Care Home: Beechy Knoll

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What the care home does well People living in the home said that the care they were receiving was good. They made comments such as, "I like it here the staff are nice". "Everyone is kind" "Its lovely here". "The staff are pretty kind". "If you`ve got a problem the staff will help you". Health professionals said, "The home has good relationships with other agencies ie: district nurses and GP`s". People`s health care was monitored and access to health specialists was available. People said that they had a choice of food and that the quality of food served was "good" and "excellent". People said that they felt safe staying at the home. Training took place, to equip staff with the essential skills needed. What has improved since the last inspection? At the previous inspection ten requirements were issued. At this inspection six of the ten had been fully or partly actioned. Staff were fully aware of peoples current needs and wishes. Relatives said they were invited to be involved in the care planning and reviewing process. MAR sheets seen were fully completed. The manager was undertaking regular monitoring of the medication procedures. The manager was benefiting from the regular and consistent support of the newly appointed regional manager. What the care home could do better: The service provided at Beechy Knoll is of an adequate standard. Although improvements to the service have been made, further work is required to enhance the service and raise the quality rating of the home. So that staff are confident that peoples needs can be met, an assessment must be carried out prior to people being offered a place at the home. All information about peoples health, care and support should be recorded appropriately in their individual plan of care. When gaps are identified in the Medication Administration Records (MAR) sheets this should be recorded separately. MAR sheets should not be signed in retrospect. The on- going redecoration of the home should continue and particular care should be taken to ensure that people are provided with clean bed linen. So that people are kept safe any volunteers working in the home should be subject to the same checks that are carried out for employed staff. So that peoples health, safety and welfare is not put at risk, the linen cupboard doors should be kept locked shut and people should not be moved around the home in wheelchairs that have not got footplate`s in situ. There were a number of discrepancies in the records kept at the home. The reasons for these discrepancies must be investigated and appropriate action taken to ensure that records required by regulation are maintained, up to date and accurate. We acknowledge that the provider and manager continue to evaluate and monitor the service and make any changes necessary. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beechy Knoll 378 Richmond Road Sheffield South Yorkshire S13 8LZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sue Turner     Date: 2 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Beechy Knoll 378 Richmond Road Sheffield South Yorkshire S13 8LZ 01142395776 01142646063 beechyknoll378@yahoo.co.uk 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) : Pearlcare (Richmond) Ltd care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care home only - Code 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 - Code OP Date of last inspection Brief description of the care home Beechy Knoll is a privately owned care home that provides care and accommodation for forty older people of both sexes. It is situated in a residential area of Sheffield, close to local amenities and bus routes. The home is built over two floors and all areas of the home are accessible to people via the use of ramps and a passenger lift. Private accommodation is provided in thirty three single and three shared rooms, twenty two bedrooms have en suite toilet facilities. Communal accommodation is provided in a variety of lounges, dining areas and a Care Homes for Older People Page 4 of 29 Brief description of the care home conservatory. Seating is provided in the homes gardens and there is a small car park available for staff and visitors to the home. A copy of the previous inspection report was available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The manager confirmed that accommodation fees from April 200 ranged from 327 pounds to 360 pounds per week and there is an additional charge for hairdressing, dial a ride and private chiropody. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced key inspection carried out by Sue Turner, regulation inspector. This site visit took place between the hours of 7.50 am and 2.30 pm. The manager is Wendy Barnes who was present during the site visit. The regional manager is Philip Middleton, who was also present during the visit. The manager and regional manager were given verbal feedback during and at the end of the site visit. Care Homes for Older People Page 6 of 29 Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were sent to people living in the home, their relatives and any professionals involved in peoples care. We received four from people, four from staff and one from a professional. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. Time was spent observing and interacting with staff and people. Eleven people, two relatives and eight staff were spoken to. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in May 2008. The progress made has been reported on under the relevant standard in this report. We wish to thank the people living in the home, staff, and relatives for their time, friendliness and co-operation throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The service provided at Beechy Knoll is of an adequate standard. Although improvements to the service have been made, further work is required to enhance the service and raise the quality rating of the home. So that staff are confident that peoples needs can be met, an assessment must be carried out prior to people being offered a place at the home. All information about peoples health, care and support should be recorded appropriately in their individual plan of care. When gaps are identified in the Medication Administration Records (MAR) sheets this should be recorded separately. MAR sheets should not be signed in retrospect. The on- going redecoration of the home should continue and particular care should be taken to ensure that people are provided with clean bed linen. So that people are kept safe any volunteers working in the home should be subject to the same checks that are carried out for employed staff. So that peoples health, safety and welfare is not put at risk, the linen cupboard doors should be kept locked shut and people should not be moved around the home in wheelchairs that have not got footplates in situ. There were a number of discrepancies in the records kept at the home. The reasons for these discrepancies must be investigated and appropriate action taken to ensure that records required by regulation are maintained, up to date and accurate. We acknowledge that the provider and manager continue to evaluate and monitor the service and make any changes necessary. Care Homes for Older People Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided information to inform people about their rights and choices. People were not routinely assessed by the home prior to their admission. Evidence: The home had a Statement of Purpose (SOP) and Service User Guide (SUG). These were available for people living in the home and anyone who may be considering living in the home. Copies of the SUG were seen in peoples bedrooms. The SOP needed to be updated to reflect some recent changes at the home. The AQAA stated that before people came to live in the home , the manager carried out a pre assessment by visiting people in their own home or hospital. We spoke to one person who said that this had not happened. Their relative had been assessed by a social worker but not by anyone from the home. The manager said this was because the person had been admitted as an emergency. We talked to the manager and the regional manager about the importance of the home assessing people so that they Care Homes for Older People Page 11 of 29 Evidence: could be assured that the home could meet the persons needs. Four people were asked Did you receive enough information about this home before you moved in so you could decide if it was the right place for you. Three people said Yes and one said No. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information recorded for people, that detailed their current individual care and support needs was not kept appropriately or securely. This meant that peoples privacy and dignity was not being promoted and maintained. Medication procedures did not fully protect peoples health and welfare. Evidence: Each person that lived in the home had an individualised plan of care. These were checked for three people. Care plans contained information about peoples health and personal needs. Staff had attempted to write care plans in a person centred way. There was information about what the person themself felt their needs were and how they would prefer these needs to be met. Care plans had been updated, however updates were brief and not always relavent. This made it difficult to establish peoples present care needs and requirements. Staff completed daily records at the end of each shift. Those seen were also very brief, often only one or two words, for example, small lunch or slept well. The most relavent and up tp date information about peoples health and welfare was recorded in a diary that was kept on the reception desk. The diary Care Homes for Older People Page 13 of 29 Evidence: detailed peoples current well being, any health professional visits, any changes to their health and welfare or any changes to their medication. Some of this information had been transferred to peoples care plans however the vast majority hadnt. We spoke to the manager and regional manager about the inappropriateness of using a communal diary to record peoples individual details. We also spoke about our concerns regarding the lack of privacy and dignity for people by recording personal information in this way and leaving the information insecurely stored. The regional manager said that he had already recognised this and this practise would be stopped. We spoke to some relatives that had been involved in care planning and others who had chosen not to be involved. Access to dentists, chiropodists and opticians was available. Individual risk assessments were seen in peoples care plans. People seen looked well cared for and were dressed appropriately. People said, Staff are good and help me if I need it. I would rather be at home but this is OK. Staff are wonderful. One professional said, Staff are able to notice a change in peoples condition and contact the appropriate services eg, district nurse and GP. Four people were asked Do you receive the care and medical support you need. Two