Care Home: Belvedere House

Similar services:

• The Shelley
• Thorndene
• Springfield House
• Sutton Lodge Nursing Home
• St Helier`s Residential Hotel
• St Joseph`s
• Ridgemount
• Wingham Court

What the care home does well The service carries out detailed pre admission assessments prior to any person moving in to ensure that they will be able to meet their needs. The residents live in an home that is friendly and homely providing a one residents stated that Belvedere House is a "great place to Live in" The service has a structured activity programme, which is designed to ensure that all residents of the home can participate in an appropriate leisure pursuits. They service has introduced more reminiscence and multi sensory equipment and materials. People receive well balanced and presented meals which meet with their preferences and they are provided with choices and alternatives, in an environment which is present and well presented. What has improved since the last inspection? The AQAA states that "the home has undertaken external maintenance and added a CCTV system. Undertaken the refurbishment of 14 bedrooms and reviewed the style of training courses on offer to the staff. What the care home could do better: The registered provider must ensure that medication storage and handling is safe and that the residents are safeguarded from errors and inappropriate storage. The registered provider must ensure that all staff are fully trained and aware of the homes policy on privacy, dignity and choice. Key inspection report Care homes for older people Name: Address: Belvedere House Belvedere House Weston Acres, Woodmansterne Lane Banstead Surrey SM7 3HA     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: Kenneth Dunn     Date: 0 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Belvedere House Belvedere House Weston Acres, Woodmansterne Lane Banstead Surrey SM7 3HA 01737360106 01737353436 home.bns@mha.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Royal Alfred Seafarers` Society care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 56 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Belvedere House is registered with the CSCI (Commission for Social Care Inspection) as a care home with nursing for fifty six service users. The home is purpose built and located in Banstead in Surrey and close to public amenities. Accommodation is on two floors accessed by stairs or a lift and comprises of lounges, dining rooms, a kitchen, Care Homes for Older People Page 4 of 28 Over 65 0 56 0 56 0 56 Brief description of the care home laundry room, bathrooms, toilets, showers and single bedrooms with en-suite facilities. The home has a large garden, which is private, secure, and accessible with private parking available. The fees charged by the home are £705 per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This site visit was part of a key inspection. The visit was unannounced. We arrived at 9.15 am and left at 14.40 pm Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment. (AQAA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date, which provided us with all the information we asked for. Reference is made to this assessment throughout this report. As part of this key inspection we were accompanied by a CQC specialist pharmacist inspector. Following recent concerns brought to the attention of the Commission regarding the the safe handling of medicines the CQC specialist pharmacist inspector undertook a focused sample of the homes medication policies and procedures. Care Homes for Older People Page 6 of 28 In addition on the day of the site visit the service was being audited by the Methodist Homes for the Aged (MHA) an umbrella organisation engaged by the home to provide additional policies, procedures and support to the service. MHA provides support to the home and conducted a compliance audit on the home during October 2009 where they produced a report and an action plan for the home to work through. Other methods used to inform our judgements made in this report include discussions with members of staff and community health based professionals. We looked at staff recruitment, and training records, care plans, risk assessments, menus, quality assurance systems, medication administration policies, health and safety records and policies and procedures were sampled. We also reviewed other information that we have received since our previous inspection including notifications that the service is required to inform us about. Care Homes for Older People Page 7 of 28 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission procedures at the home will ensure that the needs of prospective residents and their aspirations are fully assessed prior to admission to make sure that their needs can be effectively met. Evidence: The service has a robust set of policies and procedures in place to ensure that potential residents of Belvedere House will be fully assessed prior to being offered a place at the home. The assessment process has been designed to ensure that the service can effectively meet the needs of prospective residents. The deputy manager stated that people who wish to use the service will benefit from a pre-admission assessment from a suitably qualified person. The documentation used by the home for these assessments allow a through assessment to take place and care plans can then be generated from this Care Homes for Older People Page 10 of 28 Evidence: documentation. In the AQAA, to demonstrate what the home does well, the manager stated that: a full pre admission assessments of the residents care needs, abilities, interests, health and spiritual needs is carried out by a trained manager prior to admission, involving the resident and representatives, to ensure the admission is appropriate. During the site visit a random review of the personal folders of four residents highlighted that all assessment procedures had been carried out, and the information would provide a full picture of a potential resident and their care needs. It was noted that in all four care files there was not one system in place for the storage of information. This was discussed during the site visit and it was agreed that this would be reviewed to ensure that a possible alternative would be found and introduced. The home does not offer intermediate care. