Care Home: Beech House

What the care home does well The manager carried out an assessment before anyone was offered a place to make sure that their needs could be met by the staff team and that the environment was suitable. Everyone had a care plan which recorded their health and personal care needs. These were currently being audited by the new manager. Training in the Mental Capacity Act had been completed by six of the staff team including the manager. The manager was also to complete the Deprivation of Liberty Safeguards (DOLS) training in August 2010. Others were to complete this training in the future. Six staff had completed a National Vocational Qualification (NVQ) level two or three; others were working towards a level three. There was a sufficient number of staff on duty to care for the twenty residents who were living at the home on the day of our visit. The staff team was made up of registered nurses, care workers, two cooks, laundry assistant, domestic assistants, administration assistant and handyman. What has improved since the last inspection? There had been four requirements made in the previous inspection report of April 2009. These related to accurate recording of medication given, a risk assessment completed for those people who wished to manage their own medication, written assessments (where necessary) as required under the Mental Capacity Act and training for all staff in safeguarding adults. All of the above had been put in place and would continue to be monitored by the new manager. The conservatory had been re-decorated as had a small number of other rooms. The company had employed an activities organiser who worked five days a week. A weekly activities programme had been devised which included group sessions such as armchair exercises to music and one to one sessions for reading newspapers and discussions. What the care home could do better: The staff need to improve their record keeping in all areas of the care plans, daily recordings and care charts for those people being nursed in bed. This is to make sure that there is continuity of care both day and night and that all needs are being met particularly when people may have communication difficulties. Also recording of incidents should provide sufficient detail of what has happened, the action taken and the outcome. Accurate and detailed recording is necessary to make sure people are protected and kept safe. The manager should also make sure that the senior staff know that they must report incidents that affect the safety and well-being of the residents, deaths (either in the home or in hospital) and admissions to any accident and emergency unit. This requirement is to enable us to monitor the service for the peoples protection and safety. The statement regarding employment history in the application form should be amended to include `from leaving school or full time education and explain any gaps`. All photocopied documents should be signed to confirm that the originals have been seen. This is to make sure as far as possible that only suitable people are employed. The manager should introduce an induction programme that includes written evidence that the staff have understood what they have learned so that they care for the people in a safe and supportive manner. Training for staff in caring for people with a dementia type illness is necessary to make sure that they have the skills to care for this group of people who the management of the home tell us are the majority. The manager should also monitor the staffing levels so that there are enough staff on duty to meet the peoples specific care needs. The company need to upgrade the decoration and furnishings of the home as it is looking worn and shabby. As stated in the first paragraph the quality assurance assessment which forms part of our judgment process needs to be completed with more information about the service in the areas `what the service has done`, `how they have done it` and `what they intend to do`. Key inspection report Care homes for older people Name: Address: Beech House Yew Tree Lane Northenden Manchester M23 0EA     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: Jacqueline Kelly     Date: 2 5 0 5 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Beech House Yew Tree Lane Northenden Manchester M23 0EA 01619452083 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): S J Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 43. Date of last inspection Brief description of the care home Beech House is located in the Northenden area of South Manchester, close to local amenities. The home is registered with the Care Quality Commission to accommodate 43 residents over the age of 65; a the time of our visit the home had twenty people living there. The large extended detached house is set in its own grounds and has some car parking spaces. Peoples living accommodation is available on the ground and first floor, access to which is facilitated by a passenger lift. The building is accessible to wheelchair users via a ramp and the home is wheelchair accessible. Shops and access Care Homes for Older People Page 4 of 27 Over 65 43 0 0 6 0 4 2 0 0 9 Brief description of the care home to public transport is nearby and the home is within 1 mile of the M56. There are several lounge areas, a conservatory, and a separate dining room. The last inspection report of April 2009 is available on request. The fees range from £388.23 for residential care and £517.44 for nursing care. 