Care Home: Belmont Grange Care Home

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What the care home does well The home continues to provide a good standard of health and personal care. When we asked in surveys, "What does the home does well?", all three people mentioned the health care, "excellent medical care", " medical nursing towards ever improving health". The home benefits from an experienced group of staff, many of whom have worked there for some years. They have received training so they have the particular skills needed for the people they look after. A relative commented, "most excellent care which is given by friendly and hard-working and committed and concerned staff." The home has an activities coordinator who provides both group and individual activities and helps people maintain contact with the local community. What has improved since the last inspection? Care plans are being reviewed monthly to make sure they are up-to-date. Some rooms have been redecorated and special beds provided. Toilets and a bathroom have been improved. What the care home could do better: Staff must complete the form which is part of the medication record, explaining when "as required" medication should be given for each individual and any special instructions about its use, such as how much time there must be between each dose. Extra storage must be provided for controlled drugs and for drugs due for disposal, to make sure these are kept securely and safely. Care plans must include details of what staff should do to meet individual needs for leisure activities. The planned refurbishment of the home should start as soon as possible. The manager must keep under review staffing arrangements, to make sure that staff have enough time to meet residents` needs. Training in dementia care should be considered. Key inspection report Care homes for older people Name: Address: Belmont Grange Care Home Broomside Lane Belmont Durham DH1 2QW     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: Kathy Bell     Date: 1 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Belmont Grange Care Home Broomside Lane Belmont Durham DH1 2QW 01913849853 01913869513 belmont.grange@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Four Seasons Health Care (England) Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accomodated is: 33 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, maximum number of places 33 Physical disability - Code PD, maximum number of places 33 Date of last inspection Brief description of the care home Belmont Grange is a care home registered to provide care (including 24 hour nursing care) for persons aged 65 years or older. It is situated in the centre of Belmont and is within easy reach of the shops and local amenities. The main building is listed with a modern built extension added. It consists of a two-storey building. There are 25 single bedrooms and 4 double rooms, 1 of which is en suite. However double rooms are not routinely used unless specifically requested. There is a passenger lift available. Care Homes for Older People Page 4 of 27 Over 65 33 0 0 2 Brief description of the care home Sufficient toilet and bathroom areas are located throughout the home, some with specialist adaptations for people who are less mobile. Lounge and dining areas are also available. The fees for this home range from £392.09 Pounds for residential care to £413.31 Pounds for nursing care, with the health authority paying for extra nursing care if people need this. These fees do not include hairdressing, newspapers, chiropody and toiletries. The home and was purchased by the current owners Four Seasons Healthcare (England) Limited in 2000. 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: 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 inspection took place during two days in July 2009. During the visit we looked around the building, although not in every bedroom and looked at records kept in the home. We received 3 surveys for people who live in the home, completed by the relatives. We spoke to seven of the staff, five people who live in the home and four of their relatives. We also saw a nurse who visits the home to assess peoples needs for continuing health care. The manager completed and returned an Annual Quality Assurance Assessment (AQAA). The AQAA is the services self-assessment of how they think they are meeting the National Minimum Standards. This information was received before the inspection and was used as part of the inspection process. 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 the service are not being put at risk of harm. In future, Care Homes for Older People Page 6 of 27 if the requirement is repeated, it is likely that enforcement action will be taken. At the time of this inspection, 27 people were living in the home and 18 of them were receiving nursing care. 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: 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 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 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home finds out about peoples needs before they are admitted so staff can be sure they will be able to meet their needs. The home does not provide intermediate care so we did not assess Standard 6. Evidence: As well as the assessment received from care managers, the manager carries out her own assessment of peoples needs. We saw that these included essential information such as dietary needs, personal care needs, and if someone was at risk of falling. They also showed that the manager asked for up-to-date medical information. Care Homes for Older People Page 10 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a good standard of health and personal care. Care plans provide the information staff need to look after people well. Medication is generally handled safely but there was not enough information about how as required medication should be used for each person. This is less likely to cause problems in this home because they generally do not have to use nurses from outside the home to cover shifts, and so the nurse on duty should already know about each resident, unless they have recently moved into the home. Also there were not enough containers for drugs for disposal and enough secure storage for controlled drugs to be sure that there was room for any extra drugs prescribed. Evidence: We looked at the care plans which explain the help people need with every part of their lives. These were very detailed and gave staff clear guidance about what they should do