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people using the service receive is based upon their individual needs, which is documented in their care plans. The administration and storage of medication must however be reviewed in order to safeguard the residents from further medication errors. Evidence: During the site visit a random sample of four care files was undertaken. The sample demonstrated that they all contained detailed information about the person using the service. The care plans however were not user friendly as the information was hard to access and there was not one single format being followed by the service. The need to develop one single style of care details was discussed during the visit to ensure that all relevant information is in the same section in all the residents files. There was evidence that the care plans are reviewed frequently to ensure that they accurately reflect the residents needs and that people using the service had also participated and agreed the plans. It was noted that where changes had been made hand written notes were made on the actual care plan, however the changes on two plans sampled had not been officially made even after a considerable time had past since the plans were Care Homes for Older People Page 12 of 28 Evidence: altered. The sample provided evidence that detailed risk assessments for all identified risks were undertaken and were reviewed by key workers on a regaler bases. It was again noted that the risk assessments were not stored in a format that would allow easy access in a urgent situation. Following recent concerns brought to the attention of the Commission the safe handling of medicines was assessed by a CQC specialist pharmacist inspector. They looked at the medication records and medicine supplies for seven people, the care plans for one person and talked to staff. Following the recent medication incidents the service has sought the support of a consultant to help them to identify any failings in their systems and to implement improvements. People are provided with the level of support that they need to ensure that they receive their medicines. All of the people whose records we looked at had been assessed as needing to have their medicines given to them by the nurses. Clear and detailed medicine handling policies and procedures were available to the nursing staff to provide them with guidance on the safe handling on medicines. Clear records were kept of medicines received into the home and of medicines given to people. Because of the stock supply systems used in the home and the lack of any recording of the amount of any medicines carried over from one four week medicine cycles to the next it is not possible to tell from the records and the supplies of medicines in the home whether people get the medicines that they are prescribed. The records did show that one person had been without one of their prescribed medicines for three days. Another person had not been given one of their analgesic medicines on two occasions during the last 23 days. One person,whose records we looked at, had a medicine prescribed to be given up to three times daily but only when needed (PRN medicines). This person was being given the medicine every day at the maximum dose. The care plan lacked any detailed information or instructions to enable staff to make structured and consistent decisions as to when the medicine should be given. The homes procedures say that people who have PRN medicines should not be given their medicines routinely and that the reason why the medicine is given should be documented. No record as to why this medicine was being given was recorded either on the medication records nor in the daily care Care Homes for Older People Page 13 of 28 Evidence: notes. This could result in this person being given medication that they do not need. All medicines were stored securely for the protection of people who live in the home. Items requiring cool storage were kept in medicine fridges and daily temperature records were kept. Medicines that are liable to misuse, called Controlled Drugs, were stored in cabinets that would meet the standard of the Misuse of Drugs (Safe Custody) Regulations if they were correctly secured to the wall. Additional records were kept of the usage of Controlled Drugs so as to readily detect any loss. Staff have recently started to check these records on a weekly basis. This is in line with their procedures. Any medicines that are no longer needed are disposed of in a way that does not meet the legal standards for a nursing home. This must be corrected urgently. During the day staff were observed to knock on doors prior to entering and were using the preferred names of the people using the service as documented in their care plans. The AQAA states that the residents are treated with appropriate respect and dignity and staff address them in a respectful manner particularly during personal care giving, consultation and social contact However during lunch two care workers who were supposed to be assisting residents were observed to show little interest