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. The report was written on behalf of the Care Quality Commission therefore throughout the report the terms we and us were used. We last inspected this service on the 6 April 2009. This was a key inspection and we spent a total of five hours at the home. The manager did not know we were going to visit. Before this key inspection we asked the management of the home to complete an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, what they needed to do better and to give us current information as to employment of Care Homes for Older People Page 6 of 27 staff and training provided over the past twelve months. The information on the form was very basic and the questions asked how we (managers) have improved in the last twelve months and our plans for improvement in the next twelve months had not been answered. This needs to be looked at for future assessments as answering these questions shows that there is a commitment to improvement. Also all the other questions need to have more information and thought put into them. During the inspection we looked at the care files and care plans of three people who used the service and the personnel files of the care staff. We looked at other documents such as the menus and medication records. We talked to a small number of people who were sitting in the lounges or in their bedroom. We also talked with the manager, administration assistant, three nursing staff, and the two cooks. Everyone said that they were happy with the home and had no complaints. The staff said that they were well supported by the management and the residents said that they were well cared for. Questionnaires were sent out to the management of the home to distribute to ten people who lived at Beech House and ten to the staff team. At the time of writing this report we had none returned to us from either group. The information we received told us that there had been no complaints over the past twelve months. There had been one safeguarding adult protection referral which did not directly involve the staff of the home. However there were recommendations made by the investigating team from Social Services regarding the limited recording by staff of daily events. The previous manager who had commenced in January 2009; left the home in October 2009. A new manager was appointed in February 2010. We were told that an application form to register with us as the manager had been completed and was being sent to us week beginning 14 June 2010. 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: The staff need to improve their record keeping in all areas of the care plans, daily recordings and care charts for those people being nursed in bed. This is to make sure that there is continuity of care both day and night and that all needs are being met particularly when people may have communication difficulties. Also recording of incidents should provide sufficient detail of what has happened, the action taken and the outcome. Accurate and detailed recording is necessary to make sure people are protected and kept safe. The manager should also make sure that the senior staff know that they must report incidents that affect the safety and well-being of the residents, deaths (either in the home or in hospital) and admissions to any accident and emergency unit. This requirement is to enable us to monitor the service for the peoples protection and safety. The statement regarding employment history in the application form should be amended to include from leaving school or full time education and explain any gaps. Care Homes for Older People Page 8 of 27 All photocopied documents should be signed to confirm that the originals have been seen. This is to make sure as far as possible that only suitable people are employed. The manager should introduce an induction programme that includes written evidence that the staff have understood what they have learned so that they care for the people in a safe and supportive manner. Training for staff in caring for people with a dementia type illness is necessary to make sure that they have the skills to care for this group of people who the management of the home tell us are the majority. The manager should also monitor the staffing levels so that there are enough staff on duty to meet the peoples specific care needs. The company need to upgrade the decoration and furnishings of the home as it is looking worn and shabby. As stated in the first paragraph the quality assurance assessment which forms part of our judgment process needs to be completed with more information about the service in the areas what the service has done, how they have done it and what they intend to do. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process does not assess and record the persons social needs sufficiently so as to make sure that they will be met. Evidence: The people who were admitted through a local authority or through continuing nursing care had an assessment completed by a social worker or continuing care nurse. The details of these assessments were sent to the manager of Beech House. Upon receipt of the assessment the manager usually visited the person either at their home or in hospital. After the visit the manager completed the companys own assessment form. These forms had recently been amended to include information about the persons mental capacity under the Mental Capacity Act. However they need further amendments to include more information about the persons social and leisure interests for example; if they liked to read and if so what books or newspapers did they like so that the staff at the home could make sure that this activity was available. Care Homes for Older People Page 11 of 27 Evidence: This was discussed with the manager at the time of our visit. Everyone was given the chance to visit the home before making any decisions about admission and have a cup of tea or a meal if they so wished. The home did not have any intermediate care beds. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were being met however records did not always clearly identify the care given. Evidence: We looked at care files and care plans for three of the people who were living at Beech House at the time of our visit. We found that they were well organised and information was easy to find. The manager had recently been appointed and was in the process of looking at all the care files and care plans and was making amendments such as introducing separate sheets to record optician, dentist and chiropodist visits. During our walk round the home we looked at daily record charts for some of the people who were being looked after in their rooms. We discussed with the manager the need for the nurses and care workers to improve their recordings by being more descriptive about the tasks they had completed. For example to write down the amount and what food the person had eaten alongside the fluids taken. The staff also need to write when mouth care had been provided and if there were any problems and if so the