Care Home: Beachlands Care Ltd

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What the care home does well Prospective residents are given full details about the home prior to moving in, the manager also carried out a comprehensive pre-admission assessment so that she may assess if the home is able to meet the residents, physical, health and social needs. Staff were seen to respect residents rights to privacy and dignity and interact with residents in a professional but friendly manner. Residents said that they are able to choose their own daily routines, and that they enjoy the activities and mini bus outings arranged by the manager. There is evidence that residents enjoy each others company and that staff support residents in maintaining their independence. Meals in the home offer residents a choice of nutritious, appetising meals. Residents reported to the inspector that meals in the home are good. The majority of residents are aware of the complaints policy and procedure and know how to make a formal complaints. Residents indicated that if they are unhappy about any aspect of their care they know who they can approach to get things put right. Residents are protected from abuse by stringent recruitment practices and staff undertaking Safeguarding Vulnerable Adults training. The home provides residents with a homely, warm and well maintained environment in which to live. On the day of this inspection the home was clean and there were no offensive odours. Through observation there is evidence of good infection control procedures in the home. What has improved since the last inspection? All new staff are now expected to complete a `Skills for Care Induction` within the first few weeks of their employment in the home. The new appointed manager has completed the application form for registration and is awaiting her registration interview. Working is taking place on a quality assurance system for the home. The manager has sent out resident, relative and external stakeholder questionnaires. She regularly monitors the work of the staff in the home, but up to present does not record her findings. Through discussion it was obvious that the manager knows what further work she must do to ensure the home has a good quality assurance system in place. What the care home could do better: The statement of purpose and service user guide must clearly explain what category of care is offered to residents in Beachlands Care Ltd., and specify that from time to time other categories can be catered for if the pre-admission shows that staff have the knowledge and the environment is suitable to meet that residents assessed needs. While care plans are generally good, further work could be done to show that the home uses a more person centred approach to care. Information relating to residents is to be found in several different places and this information would be more easily accessible in individual residents care plans. The manager must ensure that information is not kept collectively as this contravenes the Date Protection Act 1998. Improvements needs to be made to receipt, storage, recording and administration of medications to ensure that residents are not place at risk. While residents are offered activities in the home and a member of staff has been given responsibility as activities co-ordinator, more could be done to provide residents with a wider variety of activities that they could take part in. The manager needs to ensure that more staff apply for NVQ qualifications and receive all their mandatory training, so that they have the qualifications, knowledge and skills to meet residents needs and to ensure that residents are not placed at risk. For those residents who need to use wheelchairs in the home, footrests must always be in place to that residents are not placed at risk from injury. Key inspection report Care homes for older people Name: Address: Beachlands Care Ltd Marine Parade Seaford East Sussex BN25 2PY     The quality rating for this care home is:   two star good 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: June Davies     Date: 0 9 1 1 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 28 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 28 Information about the care home Name of care home: Address: Beachlands Care Ltd Marine Parade Seaford East Sussex BN25 2PY 01323891004 01323896311 berirvin@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Beachlands Care Ltd Name of registered manager (if applicable) Miss Paula Jane Hatt Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category ; Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Beachlands is registered to provide residential care to twenty-nine older people. The home is family owned and the proprietors are committed to maintaining a homely environment. Beachlands is a two-storey detached property situated on the seafront in Seaford. The home is located in close proximity to local amenities, bus and rail links. Resident Care Homes for Older People Page 4 of 28 Over 65 29 0 Brief description of the care home accommodation consists of twenty-seven single rooms and one shared room. Many of the bedrooms have en-suite facilities. The home has a range of communal areas which exceed the amount of space as outlined in the National Minimum Standards. These include a number of lounges and a large conservatory/dining area. The external grounds offer an attractive garden and patio area which overlook the sea. Car parking is available via the side of the property. The home has a passenger lift and a series of ramps which enable residents to access all areas of the home. More detailed information about the services provided at