Care Home: Bennetts Castle Care Home

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What the care home does well Appropriate signage and decor is in place throughout the home and this makes it easier for people living with dementia to find their way around the home and especially to toilets. With the exception of three newer staff all the staff have achieved NVQ qualifications. Some of the staff team are now studying for NVQ in dementia and others are studying for NVQ in equality and diversity. In addition there is a full programme of training for staff. Therefore people are supported by staff that have the skills and experience to meet their needs and provide a good service. The home has developed good relationships with the community and art students from a local comprehensive school visited the home and painted murals along the corridors. On the day of the inspection students from the college were visiting the home and helping with activities. A healthcare professional said: "people are treated with respect and talked to." A visitor to the home said, "people are well cared for and treated nicely." People receive good care and support at the end of their life and cards and letters sent to the home confirmed this. For example one family said, "thank you for making the last years of life secure and happy and especially for giving her the dignity and comfort to die in her own home". Another said, "thank you for allowing Dads funeral to leave from his home". There is a relaxed atmosphere in the home and people appeared unhurried and to be given sufficient time and support in their everyday activities. What has improved since the last inspection? The home now has a minibus that can be used to take people out. There has been an ongoing redecoration programme and the home is comfortable and well decorated. Gates have been installed in the garden for extra security and also to make it easier to observe people when they`re in the garden. This also means that people can have the freedom to use the garden when they wish. The home has been able to arrange more outings for the people living there and this has included a trip to Clacton and a trip to a local theatre. What the care home could do better: The development of protocols for the administration of PRN (as required) medication will mean that staff will be clear as to when and how to administer this medication. Additionally staff need to sign the MAR (Medication Administration Records) if they make a hand written entry. This is for accountability and also to provide an audit trail. The maximum and minimum temperatures of the medicines fridge need to be checked and recorded each day to ensure that it is working properly and medication is being stored at the correct temperatures. Addressing these issues will make the administration of medication more robust and in line with best practice. It is recommended that more detail be included in care plans to ensure that people`s needs are met consistently and in a way that they prefer. The recruitment of a management team would make the monitoring and development of the service more robust and give better day-to-day support to the manager. Key inspection report Care homes for older people Name: Address: Bennetts Castle Care Home Bennetts Castle Lane Dagenham Essex RM8 3UU     The quality rating for this care home is:   three star excellent 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: Jackie Date     Date: 3 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Bennetts Castle Care Home Bennetts Castle Lane Dagenham Essex RM8 3UU 02085177710 01085177718 manager@bennettscastlecare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Castle Care (UK) Ltd care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 60 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 categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Bennetts Castle Care Home is a purpose built home, on three levels, situated in a residential area of the London Borough of Barking & Dagenham. It is close to local shops and is in easy reach of a bus route to the surrounding shopping areas of Dagenham Heathway, Romford and Ilford. The home offers 24 hour residential care for 60 older people with dementia and/or frail elderly people. All bedrooms are single rooms with en suite toilet and handbasin. The home operates in four units which are Leeds, Hastings, Windsor and Arundel. Each unit has its own lounge and dining area. There is a well-maintained rear garden which has seating areas, and there are car Care Homes for Older People Page 4 of 29 60 0 Over 65 0 60 Brief description of the care home parking facilities for visitors. A CCTV monitoring system is in place around the external perimeter of the home for security reasons. Personal care is provided on a 24-hour basis, with health needs being met by visiting professionals, or by relatives or staff accompanying people to hospital appointments or other healthcare specialists as required.The statement of purpose and the last inspection report are available in the reception area of the home, and a copy of the statement of purpose will be provided on request. At the time of the inspection the fees ranged from 458 pounds to 650 pounds per week, with additional fees for hairdressing and 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was on 11th December 2006. This inspection was unannounced and took place over eight hours. This was a key inspection and all of the key standards were tested. Staff were asked about the care that people using the service receive, and were also observed carrying out their duties. People using the service were asked to give their view on the service and their experience of living in the home. All of the shared areas were seen and some of the individual bedrooms. Staff, care and other records were checked. People who use the service, visiting relatives, the doctor, district nurse and hairdresser provided verbal feedback during the course of the inspection. Feedback was also received from the local authority. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in October 2009. Information provided in this document also formed part of the overall assessment. Care Homes for Older People Page 6 of 29 We would like to thank the people living at Bennetts Castle, their relatives and staff for their input during the inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The development of protocols for the administration of PRN (as required) medication will mean that staff will be clear as to when and how to administer this medication. Additionally staff need to sign the MAR (Medication Administration Records) if they make a hand written entry. This is for accountability and also to provide an audit trail. The maximum and minimum temperatures of the medicines fridge need to be checked and recorded each day to ensure that it is working properly and medication is being stored at the correct temperatures. Addressing these issues will make the administration of medication more robust and in line with best practice. Care Homes for Older People Page 8 of 29 It is recommended that more detail be included in care plans to ensure that peoples needs are met consistently and in a way that they prefer. The recruitment of a management team would make the monitoring and development of the service more robust and give better day-to-day support to the manager. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Full information is gathered prior to people being admitted to the home and therefore staff have sufficient information to meet peoples needs. People can therefore have confidence that the service will be able to meet their needs. Evidence: Standards 1, 2, 3 & 4 were tested. Standard six does not apply; the home does not provide intermediate care. The Statement of Purpose and Service User Guide contain appropriate information to assist people who are considering moving into the home and their relatives to make a decision about living there. Individual records are kept for each person and a number of files were examined. All records examined had assessment information recorded and the information had been used to prepare a plan of care for the individual. The records show that where possible Care Homes for Older People Page 11 of 29 Evidence: the person concerned and their relatives/representatives have been involved in the assessment process. Information provided by the placing authorities and other healthcare professionals was also included. We were satisfied that a full assessment of need is undertaken prior to people moving into the home, and that the manager would not admit anybody unless she was sure that the assess needs of the individual could be met From the records, observations and discussion with the manager, staff and people living at Bennetts Castle it was evident that people are referred to any appropriate specialist services and that staff receive the necessary training to meet the needs of the people living there. This includes training in caring for people living with dementia. The section on staffing later in this report gives more details about staff training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are identified and staff have information about how to meet these. People receive good personal and health care and end of life care that meets their individual needs and preferences. The principles of respect, dignity and privacy are put into practice. Evidence: Standards 7, 8, 9, 10 & 11 were tested. Each person has a care plan that gives staff information on a persons needs and how to meet them. The care plans seen had been reviewed monthly and were up to date. They covered the necessary areas. Care plans included ways in which people are supported to be as independent as possible even if it is only in a small way. For example one persons care plan said to encourage her to wash her own face. There were also up-to-date assessments of need. This included mental capacity, moving and handling assessments and falls. There was also information on peoples life history and personal preferences. Feedback received was that people are well cared for. In discussions with staff they were able to describe how they supported people and their Care Homes for Older People Page 13 of 29 Evidence: likes, dislikes and preferences. However this detail of information was not in the care plans. For example one persons plan stated that she required a regular toileting routine but there were no details of what this meant, although the staff spoken to was clear about this. It is recommended that care plans contain more detail. This will help staff to provide a more consistent service in line with individual needs and likes. This will also benefit the people living there. Feedback from one visitor was that his wife was very well looked after. All the people living at Bennetts Castle are registered with a local Doctor and specialist help is received when needed. For example the dietician. The district nurse team also provide support. Health care plans were in individual files. These were detailed and once again covered the appropriate areas. When required people have pressure care mattresses to lessen the risk of pressure sores. Also when required specific monitoring is in place. For example for weight or food and fluid intake. Records are kept of medical appointments and these show that people have checks from the optician, dentist and chiropodist. People are never sent to hospital or to attend appointments outside of the home without being accompanied. Wherever possible family and friends are encouraged to support appointments but when it is not possible then a member of staff accompanies the