people said always and two said usually. Carers that had undertaken training in medication administration. Medicines were securely stored in locked trolleys. Medication Administration Records (MAR) sheets seen had been signed by the staff. Controlled Drugs (CD) were kept securely stored. Staff recorded CDs in a CD register. This was checked and found correct. The manager said that when she monitored medications, if staff had not signed the MAR sheets this was brought to their attention and they where asked to sign the sheet on their return to work. We said this must stop as this was not a safe practice. We said that staff must sign for medications given at the time of administration. If errors or omissions occur then this must be recorded seperately but MAR sheets must not be signed in retrospect. During the site visit we observed that people were cared for in a friendly way. Staff were skillful in ensuring that people maintained their privacy and dignity when receiving personal care. One health professional was asked Does the service respect individuals privacy and dignity. They said usually. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples recreational interests and needs were met. People were receiving a balanced diet in pleasant surroundings. Evidence: People said they were able to get up and go to bed when they chose, and were seen to walk freely around the home, if able. Two relatives spoken to said they were able to visit at any time and were made to feel very welcome. Staff took time to make sure friends and family were made to feel comfortable whilst visiting their loved one. Some people said they preferred to stay in their room at certain times of the day and that the staff respected their decision. The activities co ordinator worked Tuesday, Wednesday and Friday. Activities available to people were advertised around the home, which included, board games, quizzes, arts and crafts and movement to music. People said that entertainers also visited the home. People said, Theres not enough activities taking place, my mind is not kept occupied. I like it when we play bingo. The activities lady is lovely, she has recently been reading to us about old Sheffield, I enjoyed that very much. Care Homes for Older People Page 15 of 29 Evidence: Four people were asked Are there activities arranged by the home that you can take part in. Two people said always, one said usually and one said sometimes. We observed breakfast and lunch being served in the dining room. Choices were available and staff were aware of peoples meal preferences. At breakfast people had a choice of cereals, grapefruit or porridge followed by bread or toast with preserves. People said that cooked breakfasts were available if requested. At lunchtime the dining room tables were set nicely with tablecloths, cutlery and matching crockery. The dining rooms were quite small. Two sittings had been introduced so that more space was available and people were given more help. We observed that people were not given much independence at meal times. Drinks came to the tables already poured and food was plated up. We believe that people would benefit from having more independence at meal times, thus helping them to exercise choice and control. People said If I dont like it I tell them. Theres always a choice. The food isnt bad. The meals are very good. Relatives said, The meals always look and smell good. Mum is a really faddy eater and they do try to suit her. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were dealt with effectively. The policies and practices for referring adult safeguarding concerns was adequate which assisted in keeping people safe. Evidence: People and their families had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall. This detailed who to speak to at the home or, if preferred, external to the home to make a complaint, should they wish to do so. The complaints procedure directed people to the manager to deal with any complaints. If the manager was unable to resolve complaints then people were directed to the provider of the service. The home kept a record of complaints, this detailed any action that had been taken and the outcome of the complaint. Since the last inspection the home had not received any complaints. Four people were asked Do you know how to make a complaint. All four people said yes. People said, I would go to the team leader if I had any complaints. I would go to the manager. One relative said they had raised a concern with the manager and this had been dealt with immediately. Since the last inspection there had been one referral to the adult safe guarding team. This had been resolved without the need for a case conference. The manager said that majority of staff had completed training in adult safe guarding. The kitchen staff and laundry staff had not received adult safeguarding training. Staff spoken to were aware Care Homes for Older People Page 17 of 29 Evidence: of their role and responsibilities in dealing with any alleged safeguarding incidents. The home had copies of, and were working with the revised South Yorkshire protocols for adult safeguarding. People spoken to said they felt safe living in the home. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was maintained to a good standard. In the main procedures for the control of infection were in place which promoted peoples health and welfare. Evidence: The AQAA stated, We provide a safe well maintained home to ensure the comfort and safety of residents, visitors and staff.The home has a dedicated maintenance operative who has a schedule of jobs to keep the home well maintained.Residents who are able have a key to their individual bedroom areas.The home is clean, tidy and free from unpleasant odours. A gardener maintains the gardens. A high standard of cleanliness is upheld by a good team of domestics and care staff. We saw that the lounge and dining areas were domestically furnished and bedrooms were personalized. There were some areas of the home that were beginning to look worn and in need of redecorating. A number of lounge carpets were stained and marked. We saw two beds that had stained and marked covers. Bathrooms and toilets looked bare and clinical and a toilet seat was broken. The regional manager showed us a copy of the homes business plan for 2009/10. This highlighted a number of improvements that were planned for the environment. Since the last inspection some refurbishment of the home had been completed and some carpets and furniture had been replaced and bedrooms redecorated. The home smelt fresh and clean. Controls of infection procedures were in place. Staff were Care Homes for Older People Page 19 of 29 Evidence: observed using protective aprons and gloves. The homes laundry was sited away from food preparation areas. There were no separate hand washing facilities provided for staff in the laundry room which could result in the risk of cross infection. Staff had undertaken training in infection control. One relative said, I think the home is clean. One person said, The lounge where I sit sometimes smells. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers were appropriate to meet the assessed needs of people. Recruitment information obtained for volunteers did not adequately protect the welfare of people. Staff had completed training. Evidence: Staff interviewed said that they enjoyed working at the home and got a lot of job satisfaction. On the day of the site visit staffing numbers were adequate. Four people were asked, Are the staff available when you need them. Two people said always and two said usually. Relatives said, Staff are consistent, caring and nurturing. The staff are always pleasant and helpful. The manager had undertaken a review of staff training and had identified the shortfalls. Mandatory training had been booked and further training in specialized topics for example dementia and diabetes was being delivered. One health professional was asked Do the staff have the right skills and experience to support peoples social and health care needs. They said usually. Four staff were asked Did your induction cover everything you needed to know to do the job when you started. Two said very well, two said mostly. Staff were able to talk about the various training courses that they had attended which included, Moving and Handling, Food Hygiene, First Aid and Fire. As the home cares for Care Homes for Older People Page 21 of 29 Evidence: people with Parkinsons Disease we believe that staff would benefit from completing training in Parkinsons Disease awareness. Staff would also benefit from receiving training in care planning and report writing. A high number of care staff had completed the NVQ Level 2 in care and others had commenced the training. The number of staff trained exceeded the required minimum of 50 per cent of the staff team trained to NVQ Level 2 in Care. Three records of employment were checked. These included the required references, certificates of training, health checks and evidence of Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. The home had a volunteer who spent time at the home mixing with people and setting tables etc. The volunteer had not been asked to provide any details about themselves, for example character references. A CRB check had not been completed. We asked the manager to arrange this so that they were confident that the volunteer did not pose any risk to people living in the home. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home had a management structure, that people and staff were aware of. Peoples health and safety was not being promoted in some areas. Evidence: The manager had completed the Registered Managers Award (RMA). Staff said that they found the manager easy to talk to and they could go to her at any time to discuss issues or concerns. They said they also met with the manager formally for one to one supervision. The home was visited on a regular basis by the regional manager. He was nominated to carry out Regulation 26 visits. Following his visits a report was completed which highlighted any action that needed to be taken to improve the service. Staff said he was available for them to speak to should they wish to. We asked to see the quality assurance surveys that the manager said had been sent out to people and relatives in 2008. We saw that the date on the front page of the surveys looked to have been changed from 2007 to 2008. Other dates recorded on the Care Homes for Older People Page 23 of 29 Evidence: inside of the surveys stated 2007. The manager said that she could not remember if the surveys had been completed in 2007 or 2008. She said she did not know why or who had changed the dates on the front of the surveys. Whilst looking at other documents we found several discrepancies in the information provided. The minutes from the last team meeting were typed. The date of the meeting was written in pen as 11.02.09. The information in the minutes talked about the Christmas rota and that this was completed and would be put out soon. We asked the manager about this. She was unable