Beachlands, including the range of fees can be found in the home,s Statement of Purpose and Service User Guide - copies of these documents can be obtained directly from the Provider. Latest CSCI inspection reports are on available in the reception area of the home. Cost of hairdressing, chiropody, newpapers, magazines and other luxuries are not included in the fees. Care Homes for Older People Page 5 of 28 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: two star good 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: This unannounced key inspection took place on Monday 9th November 2009 over a period of 7 hours. During the inspection the inspector spoke with the Registered Provider, appointed Manager, members of staff and four residents. Observations took place of a lunch time meal and lunch time administration of medicines, staff interaction with residents and the environment. An short audit of medication records was carried out. Documents relating to the key standards inspected were viewed. Some information contained within the Annual Quality Assurance Assessments (AQAA) was also used. The inspector received ten resident surveys and reference to information contained within these surveys has also been used in this report. Residents spoken to on the day of this inspection and via the residents surveys reported that generally the home offers a good quality service. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose and service user guide must clearly explain what category of care is offered to residents in Beachlands Care Ltd., and specify that from time to time other categories can be catered for if the pre-admission shows that staff have the knowledge and the environment is suitable to meet that residents assessed needs. While care plans are generally good, further work could be done to show that the home uses a more person centred approach to care. Information relating to residents is to be found in several different places and this information would be more easily accessible Care Homes for Older People Page 7 of 28 in individual residents care plans. The manager must ensure that information is not kept collectively as this contravenes the Date Protection Act 1998. Improvements needs to be made to receipt, storage, recording and administration of medications to ensure that residents are not place at risk. While residents are offered activities in the home and a member of staff has been given responsibility as activities co-ordinator, more could be done to provide residents with a wider variety of activities that they could take part in. The manager needs to ensure that more staff apply for NVQ qualifications and receive all their mandatory training, so that they have the qualifications, knowledge and skills to meet residents needs and to ensure that residents are not placed at risk. For those residents who need to use wheelchairs in the home, footrests must always be in place to that residents are not placed at risk from injury. 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 8 of 28 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 9 of 28 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. The homes statement of purpose and service user guide need to be updated, to ensure that prospective residents are given the correct information. Prior to moving into the home prospective residents have comprehensive preadmission assessment carried out by the manager to ensure the home can meet their assessed needs. Evidence: The homes statement of purpose needs to be updated to reflect that from time to time residents with specialist needs are admitted into Beachlands Care Limited. Prior to admitting these residents the manager ensures that the home and the skills and knowledge of staff are able to meet the residents needs. The inspector viewed three pre-admission assessments for three residents who had been admitted into the home in the last year. These pre-admission assessments were Care Homes for Older People Page 10 of 28 Evidence: found to be detailed, and provided sufficient information on which to base a care plan. The manager uses the pre-admission assessments to ensure that the home is able to meet the residents needs. While the three pre-admission assessments viewed by the inspector, were for privately funded residents, the manager assured the inspector that if the resident is to be funded by the local authority, she would ensure that a care manager plan of care is applied for and received prior to admitting a resident into Beachlands Care Limited. Ten residents surveys received by Care Quality Commission, showed that these residents were given sufficient information about the home which enabled them to make a decision about moving into Beachlands Care Limited. The home does not offer intermediate care. Care Homes for Older People Page 11 of 28 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. Further improvements to care plans and daily reports will show that residents in the home are treated as individuals. Information in relation to health care and risk assessments should be on each residents care plan rather than kept separately, this will ensure that all information is easily accessible. The receipts, administration and recording of medication must improve to ensure that residents are not placed at risk. Staff demonstrate that they respect the residents rights to privacy and dignity. Evidence: Three care plans were viewed and found that while they contained good information, further improvements could be made to ensure that the care plans were more person centred. One risk assessment found in all three care plans was generic and related to hot water temperatures. Other