event of a safeguarding matter arising so that people living there can be protected by correct action. An examination of training documents showed that safeguarding is a compulsory subject for the training of staff so that they remain up to date in this subject. Care Homes for Older People Page 17 of 27 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. Some further improvements to the premises are required to enhance the conditions for people living there. Evidence: The AQAA stated that there had been significant improvements to the premises with the redecoration of the upstairs areas and the installation of new bathing and showering facilities. This was confirmed by the tour of the premises which showed that the new facilities are of a high standard and significantly help staff care for people living there. The redecoration of the upstairs area has produced a pleasant environment for people there. The downstairs area still requires remedial work to bring it up to the standard of the rest of the home. One relative, who was very complimentary about the care her mother receives, did state that the furniture was not of the required standard. The lounge areas are pleasant for their purpose and bedrooms are of a good standard with a significant number having toilet facilities for the convenience of the occupants. One issue that arose as a result of observations and interviews with managers and staff was the shortage of hoists in the home which led to a queue of people using the toilet facilities. The increased disabilities of people living in the home means that a high proportion are dependent on this equipment and all staff felt more was required to help them. The AQAA stated that the home has implemented new procedures to ensure a good Care Homes for Older People Page 18 of 27 Evidence: standard of hygiene is maintained. A tour of the premises found a good standard of cleanliness throughout, with appropriate action being taken to maintain this standard. The home employs three domestic staff and contact with two of them confirmed that there is full equipment and facilities to maintain standards within the home. Care Homes for Older People Page 19 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The increased disabilities of people living in the home require more staff who have been better trained to meet their needs. Evidence: The AQAA stated there had been a high turnover of staff recently resulting in a less integrated staff group. The manager felt this had improved but confirmed she still has a number of staff vacancies which is putting strain on the rota. She herself is covering some duties as was evidenced on the day of the visit to the home which detracts from her other responsibilities. The home is recruiting although there are difficulties in this area particularly in appointing senior staff. All staff interviewed felt there was a shortage of care workers in the home which was making it more difficult for them. Although the numbers employed appear reasonable for the size of the home, the physical demands on staff due to the disabilities of people living there is high. A large proportion require two care workers to move them which creates a high demand on these workers. This is compounded by the fact that a high proportion of people living in the home have dementia although this has not reflected in the registration document and, therefore, in the staffing numbers being employed. A review of evidence has found no concern with the number of qualified staff in the home which has been at a sufficient level to promote good practice. The manager confirmed that there is a good level of trained staff within the home to reinforce Care Homes for Older People Page 20 of 27 Evidence: practice. This was confirmed by interviews with staff which showed that they all had had vocational training, some at a higher level to further improve practice. The AQAA stated that there were full policies and procedures in place for the safe recruitment of staff. This was confirmed by the visit to the home where staff files were examined and found to contain all the necessary information for the proper and safe recruitment of staff. The manager stated that full police checks are undertaken prior to employment and staff files seen confirmed this. In addition, the files also contained terms and conditions of employment to specify the responsibilities of staff. The last inspection found the need for an improvement in some areas of training so that staff were fully equipped for their role. The manager stated that training is being provided regularly although she was disappointed that recent training had been cancelled at short notice by the provider which meant that some refresher training was outstanding. An examination of training records showed that a programme of training is being provided by the home to update staff. In addition, it showed that a full induction programme is provided to prepare staff for their work. However, none of the training records seen showed any training in the field of dementia care to meet the needs of a high proportion of the people currently accommodated. This was confirmed in interviews with staff. In addition, one relative contacted felt that this was a significant deficit in the training of staff. One member of staffs training record was not in the home which is contrary to best practice in that it does not allow an oversight by the manager. Care Homes for Older People Page 21 of 27 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 management structure should be strengthened to enable the manager to completely fulfill her role. Evidence: Since the last key inspection the registered manager has left and her deputy has been promoted to fill the post so that there is a level of continuity in management. The manager has a long experience of working in the home and is currently undertaking training to complete her qualification for her post. Her application for registration with us was returned as incomplete but she hopes to resubmit in the near future so that this matter can be resolved. An examination of her training record confirms that she has had regular training which has been refreshed as necessary to update her knowledge. In interview, she confirmed that she plans to take further training for the same reason. The position of head of care is currently vacant, but the manager said she received good support from other managers within the group to help her in her work. However, the lack of formal support for the manager is a weakness in the management structure which needs to be addressed so that she can be developed in Care Homes for Older People Page 22 of 27 Evidence: her role. This is compounded by her need to cover shifts at times which means other management functions, for example staff supervision, are falling behind schedule. The AQAA stated that the home uses questionnaires to gauge the views of people living there and their families about the home and adapt practice accordingly. However, the visit to the home could not locate any such questionnaires except for those being send by us as part of the key inspection. The manager accepted that there is a need to establish a full quality assurance system as a way of improving practice in the home. She is aware of the implications of the Deprivation of Liberty legislation and has had training in this subject to acquaint her with the legislation. The home has not made any such application and the visit did not find any example where this would apply. The manager stated the company had guidance for staff on this matter but it was not present in the home which would be preferable as a guide to staff. Due to the capacity of people living in the home, none are capable of managing their own finances. These are mainly managed by family members although the home does have individual records where it manages some monies on the behalf of people living there. An examination of those records for the four users being case tracked showed that they were individually maintained and were correct in their content. The home has secure facilities for the storage of monies for the protection of people living there. Previous inspections of this home have commented on the lack of formal supervision being provided to staff so that they can be directed in their work. This remains the case. The manager confirmed that she had started the process of supervision but admitted that it was very deficient in the frequency. Supervision records seen during the visit to the home confirmed this to be the case with a minimal of formal supervision being given. Interviews with staff also confirmed this to be the case although all felt they were well supported generally in their work. However, the lack of formal supervision has now existed for a considerable time and must be urgently addressed so that staff are given further direction and help in their work. A tour of the premises found the home to be a safe environment for the accommodation of elderly people. In addition, training documents seen at induction and subsequently showed that health and safety matters are being taught to staff regularly for the safety of people living there. An examination of documents held in the home showed that there are full policies and procedures in this area to underpin practice. In addition, the home is regularly checking its facilities to ensure the safety of the premises. However, there is a lack of an annual risk assessment of the premises which would be preferable to ensure that the home remains a safe environment. Care Homes for Older People Page 23 of 27 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 36 18 The registered manager 01/02/2010 must ensure that members of the staff team receive regular supervision and that this is evidenced as part of ongoing continuous professional development and to consolidate direction and recent training received by the staff team. (Timescale of 31st July 2008 not met). Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The home must complete its 01/01/2010 process of redecoration and provide an extra hoist. So that the premises are fully suitable for their purpose. 2 27 18 The home must complete its 01/01/2010 staffing complement. So that it can operate more effectively. 3 30 18 The home must provide training in dementia care So that staff can better meet the needs of people living there. 01/01/2010 4 33 24 The home must establish a 01/01/2010 system for reviewing quality. So that a programme of continuous improvement can be introduced. Care Homes for Older People Page 25 of 27 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 12 Activities in the home are publicised so that this information is available for people living there and their families. The home should reconsider its registration status to reflect the number of people being accommodated with dementia. The appointment of a head of care is required so that the manager can be more effectively supported. An annual risk assessment of the premises should be undertaken to ensure the continuing safety of the home. 2 3 4 27 31 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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