in the task they were undertaking. The staff demonstrated no empathy with the person they were supporting one in particular did not even look at the person they were helping. This was discussed with the deputy manager during the site visit who stated that this issue would be dealt with. The dignity afforded to the the residents was further raised because of a series of A4 signs that had been printed and laminated throughout the home, in many cases they only contained instructions to staff and had no relevance to the people who live at the service or placed restriction on them within their own home one particular sign displayed opposite the first floor dining room stating The ward kitchen is strictly out of bounds to all residents. This was discussed during the site visit and it was agreed that if staff followed basic measures to safeguard the residents i.e locking doors after use, the need for signs would be greatly reduced. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a varied activity programme which aims to meet their needs. Menus are varied and offer choice and the dining arrangements should offer a pleasant mealtime experience. Evidence: On the day of the site visit a notice board in the reception area detailed the activities arranged for that week. The activities offered to the residents included art, gentile exercise, bingo and reminiscence groups. The residents have the ability to access the community on a very regular bases utilising the homes own transport. The service celebrate residents special days and golden moments The deputy manager provided detailed evidence of a recent trip to visit St James Palace in London by a group of residents. In addition the residents of Belvedere House have the use of a club bar, which is located between the registered part of the site and the supported living apartments. At the time of this site visit one resident was an active member of the bar committee who manage and operate this facility. The AQAA states that the residents are encouraged to maintain full control over their lives and daily activities and where appropriate the service put the residents in touch with a local advocacy service. Care Homes for Older People Page 15 of 28 Evidence: During the site visit the people who use the service stated that there is a variety of activities on offer and they can select those that interest them. One person said there is always something to do but I dont have to join in if I dont want to. The service ensure that the religious and cultural needs of the residents are explored. The deputy manager stated that the service will always assist the residents to attend what ever service the wish and will endeavour to met any cultural requirements of the residents. Family and friends are welcome at the home at any time. Visiting is not restricted and people using the service can return to their bedrooms if they wish to see their visitors in private. One person stated that there family is always made welcome by the staff and that they are treated just like friends by the staff. The service provided detailed evidence of the support offered to the residents in the event that they wish to participate in voting during local and national elections. The AQAA provides details of the strong links the residents have with a number of local community organisations such as the local church, Not Forgotten Association, Least We Forget Association and the Woodmansterne Residents Association. Two residents and a person visiting a member of there family who is a resident stated that staff ask when people would like to go to bed and get up in the morning and the time they would like breakfast. The AQAA stated as a service they are always looking at ways to make the dining experience for the residents more enjoyable and relaxed. We have clear standards for catering and strive to provide a nutritious, varied diet, well-presented and incorporating as much choice as possible. after regular consultations with residents. We are able to provide diets for all lifestyles, cultural, medical and preference reasons. Our chef manager frequently holds Theme Days and devises an alternative menu appropriate to the date eg a Red and White menu for St Georges Day. During a discussion with one resident the food was described as being very nice and there is always something I like. However as has been previous stated in this report there is a need for the staff who are assisting residents during meals to engage with the individual they supporting. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service should be confidant that their complaints are listened and acted upon. Policies and procedures are in place ensure that the people living at the service are protected from abuse. Evidence: The manager provided details in the AQAA of 10 complaints received by the service in the last 12 months. During the site visit this was corroborated by randomly sampling the complaints in a book. The complaints book provided evidence of the complaints and the outcome of the investigations. The manager stated in the AQAA the complaints policy is accessible to everyone living in or visiting the home. The policy is advertised in the home, and residents encouraged to use it for any concerns which cannot be immediately resolved by staff. The complaints are responded to as fully as appropriate within 28 working days. We always apologise for mistakes or bad practise, and take action to remedy things. Our aim is to satisfy the complainant as quickly as possible, but where we do not they are given the information to take the matter further. During this visit people using the service were asked if they knew how to complain and who to complain to and all