for each person. They included information about any help people needed with personal care, if they needed a special diet, if they were at risk of developing pressure sores etc. They were usually reviewed every month to make sure they were up to date. The home had carried out an assessment, as they should do, about Care Homes for Older People Page 11 of 27 Evidence: whether it was safe for each person who had bed rails on their bed to use them. The home has special beds which include raised sides, designed so that they are safe. Possibly because of this, staff had completed these assessments even though they sometimes wrote on the form that the person did not need to use bed rails. The manager agreed to look again at how staff were completing these forms to make sure everyone was clear if bed rails were needed, why they were needed, and whether the resident themself, or somebody who could speak for them, agreed with their use. The three relatives who filled in surveys all said that one of the things the home did well was healthcare. They said, excellent healthcare, and medical nursing towards ever improving health. A relative we spoke to describe how staff had nursed her father back to health from a serious illness. The nurses keep detailed records of the care provided and of medical advice or treatment provided by doctors. A nurse employed by the Health Authority, who has to look at whether people need continuing healthcare, said she found that the records in this home were complete and well organised. The nurses on duty in the home provide nursing care for people who have been assessed as needing this. People who do not need nursing care on a regular basis are assessed as just needing residential personal care. When these people do need nursing care, a district nurse comes in to provide this. The records showed that the staff in the home had not always been kept informed when a nurse had visited and what they had done but the manager was aware of this and said that she is discussing this with the local surgery, which sends the nurse, to make the system work better. When we asked in surveys if people received the care and support they need and did, all the relatives said they did. Two of them said that staff were always available when needed and listened and acted on what they said and one said they usually did. People we spoke to in the home said that staff did respond promptly when they rang their buzzers for help. They said they felt well looked after. Staff said that they were kept up-to-date with any changes in peoples needs. But we felt the home could improve by having a more formal system to make sure people knew what had been happening since they were last on duty. The home has generally safe systems for looking after, giving out and recording medication. They were carrying out the extra recording needed when they handle medication which is classed as a controlled drug because, for example, it is a powerful drug for pain relief. But they had only a very small extra secure storage area for these drugs and when we visited it was completely full. That meant that staff had to take everything out to get one pack of drugs out and then repack everything back in. It also could cause problems if they had received more controlled drugs. Also, the bins containing drugs to be disposed of were full to overflowing. These more powerful drugs were being disposed off separately, but even so the home must arrange better Care Homes for Older People Page 12 of 27 Evidence: storage urgently. The drug records contain special forms to record when somebody is prescribed as required medication, often for pain relief or if someone is agitated. These forms are a good idea because they prompt staff to say clearly when the drug should be given, how often it can be given and how long an interval there must be between doses. But staff had not always been completing these properly. When we discussed this with the nurse on duty, it was clear that she was aware of peoples individual needs and that, for example, for one person, agitation could be caused by them being in pain and so staff should start by giving pain relief. But this information should be recorded, so that any nurse who may be responsible for giving out medication in the home knows this as well. The home provides care for people who need palliative care at the end of their lives. Staff have received special training in this. During the inspection we heard staff discussing arrangements to make sure someone received the extra care and medication they would need. We also heard how they recognised the needs of relatives in these circumstances and tried to support them. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities and tries to meet individual needs. But care plans should include details of how individual needs will be met. The home helps people stay part of the local community and makes visitors welcome. People seem to be able to make choices in their daily lives. The home provides a good diet, and people can choose what they eat. The home already meets individual needs for special diets but is working to improve how they do this. Evidence: A range of activities are provided in the home. An activities coordinator works 20 hours a week and the programme of activities was on display in the hall. As well as arranging activities for groups, as part of her working week, the activities coordinator spends time with individual people, just talking or reading to them, whatever they want. Care staff explained that it is part of their job to sit with people to help them with activities. We saw photographs of trips out to the Shildon Museum and the Glass Museum. The home has also had a visit from a brass band and choir. Some people cant take part in activities like quizzes or bingo or word games, perhaps because they have dementia. We asked how the staff tried to make their lives more enjoyable. They described how they knew the kind of music one man used to enjoy and so put music Care Homes for Older People Page 14 of 27 Evidence: on for him in the room he sat in. The activities coordinator said that the staff had followed the advice provided by the relative of another man, setting out what TV programmes staff should put on for him, based on what had interested in in the past. This showed that the home does try and meet individual needs that these were not recorded as part of the care plan. The care plans do include some information about peoples lives and interests but these should be developed to include specific information about