risk assessments are kept in a separate file, and Care Homes for Older People Page 12 of 28 Evidence: should be retained on individual residents care plans. A daily diary is kept and related to residents visits to health care professionals and changes in medication, this information should also be transferred to residents individual care plans. There was evidence in the home that residents have access to health care specialists as and when required. Residents are weighed on a regular basis, with their weights being recorded collectively which contravenes the Date Protection Act 1998. All the above issues were discussed with the manager, who will endeavour to ensure that relevant information about residents is kept on each residents care plan. Daily reports were not explicit in relation to each resident, and did not record in detail, personal care, daily mood, visits from health care professionals or activities they have participated in during each day. During this inspection the inspector observed a lunch time medication round, and found that medication was not being administered appropriately and could place residents at risk of receiving the wrong medication. A short audit of medication was carried out which included viewing the Monthly Administration Records, from these records it was noted that prescribed creams where not being signed off when applied in accordance with prescription. There was an error found on one Monthly Administration Record, which the manager said was on the part of the supplying pharmacy, but this should have been checked on receipt of the medication, and the pharmacy informed and a request made for the Monthly Administration Record to be changed. On the Monthly Administration Records, there were many medications that the manager informed the inspector were no longer being given, and these must be removed by the pharmacy from the Monthly Administration Records to save confusion. Five members of staff have received appropriate medication training and are the only staff who are permitted to administer medication in the home. The medication policy and procedure was reviewed in April 2009. During the audit the inspector also noted that where some residents are prescribed PRN medication (as required) there is no PRN risk assessment for each resident. This matter was also discussed with the manager who will obtain the appropriate risk assessments and ensure they are put in place. A requirement is being made in this report in relation to medication improvements being made to help ensure that residents are not placed at risk. During inspection - inspector observed that staff talk to residents in a kindling and respectful manager. Residents requiring assistance with personal care have their privacy and dignity respected by staff assisting. Ten resident surveys were returned to CQC showing that nine out of ten residents saying that they always receive the care and support they need and one resident saying they usually receive the care and support they need. Seven out of ten residents Care Homes for Older People Page 13 of 28 Evidence: said they always receive the medical care they need and three residents said they usually receive the medical care they need. Six residents spoken to on the day of the inspection said they do receive good care and support and that their health care needs are met. Care Homes for Older People Page 14 of 28 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. Residents are able to make choice in regards to their daily lives, although there could be more choice of activities in the home, that residents are able to choose from. Residents are encouraged to maintain the independence for as long as they are able to. Meals in this home are good offering residents a choice and variety at each mealtime. Evidence: Residents are able to make choices in regards to their daily living routines. The home has recently employed an activity co-ordinator, who helps residents with activities. At present activities consist of arm chair exercises, manicure and hand massage, quizzes, bingo and some craft work. Occasionally outside entertainment is brought into the home. Residents should be involved in making decisions about the activities they would like have in the home, with the activities co-ordinator suggesting ideas. On the day of the inspection some residents went out in the afternoon on a minibus trip. There are regular minibus trips for residents who wish to take part. From surveys returned to Care Quality Commission, five residents said that there are always activities they can take part in, while four residents said there are usually activities Care Homes for Older People Page 15 of 28 Evidence: they can participate in with one residents saying that sometimes there is an activity they can take part in. Residents are encouraged by the manager and staff to maintain autonomy in the lives. Most the residents have elected a family member to manage their finances. There was no information in the home in relation to external advocacy services. The inspector observed that residents are encouraged to bring small personal items into the home with them when they move in so they are able to personalise their own bedrooms. Residents are able to have access to their care plans, although not all information in relation to individual residents is kept in accordance with the Data Protection Act 1998. This was discussed with the manager who will in future ensure that personal information is kept on each individuals records. The home supplies its resident with a four week rotating menu, there is a choice at all three daily meals. The inspector observed that menus are printed in large type