action taken. These records are important to ensure that there is continuity of Care Homes for Older People Page 13 of 27 Evidence: care and that all needs are being met especially when the person has no verbal communication or has limited mental capacity. We looked at the storage and recording of medication; all was found to be satisfactory. The medication was stored in a locked cabinet within a locked room and the controlled drugs were locked in a cupboard within a locked cupboard. The medication records were all completed and up to date. None of the residents who were living at the home on the day of our visit was administering their own medication. Should anyone wish to do so in the future there was a risk assessment available for the staff to complete. The trained nurses were responsible for medication and all had received safe handling of medication training through Boots Pharmacy. The new manager now had a system in place to monitor medication and to discuss any problems during supervision with the nurses; all of which helped to make sure that people were being kept safe. As we looked around the home we found that the residents privacy and dignity was being respected by the nurses and the care staff. We found that staff knocked on bedroom doors before entering and people looked clean and tidy. We spoke to one resident who was able to communicate and she told us that she was very happy with the home, the staff, and had no complaints. Care Homes for Older People Page 14 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. People are provided with activities and a variety of home cooked food which they enjoy. Evidence: An activities organiser was appointed in March 2010 and worked five days a week from 9am to 3pm. A weekly activities programme which included games, discussions and special events such as a party for St Georges day had been introduced. We saw during our visit a group of the residents doing armchair exercises to music; all seemed to be enjoying themselves. The organiser also did one to one work with those people who did not want to join in group activities. A representative of the local Anglican church visited once a week. Relatives and friends were able to visit as and when they wished and there was the opportunity to meet people in private. The administrator was responsible for holding small amounts of money for residents to pay for day to day items such as hairdressing. A record was kept however we did not look at the records during this visit. Care Homes for Older People Page 15 of 27 Evidence: A number of bedrooms had been personalised with items that people had brought from home. People had a choice at meal times and one of the cooks asked them what they would like. A record was kept of the people who had an alternative. For those people who were not able to make a daily choice the cooks were aware of people likes and dislikes so that they were able cater for individual peoples appetite. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place are not always completed thoroughly to make sure that people are kept safe and protected at all times. Evidence: There was a complaints procedure which needed to be updated with our latest address and telephone number. The complaints procedure should also have timescales written in the policy as to when people can expect replies and investigations to be completed. This had been discussed with the previous manager but had not been implemented. It was therefore discussed again with the new manager who said that she would act upon the recommendation immediately. The information we received before the inspection said that there had been no complaints received over the past twelve months. There had been one safeguarding referral and investigation over the past twelve months which related to an incident between particular people who lived at the home. An investigation was conducted by Manchester City Council who made reference to the lack of detailed recording by the nursing staff of the home. It was suggested by the social work team that the training Recording with Care be added to the homes list of required training in order to improve the quality of record keeping. The new manager had agreed to this. Care Homes for Older People Page 17 of 27 Evidence: Training for staff in safeguarding adults had taken place as had training on the Mental Capacity Act. The manager was to complete Deprivation of Liberty Safeguards (DOLS) training in August . Care Homes for Older People Page 18 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. Not all areas of the home are well maintained to provide a tidy well decorated and furnished home. Evidence: We looked around the home which included the communal areas and a number of bedrooms. Whilst the home was clean it was in need of refurbishment in most areas such as decoration, floor coverings, chairs and bedding. The home in general was looking shabby and well worn. The new manager had started to make an inventory of what needed to be done. One bedroom was seen that had been re-decorated and did look much brighter. The manager said that new carpet and bedding was to be purchased which would improve the overall appearance further. 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 people who live at Beech House receive care and support from staff who have the skills to support them. Evidence: The home had sufficient qualified nursing and care staff for the number of residents living at the home at the time of the inspection. Additional care staff were on duty in the mornings to help people get up and dressed. A laundry assistant worked five days a week and there were two domestic assistants, administration assistant, two cooks and a handyman. Six of the care workers had a National Vocational Qualification (NVQ) level two or level 3 and a further three were working towards a level three. We looked at the personnel files of the last two people to be employed. We recommended that the application form be amended regarding employment history to state from leaving school or full time employment and explain any gaps. The file also contained two references, interview form and Criminal Record Bureau check. It was suggested that any photocopies taken of documents such as birth certificates and qualification