what each person enjoys and what they need staff to help them with, to enjoy leisure activities. The home keeps up contact with the local community by taking people to the library, and a local coffee morning. We saw visitors visiting freely through the day. The husband of someone who has recently moved to the home can spend most of the day there and is given his lunch. One relative said that staff were excellent at keeping the family informed. We saw that people had been able to bring personal possessions in with them, where there was enough space in their rooms. Some people chose to eat in their rooms and this was made possible, with staff helping them if necessary. We saw some people choosing to have a stroll around the gardens when they wanted to. In the surveys, all three people said they usually like the meals. The menu showed a varied diet with choices always available. Although a nutritious diet is provided, we saw one person having a chip butty because that was what she wanted. She said the home had the best cook in the county. Other people praised the food. Some relatives described how someone had been quite underweight when she moved into the home but had been helped to put weight back on. Advice from the speech and language therapist about the diet individual people should have was available in the kitchen. The cook explained she is involved in the meetings when dieticians look at peoples needs. The manager and the two cooks have started training in how best to meet older peoples nutritional needs. The cook explained she is already revising the menus to include finger food and drinks which provide more calories. We saw the records kept in the kitchen to ensure food hygiene standards are met were satisfactory. All the catering staff have been trained in food hygiene. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can raise concerns if they have them and the manager takes complaints seriously. People are protected from harm as far as possible. Evidence: The home has an established complaints procedure. In the surveys, all three people said they could speak to someone informally if they were not happy and knew how to make a formal complaint. A relative confirmed that she could say if something was wrong. The home has not had any formal complaints in the last year. But records showed that the manager responded to a comment in a survey which showed someone was not happy about something. She treated this as a complaint and responded to the person properly. All the staff have had training in safeguarding adults, recognising abuse and understanding what to do if they suspect someone is abused. They had had refresher training in this the week before the inspection. Recently the home had to make a safeguarding referral and they followed the proper procedures. It was agreed that no abuse had taken place but this raised an issue about the administration of medication which it was agreed that the company would investigate. The manager showed she is aware of the importance of respecting peoples rights. Recent changes in the law mean that if someones freedom is being restricted, there is a formal process to look at whether this is justified or not, in their best interests. The manager had made an Care Homes for Older People Page 16 of 27 Evidence: application under this law for a particular resident but was advised that he was not restricted so much that this formal process had to be used. Proper records are kept of money handled for people who live in the home and someone from outside the home audits these accounts. Before anyone starts work in the home, the company carries out checks to make sure there is nothing in their background which would mean they were unsuitable to work in a care home. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable place to live with enough facilities and equipment to meet peoples needs. The planned refurbishment will improve the the appearance of the home. The home is kept clean and there are systems to prevent the spread of infection. Evidence: Staff and relatives are looking forward to a planned refurbishment of the building, which is to include redecoration and new furniture. But improvements have been made in the last year, with a special bath replaced, two toilets improved and some redecoration. The home is an older building with a modern extension. There are lifts for access to the first floor. There is a lounge, separate smaller lounge and conservatory room. There is access to the garden although differences in level and a pond would mean that most people would need staff help to spend time in it. All the bedrooms are single and of an adequate size, while some in the older building are spacious. Most of the bedrooms have been provided with a special bed, which can be raised or lowered to the right height and is fitted with safe bed rails which can be used if people need them. The building seemed clean throughout during the inspection. One person who lives there said it was always spotless. All the staff have had training in preventing the spread of infection. Care Homes for Older People Page 18 of 27 Evidence: 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough, suitably qualified staff on duty but the manager must keep under review whether care staff do have enough time. Staff are checked before they start work to make sure there is nothing in their backgrounds which would mean they are not suitable to work in a care home. Staff receive comprehensive, specialised training but training in dementia should be considered. Evidence: The rota showed that there is a qualified nurse on duty in the home 24 hours each day. Four care assistants are on duty during the day until 8 PM and two from 8 PM until the morning. There are enough domestic and catering staff so that care staff do not have to spend time cleaning or clearing up after meals. The manager said that she arranges for staff to work extra shifts if they need to take somebody to hospital for medical appointments. There is also a part-time activities coordinator and the manager, also a qualified nurse is full-time. The home has a part-time handyman who carries out all the regular safety checks. When he is absent, a handyman from another home comes in to do these. When we spoke to care staff they felt they were rushed at the moment but were still meeting peoples needs. They felt they worked well as a team, which helped. They said they were supported to spend time with residents, for example, while doing activities. But they believed that the people who lived in the Care