and are placed on dining room tables so that residents can clearly see what food is on offer over the week. Where liquidised meals are required the food is presented in an attractive and appetising manner. The chef was able to confirm that he is able to cater for specialised diets as and when required. One resident who does not often wish to have the meal or choice meal is catered for in accordance with her wishes. From ten resident surveys sent back to Care Quality Commission, six residents said they always liked the meals in the home and four residents said they usually like the meals in the home. Residents spoken to on the day of the inspection said that the meals in the home are very good, and they are always given choice. Care Homes for Older People Page 16 of 28 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. Residents know that their complaints will be listened to and acted on. Staff have received the appropriate training in regard to Safeguarding Vulnerable Adults and this helps to keep residents free from abuse. Evidence: The complaints procedures which has been reviewed this year is available to both residents their friends and relatives. There have been two formal complaints made to the home since the last inspection. These complaints were recorded, investigated and response made to complainant in a timely manner. The registered provider and manager said that they also receive non-formal complaints (daily niggles) which they listen to and put right straight away. Four residents spoken to on the day of the inspection said that they would know how to make a formal complaint. From ten residents surveys returned to Care Quality Commission, seven residents said they would know how to make a formal complaint and three residents said they would not know how to make a formal complaint. The Safeguarding of vulnerable adults policy and procedure is in place and was reviewed in April 2009. There have been no Safeguarding Vulnerable Adults referrals since the last inspection. All staff have received training in the Safeguarding of Vulnerable Adults. All prospective new staff are CRB and POVA checked prior to being offered employment in the home. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home provides residents with space and comfort and there is evidence that good maintenance ensures that residents have a warm and comfortable home in which to live. Evidence: Beach lands Care Limited provides residents with a comfortable, warm, homely and well maintained home. There is level access throughout the home, with a passenger lift and series of ramps and grab rails to assist residents with mobility. The communal areas in the home provide resident with a warm homely environment, that is well furnished and maintained. Some of the five communal sitting rooms have views out to sea, which residents enjoy. In one smaller communal lounge area that can be used for entertaining relatives privately, the inspector noticed that it was being used for storage. A comment from a relative on one of the surveys returned to CQC, stated that she wished there was a room (not residents bedroom) where she could sit and talk privately with her aunt who is very deaf, she states that when she asks her aunt a question all the other residents answer for her. The outside space at the home is tidy and well presented and there is a patio area overlooking the seafront, that in good weather residents like to use.Four residents told the inspector that they like living at Beachlands Care, and that they like their bedrooms. The home on the day of inspection was clean and hygienic with no offensive odours. Care Homes for Older People Page 18 of 28 Evidence: Alcohol hand rub is supplied for visitors to prevent the risk of cross infection. It was observed that communal toilets and bathrooms are kept clean and are provided with grab rails and aids to help residents maintain mobility. Laundry room provides the appropriate washing machine and tumble drier. Comments on ten resident surveys showed that six resident said that the home is always fresh and clean and four residents said that the home is usually fresh and clean. A comment on one of the surveys said, the laundress is so appreciated. Care Homes for Older People Page 19 of 28 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. Staffing levels in the home at the time of the inspection were satisfactory to meet residents assessed needs. Staff levels of qualification and mandatory training must improve to ensure that residents are receiving care from staff who have the skills and knowledge to meet their needs. Staff recruitment practises have improved which helps residents being placed at risk of abuse. Evidence: On the day of this inspection there were sufficient staff on duty to meet the residents assessed needs. Four residents spoken to confirmed that they found staffing levels to be good. Resident surveys returned to CQC showed that seven residents said there was always members of staff available and three surveys said that there are usually staff available when needed. From evidencing staff certificates and the training matrix it was found that only 23 percent of staff have achieved a NVQ qualification, and that the is one member of staff in the process of completing this qualification and two other members of staff signed onto an NVQ course. Once further staff have completed this qualification, 46 percent Care Homes for Older People Page 20 of 28 Evidence: of staff will then have a Social Care qualification. The manager must endeavour to bring staff qualifications levels up to at least 50 percent. Since the present manager has been appointed staff recruitment practises have