said yes. However one complainant who contacted the commission directly felt that the initial complaint they had raised to the staff on behalf of a family member living at the service was not dealt with under the proscribed Care Homes for Older People Page 17 of 28 Evidence: measures, they and their relative had not received a written response or an apology. The AQAA states that the service has a robust Safeguarding of Vulnerable Adults policy and procedures for dealing with any allegations or suspicions including a Whistle blowing policy which has two free phone confidential 24 hour lines (one for staff, and one for residents) both run by external agencies. The manager told us that the home follows the local authoritys procedures for the safeguarding of adults. Staff have access to these procedures and the homes own internal policy. The AQAA provided details of support offered to Staff in the form of in-house abuse awareness training. Staff spoken to on the day confirmed that they had received training in safeguarding adults and the records also confirmed this. During discussion with staff there was a feeling that they would be happy to intervene if they came across any form of safeguarding issues and would be able to contact the relevant groups to make a safeguarding referral. The service has over the last 12 month has made 5 safeguarding referrals to the local authoritys safeguarding team for medication errors, which is discussed in section 2 of this report. A review of the action plan produced by the organisation the service has brought in as a result of the medication errors provided evidence that the service is attempting to rectify these errors if they adopt the policies that have been advised. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a, comfortable and well maintained home and have access to a suitable accessible gardens. Evidence: A part tour was undertaken during this site visit, concentrating on all communal areas and a random sample of some residents bedrooms. The bedrooms seen had been personalised by the residents and were well decorated and maintained. All bedroom doors have locks and the keys are available to the residents. The communal areas were clean, bright with furniture that should meet the needs of the residents. The decoration in the home was very reflective of the seafaring tradition the former profession of many of the residents. With items on display that have special meaning to the seafarer and their families. The supported bathrooms were large and well planned, however on the day of the site visit all bathrooms seen were being used to store surplus items or seldom used pieces of equipment. The storage of items in the bathrooms could potentially be a trip hazard and during a discussion with the deputy manager it was agreed that all items that were not required to be in the bathrooms for the support of the residents must be removed. Care Homes for Older People Page 19 of 28 Evidence: Paper towels and soap dispensers were available for staff and visitors for hand washing and aprons for use during personal care. The home has a laundry room and documentation confirmed that infection control training had taken place. In the AQAA, to demonstrate what the home does well This home was purpose built with design features to enhance person centred care and assist the residents who live here. This includes en-suite toilets, profiling beds, air flow mattresses, wide corridors, hand rails, grab rails and the use of colours and fabrics that add a feeling of light and space. Bedrooms are generous in size and we are able to provide all necessary furniture and facilities for comfort, safety and privacy. Our communal areas are large, well decorated and comfortably furnished. We have an annual repairs and renewals plan and a separate budget controlled by the Manager. Comments received during the visit from one resident and a visitor were very complementary about the home and the way it is always kept clean and tidy. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing numbers are sufficient to meet the needs of the residents currently in the home. Staff recruitment practises are robust and should safeguard people in the home. Staff training should be reviewed to ensure the dignity, safety and wellbeing of residents. Evidence: A review of the staff rota on the day of the site visit demonstrated the number and grade of staff on duty to provide care to the people who live at the home was sufficient to meet their assessed care needs. This supported the declaration made by the manager in the completed AQAA, which states that The home always maintains nursing and care staffing levels which meet the needs of the residents by day and night (and can be adjusted as these change) and which are higher than set out in the Residential Forum guidelines. The service employees a large team of domestic and catering staff appropriate for the needs of the home and the services that are provided. The home has a programme of planned training in place and all members of staff have an individual training record. The home has a good commitment to the National Care Homes for Older People Page 21 of 28 Evidence: Vocational Qualification (NVQ) at the time of the visit 64 of the staff had obtained an NVQ. All newly appointed staff undertakes an induction programme. The home ensures that staff undertakes the mandatory training with yearly updates as necessary to maintain their competency to fulfil their duties. This was evidenced through discussion with the deputy manager and care workers. In the completed AQAA the manager stated that All staff are properly inducted through a programme in line with the Skills for Care Foundation guidelines. Additional