certificates be signed and dated to confirm that the originals had been seen. Care Homes for Older People Page 20 of 27 Evidence: There needs to be a programme put in place for the induction of new staff. This should include the completion of a work book which would provide evidence that the person had understood what had been discussed and was aware of what they should do to carry out their duties. This was discussed with the manager who said that this was something she would look into. Training was on-going in all areas such as food hygiene, fire awareness, infection control and moving and handling. The new manager had a record of what training people had completed and what they needed to do. The majority of the people who lived at Beech House were suffering from a dementia type illness in varying degrees. Although some of the staff had received dementia care training all staff need to do this. Also the manager should continually monitor the situation to make sure that the staffing levels are maintained to cater for people with dementia particularly should more people be admitted with a dementia type illness. 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 current management systems do not always ensure the efficient running of the home and the ongoing improvement of the service Evidence: There had been an absence of a registered manager for approximately six months. The new manager commenced in February 2010. She had a nursing qualification and experience of working in a care home in a managerial capacity. She had completed an application form to register with the commission as the registered manager. The form had been sent to the owner for him to sign and send onto the registration team at the commission. This is the first step in the process to become the registered manager of Beech House. The new manager was in the process of producing a development/action plan. To assist in this it would be beneficial to seek the views of the people who used the service such as relatives as well as the people who worked and lived at the home. The manager had said during our visit that she hoped to have regular resident and Care Homes for Older People Page 22 of 27 Evidence: relatives meetings. The resident or a relative/advocate are responsible for residents money. The manager does hold small amounts of money for residents to pay for day to day items for which records and receipts were kept. Training in health and safety, fire awareness, moving and handling, first aid, infection control and food hygiene was on-going. Risk assessments were completed and kept in the care files. The management of the home is required to inform us of any admission to an accident and emergency unit and of any deaths that occur at the home or in hospital. This did not seem to have been happening. This may have been due to the lack of a registered manager however the owner should ensure that this requirement is adhered to at all times. It is recommended that the new manager makes sure that all senior staff are aware of the procedure. Guidance on this requirement can be found on the Commissions web site. The Annual Quality Assurance Assessment which the organisation were required to complete before the inspection was not good. The areas where we asked for information on where the home had improved and plans for improvement had not been completed. Also the information we did received to the questions what we do well, our evidence to show we do it well and what we could do better was very brief. This was not acceptable and requires improvement for future assessments. This was discussed with the new manager although we recognise that this was not completed by her. Care Homes for Older People Page 23 of 27 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 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 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 7 The daily records and charts should contain more information of what care has been given such as mouth care and food given. This is to make sure that there is continuity of care both day and night and all needs are being met particularly when people may have communication difficulties. The manager of the home should make sure that the care staff record all incidents as and when they happen and provide sufficient detail of the incident, the action taken and the outcome. Accurate and detailed recording will make sure that all the residents are protected and kept safe. The company need to implement a work programme to improve the decoration and furnishings of the home as it is looking worn and shabby. It is recommended that the statement regarding employment history in the application form be amended to include from leaving school or full time education and explain any gaps. All photocopied documents should be signed to confirm that the originals had been seen. This is to protect people and ensure that the only suitable people Page 25 of 27 2 18 3 19 4 29 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations are employed. 5 30 The manager should ensure that all the staff are trained to care for people with a dementia type illness as we were informed that the majority of the residents were suffering from this illness. The manager should also monitor the staffing levels to make sure that there are enough staff on duty to care for people who have mental health problems. The manager should introduce an induction programme that includes written evidence that the staff have understood what they have learned so that they care for the people in a safe and supportive manner. The Annual Quality Assurance Assessment (AQAA) was very limited in the information it contained and much of the information required was not provided. The owner and the new manager of the home need to look at this for future assessments so that we are given sufficient information to review the service provided and conduct of the home. The manager should make sure that all senior staff are aware of the requirement to report to us notifiable incidents such as deaths and admissions to any accident and emergency unit. This requirement is for the protection of the people who use the service. 6 30 7 33 8 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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