Homes for Older People Page 20 of 27 Evidence: home these days needed much more support and care than in the past. An additional demand on staff is that the home provides care for people who are dying. Apart from the time needed to arrange and coordinate healthcare, staff will need to spend extra time with the person and their relatives. People living in the home said that staff were able to help them when they needed and came quickly enough when they rang the buzzer for help. But a relative commented in a survey , a higher staff/resident ratio would enable them to give more dedicated one-to-one time with residents and relieve some of the pressure under which they work. Although there are no signs that the home is not meeting its own high standards of health and personal care, the company must keep under review whether there are enough staff on duty at all times. This would help them retain their skilled and committed workforce. The home has been successful at retaining staff. The manager explained that most of the staff work parttime and if she needs someone to cover a shift, one of the existing staff is always available to cover it. This is good because it means that people are always looked after by staff they already know. Eight out of the 14 care staff have already achieved the National Vocational Qualification in care at level 2, which is the recognised qualification for care workers.This means the home is meeting the recommendation in the National Minimum Standards that half of the staff should achieve this qualification. We looked at the records of the recruitment of two staff. These showed that the company had obtained checks from the Criminal Records Bureau and references before people started work. There is a training programme which makes sure that all staff receive key training such as safeguarding adults, fire safety and moving and handling. Staff have been doing a distance learning course in infection control and have had training in palliative care. Some staff have had training in the new Deprivation of Liberty Safeguards. Staff have not had specific training in dementia although they care for people who show symptoms of dementia. The manager has also arranged training from local care professionals. A community psychiatric nurse with training in challenging behaviour, a modern matron gave an update on end of life care and the nurses have been given updated medication training. One of the nurses and the activities coordinator has done a six week course in bereavement and counselling. The cook and the manager are currently on a course about meeting the nutritional needs of older people. Domestic staff have been able to obtain vocational qualifications as well. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and there are systems to check it is running well and that people are satisfied with it. There are good systems to make sure it is maintained as a safe place to live and work. There is a satisfactory system to look after and account for any money which the home handles for people who live in it. Evidence: The manager is an experienced, qualified nurse with many years experience in care homes. She is completing the recommended qualification for managers, which is the National Vocational Qualification in management at level 4. We saw during the day that she is closely involved in the day-to-day care of people who live in the home. Staff said that they could raise any issues with her. There seemed to be a culture in the home of valuing the contribution and skills of nurses, care staff and ancillary staff. There are a number of systems to check on the quality of care in the home. The company sends out surveys. These include very detailed questions so the manager Care Homes for Older People Page 22 of 27 Evidence: would be able to tell, for example, if people liked the lunches but not that teas. The results of these surveys are analysed and the manager sets out in an open letter for people what the results were and what the home is doing about them. Residents meetings are held, which gives the manager more regular feedback about peoples views. The company carries out the monthly visits to check on the running of the home which are required by law. Also we saw records of their internal audits of medication and health and safety, which were done this year. We saw the records of regular safety checks in the building. The fire system was checked at the recommended intervals and the temperature of hot water was checked. There were records of six monthly checks of lifts and hoists. There was a current gas safety certificate and portable electrical appliances checked in March this year. The company arranged for the retest of the electrical installation of the building in February this year, when it was due. This inspection found a number of faults. The company has advised us that the urgent issues have been dealt with and some of the faults only arose because of higher standards implemented since the last test. They have told us that most of the work has been done and it will all be completed in the near future. The home keeps proper records to account for money it looks after for some people who live in the home. Receipts are kept and the manager explained that the records are audited by someone in the company outside the home. 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 1 9 13 Staff must record the details 12/08/2009 of when and how as required medication should be given. This is required so that staff who give out medication will always know when it should be given and how it should be given. 2 9 13 Extra storage be provided for controlled drugs and for drugs for disposal This is to ensure drugs are stored securely. 28/08/2009 3 12 15 Care plans must include 14/09/2009 information about how peoples needs for recreation and enjoyable activities will be met. This is to make sure that staff know what they must do to meet each persons needs for enjoyable activities. Care Homes for Older People Page 25 of 27 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 4 27 18 The manager must keep under review whether staff have enough time to meet peoples needs at all times. This is to make sure there are enough staff hours to meet peoples needs. 02/10/2009 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 2 19 30 The planned refurbishment of the home should start as soon as possible. The manager should consider providing training in dementia care. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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