person. There is a medical room on each floor and medicines trolleys for each unit are stored in these. They are chained to the wall as required. The key to the medical room is held by the senior on duty. Most medication is administered via a monitored dosage system and medication was appropriately stored. Medication trolleys and cupboards were tidy and well organised. Medication is administered by the seniors and they have had training to do this. There are appropriate facilities for the storage of controlled drugs. Controlled drugs records are kept as required and these were checked and the medication counted. The records for controlled drugs were accurate. Opening dates were on inhalers, creams and drops. There were a list of staff that could administer medication and a copy of their signatures or initials. These are both good practice. There are medicines fridges and the daily temperatures are recorded. However only one temperature was being taken and to ensure that medication is being stored at the appropriate temperature at all times the maximum and minimum temperatures must be checked and recorded. MAR (Medication Administration Records) were appropriately kept and up-to-date. In some cases the doctor had signed a change to the MAR (Medication Administration Records). In other cases these change has been made by staff but had not been signed. For accountability and to provide an audit trail any hand written entries made by staff on the MAR (Medication Administration Records) must be endorsed with the date and signed initials or signature of that person. In some cases people were prescribed PRN (when required) medication. Care Homes for Older People Page 14 of 29 Evidence: Protocols/guidelines must be in place for each of these to ensure that people get this medication correctly and that staff are clear as to how and when to administer this. The service is able to and does care for people at the end of their life. This is done with support from the Doctor and other health care practitioners when needed. Compliments seen at the home, from relatives, included: Thank you for making the last days of her life secure and happy and especially for giving her the dignity and comfort to die in her own home. I am glad he was with you all at the end. Thank you for allowing dads funeral to leave from his home. Care Homes for Older People Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a general programme of activities available, which is varied to suit individual interests, preferences and capabilities. People are helped to exercise choice and control over their lives and to maintain contact with family, friends and the local community. People are provided with food that meets their preferences, nutritional and health needs. Evidence: Standards 12, 13, 14 & 15 were tested. The home employs an activity coordinator who works five days per week. There is a programme of activities available for people to participate in if they choose. This includes card games, bingo, reminiscence, food tasting, memory games, karaoke, music and movement and arts and crafts. There are also visiting entertainers and a pat dog visits every two weeks. The home now has a minibus and people can be taken out in this. Some people went to Clacton for the day and another group went to a local theatre. Records are kept of activities and who has participated. In addition Care Homes for Older People Page 16 of 29 Evidence: celebrations are held at the home. For example a Halloween party and Christmas party. In addition there is a regular church service, weekly holy Communion and a gospel choir visits every second Saturday. The home has links with a local comprehensive school and students from there painted various murals on the walls of the corridors around the home. At the time of the inspection students from a college were helping with activities as part of their courses. Relatives are encouraged and welcomed to join celebrations, to visit and to have meals with their relative. From observations on the day, discussions with staff, relatives and people living at Bennetts Castle it was evident that people are encouraged to make choices about what they do, where they go and what they eat. Pictorial menus and photographs of food are available to help people choose what they want to eat. Although each floor has two units people are free to use any of the communal spaces. Appropriate signage and decor is in place to aid the orientation of people living with dementia. A new catering system has been introduced. The cooked meals arrive at the home frozen and are then regenerated. Feedback was that people are eating more under this new system. A tasting evening was held for relatives and they were happy with the food. In addition snacks and drinks are available and are prepared either in the kitchen or in one of the serveries. There is a choice of meals each day and meals are available for people on special diets or with specific requirements. For example pureed meals and gluten-free meals. One of the people living at Bennetts Castle said that the food was good and that she enjoyed it. At lunchtime on both floors the tables were appropriately laid with tablecloths, cutlery, drinks and condiments. Staff were observed to sit with people who need assistance to eat. These people were supported discreetly and patiently. A visit was made to the kitchen and we were able to discuss the storage and preparation of food with the cook and she was aware of peoples different needs in terms of their diet. Care Homes for Older People Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safeguarded by the working practices and support of the staff team. In addition their rights are actively promoted. Evidence: Standards 16 & 18 were tested. The home has a written complaint policy and procedure and staff spoken to were aware of the