improved in that she ensures that all prospective staff are appropriately vetted prior to taking up employment in the home. She also ensure that appropriate written references are sought, one of which is from the previous employer. There was evidence of several forms of identification on each file. From viewing staff training certificates and the training matrix the inspector found that while all staff had attended some mandatory training course there was other mandatory training that not all staff had attended. This was discussed with both the registered provider and appointed manager who confirmed that they will ensure all staff will complete their mandatory training within the next six months. Care Homes for Older People Page 21 of 28 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. There is a new appointed manager in post who has applied to Care Quality Commission for registration. The quality assurance system in the home is in the process of being developed to ensure that throughout the residents receive the best quality of care. Residents personal allowances are well managed in the home and their money and records are kept safely. Health and safety in the home are generally well managed, but some further improvements need to be made to ensure that residents are not placed at risk of injury. Evidence: The home has undergone another change of manager since the last inspection. The present appointed manager has only been in post for a short while but has made Care Homes for Older People Page 22 of 28 Evidence: application in October 2009 to be registered by Care Quality Commission and is awaiting her interview date. The new appointed manager has worked in the home as a carer for a number of years and is known to both residents and staff. Residents told the inspector that the manager was very good and they knew they could approach her at any time. There is evidence within the documentation that the appointed manager is in the process of updating and amending to ensure that the standard of care that residents receive is recorded. While the appointed manager was able to show the inspector that she is in the process of compiling and quality assurance system in the home, at the present time, she has only got as far as sending out quality questionnaires to residents, relatives and external stakeholders. The appointed manager said that she does monitor systems used the home but does not record her findings. Discussion took place in regard to carrying out regular monthly checks on medication, administration of medication, care plans, reviews, daily reports, staff competency after training, cleanliness, cooking and laundry to name but a few. Regular fire, health and safety checks are carried out for every room in the building, and notes made of any issues that need rectifying. Through discussion with the registered provider and appointed manager it was pointed out that an annual development plan should be produced along with a summary of the quality assurance findings. At the previous inspection a requirement was made that a Quality Assurance System must be developed, bearing in mind the change of management, the changes made in the home since the present manager was appointed, and that the manager has started developing the Quality Assurance System, this requirement not be made for this inspection. Where the home has been asked by residents or relatives to look after personal allowances. There was evidence to show that all residents have their own separate finance sheet in a ledger and that all incoming and outgoing money is recorded. For any expenditure a receipt is retained, in a separate envelope. All monies and records are kept safely within the home. Mandatory training in relation to Health and Safety have been reported on under staffing in this report. The inspector viewed certificates of maintenance for all appliances used in the building. Logs for fire call point testing, emergency lights and hot water supply are carried out on a regular basis. The inspector did observe during the course of this inspection that two wheelchairs being used were without foot rests. This was pointed out to the manager who spoke to Care Homes for Older People Page 23 of 28 Evidence: members of staff about the risk of using wheelchairs without foot rests. The accident book showed that all falls and incidents are recorded appropriately and any concerns in regard to a resident falling regularly are reported directly to the residents General Practitioner or District Nurse. Care Homes for Older People Page 24 of 28 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 25 of 28 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 17 The registered person shall - 11/01/2010 (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user. Daily reports need to be more specific as to the residents well being, health care, and personal hygiene care. Information in relation to resident should be kept on their care plan. 2 9 12 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Medication must be 11/01/2010 Care Homes for Older People Page 26 of 28 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 administered safely to ensure that residents are not placed at risk. All prescribed medication must be signed off when administered or applied to each individual resident. Each resident must have an up to date Monthly Administration Record. Each resident prescribed PRN(as required) medication must have an individual risk assessment 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 Care Homes for Older People Page 27 of 28 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). 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