to clarify why the date on the minutes didnt reflect what was talked about during the meeting. The most recent fire drill was recorded as 24.04.09. We asked the manager if this date was recorded incorrectly as this was the day of the site visit and no fire drill had taken place. Again she was unable to clarify this, firstly saying a fire drill had taken place that day then saying that the date recorded was incorrect. Due to the number of discrepancies in the records seen we asked the regional manager to carry out an investigation. We agreed with the regional manager that feedback would be provided to us by 8th May 2009. The regional manager promptly carried out an investigatation and the outcome of his findings was sent to us. We were satisfied that the investigation had been carried out appropriately and it was not necessary for us to take any further action. The home handles money on behalf of some people. This was checked for three people. Account sheets were kept, receipts were seen for all transactions and monies kept balanced with what was recorded on the account sheet. Whilst looking at peoples care plans, risk assessments and records, we saw that some information was very poorly written. Both the staff and the manager had used inappropriate language in the minutes of meetings and in information recorded in the diary. This was brought to the attention of the manager and regional manager. Fire records evidenced that fire alarm checks and fire drills took place. A fire risk assessment had been completed and updated. In the upstairs bathroom there were two cupboards that had notices stating that they must be kept locked shut for fire safety. We saw that these doors had been left open and unlocked. We asked to see the electrical certificate for periodic inspection, this had not been completed. The regional manager said this would be carried out promptly. At the last inspection people were seen being moved around the home in wheelchairs without footplates fitted. At this site visit we saw two people being moved without footplates. The manager said that she was aware that staff were not routinely using footplates. She said that action was being taken with the staff members who were found to remove or not use footplates when people were being moved. This requirement is carried over into this report with a short timescale for action. Care Homes for Older People Page 24 of 29 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 1 6 The Statement of Purpose must be reviewed and updated so that it provides accurate information to people. To ensure the protection of people all staff must be trained adult safeguarding procedures. 01/07/2008 2 18 18 01/08/2008 3 37 17 So that people are protected, 19/05/2008 records required by regulation must be maintained, up to date and accurate. The health, safety and 19/05/2008 welfare of people must be promoted and protected at all times, therefore: Wheelchairs must have footplates fitted and these must be put in place whilst people are being transferred. 4 38 13 Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 People must be assessed by a representative of the home prior to their admission. So that the home can be reassured that they can meet peoples individual needs. 04/05/2009 2 7 15 Any information regarding peoples health, safety and welfare must be recorded in an individualised plan of care. So that peoples needs in respect of their health and welfare are met. 04/05/2009 3 9 13 When errors or omissions 04/05/2009 from MAR sheets are identified staff must not sign the MAR sheets retrospectively. To ensure that peoples health, safety and welfare is maintained. Care Homes for Older People Page 26 of 29 4 10 12 Personal and confidential information regarding peoples care must be kept appropriately and securely. So that peoples privacy and dignity is promoted and maintained. 04/05/2009 5 26 23 Bed linen must be changed as frequently as necessary. So that people are provided with a clean and fresh bed. 04/05/2009 6 29 19 The information listed in Schedule 2 of the Care Homes Regulations must be obtained for the volunteer working in the home. So that peoples health, safety and welfare is not put at risk. 01/05/2009 7 37 17 Information and records at 04/05/2009 the home must be written in a professional manner. So that peoples rights and best interests are safeguarded. 8 37 17 An investigation must be completed regarding the discrepencies found in records seen at the home. So that the home is run in the best interests of people. 08/05/2009 9 38 13 The linen cupboard doors in 04/05/2009 the bathrooms must be kept locked shut. So that peoples health and safety is not put at risk. Care Homes for Older People Page 27 of 29 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 9 A separate record should be kept of any errors or omissions made following the administration of medications. This should also detail what action the manager has taken to prevent errors reoccurring. People should be encouraged and supported to exercise choice and control over their life. The planned programme of maintenance and refurbishment should continue. Hand washing facilities should be available in the laundry room. Staff should be provided with training in Parkinsons Disease awareness, care planning and report writing. There should be available on site a certificate that confirms that the electrical periodic inspection has been completed. 2 3 4 5 6 14 19 26 30 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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