mandatory and developmental training is also provided and an allowance of at least 5 days per person made in the staffing budget. RGNs are supported in obtaining their Prep requirements. However as has been previously mentioned in this report the home has had a series of medication errors and during the site visit poor practices in regards to respect and dignity were witnessed. These short falls were discussed during the site visit and appropriate action will be undertaken to provide additional training and support to ensure that the safety and dignity of the residents is maintained at all times. A random sample of five staff files was undertaken as part of the site visit this demonstrated that all staff are Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checked prior to commencing employment, and they are in receipt of terms and conditions of employment. It was evidenced that in all sampled staff files there were gaps in the educational and employment histories in all five files. The manager stated that the home has undertaken a review of staff files and thought that sufficient gaps had been eliminated. The discussion that ensued highlighted the need for all gaps to be fully detailed and a declaration placed on file to explain the gaps and to provide the relevant details of the periods missing from the initial application form. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the best interests of people living there. The wellbeing, health and safety of the residents however require to reviewed in order to provide future protection. Evidence: During this visit the registered manager was not initially on site, the deputy manager therefore assisted with the inspection visit. During the visit staff stated that the management of the home was open and the senior staff regularly made themselves accessible to both people using the service and staff. Staff spoken also said that they felt supported by the manager, there was good communication, teamwork and regular meetings take place. Systems are in place to ensure that the views of people are sought as part of the Care Homes for Older People Page 23 of 28 Evidence: homes quality assurance systems. The outcomes of feedback of surveys viewed were analysed. The manager stated in the AQAA that as a service they are proud of their quality assurance programme, set out in our Quality Manual, and including an Annual SelfAssessment (Standards and Values Assessment) carried out by senior advisors in MHA, a six monthly internal audit involving residents and junior staff, annual residents survey, and internal management reviews including a clear business plan and action plans from internal and external audits. We ensure residents are receiving high standards of service by seeking feedback from them, their families and health care workers, to this end. During the site visit the deputy manager stated that wherever possible the service does not become involved in the financial interest of the residents, this was supported by information provided by the manager in the AQAA. The AQAA states that We do not generally handle residents money or finances, preferring that they remain independent or a family member/attorney assists them. However, detailed systems are in place to control and record all transactions. The Home has a safe for residents use and all rooms have a lockable facility. The service made available detailed evidence to demonstrate that the health and safety of the residents are protected and promoted by the home. However as has been previously detailed in this report there has been five referrals made by the home to the local adult safeguarding team for medication errors. The service has identified the medication deficiencies within its procedures and had prior to this site visit by the commission invited a representative from MHA to provide support and guidance to the home. During the visit a copy of the MHA action plan was reviewed where they highlighted 5 areas under the topic of Drug Administration and Storage, which provided detailed actions to be taken by the home in order to improve medication procedures. The action plan required immediate action to be undertaken by the service to comply with the MHA audit. During the visit the concerns brought to the attention of the Commission for the safe handling of medicines was assessed by a CQC specialist pharmacist inspector. This resulted in further requirements being made for the home to action in order to ensure that their medication protocols would ensure the safety of the residents. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 People must receive their 04/01/2010 medication as prescribed. Particular attention must be paid to: - Ensuring that people do not run out of their medication - Ensuring that people are given their medicines at the prescribed dose and frequency - Ensuring that there are systems in place that show that people are given the medicines that they are prescribed - Providing care plans that include detailed information and instructions to staff on when to give medicines prescribed to be given only on an as and when required basis. - Storing Controlled Drugs in a cabinet that meets the requirements of the Misuse Care Homes for Older People Page 26 of 28 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action of Drugs (Safe Custody) Regulations. To show that people get the medicines that they need 2 9 13 Medicines no longer needed must be disposed of in a way that complies with the law. In order to comply with the law. 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 28/12/2009 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Older People Page 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!