complaints procedure and how to deal with complaints or concerns made to them. In 2009 there were two formal complaints made to the home. Neither of the relatives were satisfied with the response from the home and had contacted placing authorities and the Commission. Both of these were investigated in depth by the local authority and found to be totally unsubstantiated. The home has policies and procedures for safeguarding people from abuse. Staff have had safeguarded training and are aware of safeguarding issues and their responsibilities. Staff have also had training from the Independent Mental Capacity Advocate. Independent Mental Capacity Advocates have been contacted to advocate when people have not been able to express their wishes. The manager has made safeguarding referrals when there has been a concern. She is clear about individual rights and responsibilities and advocates for people. The section on staffing later in this report gives information that confirms that there is Care Homes for Older People Page 18 of 29 Evidence: an appropriate recruitment procedure and this also helps to safeguard people living in the home. The home do not deal with peoples overall finances, but some people have small cash amounts held in safekeeping. The section on management and administration gives more details on this and confirms that systems are in place to safeguard people from financial abuse. The manager audits and monitors accident records and checks for any recurring patterns and addresses any issues that arise. This also helps to safeguard people. Care Homes for Older People Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are living in a safe, well maintained environment that is suitable to their needs. The home is clean, pleasant and hygienic and has been decorated and furnished in a way that supports and assists people living with dementia. Evidence: Standards 19, 20, 21, 22, 23, 24, 25 & 26 were tested. Bennetts Castle Care Home is a purpose built home, on three levels, situated in a residential area of the London Borough of Barking & Dagenham. It is close to local shops and is in easy reach of a bus route to the surrounding shopping areas of Dagenham Heathway, Romford and Ilford. The home offers 24 hour residential care for 60 older people with dementia and/or frail elderly people. All bedrooms are single rooms with en suite toilet and handbasin. Bedrooms are personalised to suit individual preferences and people are encouraged to bring familiar things from their home. When possible bedrooms have signage that is familiar to the occupant to help them to identify their own room. The home operates in four units which are Leeds, Hastings, Windsor and Arundel. Each unit has its own lounge and dining area. There is a wellmaintained rear garden which has seating areas, and there are car parking facilities for visitors. A CCTV monitoring system is in place around the external perimeter of the home for security reasons. Care Homes for Older People Page 20 of 29 Evidence: The building was found to be well lit, clean, pleasant and hygienic with no offensive odours. However one person fedback that there is a very strong smell of urine if you are at the home early. It is therefore recommended that this is looked into and if necessary the arrangements for dealing with soiled laundry first thing in the morning be reviewed. Specialist equipment such as hoists and handrails were evident, telecare equipment such as infrared beams is used to alert staff to people who are in danger of falling if they get out of bed. Pressure relieving mattresses are used when required. Any other equipment would be provided where necessary to enable people to maintain independence. There is a mixture of suitable baths and showers which gives people a choice. Toilet door frames have been painted a different colour with appropriate signage to aid orientation for people living with dementia. The lounge/dining area is well furnished and carpets are not highly patterned which prevents visual disturbance. There are various lounge areas throughout the home, which means people have a choice of places to sit. One of the lounges is a reminiscence room and has appropriate furniture and memorabilia. People are able to walk around the home freely and there are murals of shop fronts and other things of interest on the walls in the corridors. These were painted by young people from the local secondary school and they will be painting more in the near future. The kitchen has recently been extended and was well maintained, clean and hygienic. The food was correctly labelled and dated in fridges, all other foods were being stored appropriately and the chef was aware of hygiene requirements. The service has been awarded a 5 star food hygiene rating by the London borough of Barking & Dagenham. With the exception of the servery on the first floor the building is well maintained and in a good state of decoration and repair. The servery needs to be re-fitted and redecorated to ensure that it is in an acceptable standard of hygiene and repair. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people are supported and protected by the recruitment practices of the service. They are supported by a competent and well-trained staff team who have the necessary skills and experience to meet their needs. Evidence: Standards 27, 28, 29 and 30 were tested. The usual staffing levels during the day are two seniors and three carers on each floor. In addition they are supported by housekeepers, laundry assistants, a maintenance person, a chef and two kitchen assistants, an administrator and an activity organiser. At night there is one senior and four carers on duty. The night staffing levels mean that if somebody needs to go to hospital they can be accompanied by a member of staff. At the time of the inspection sufficient staff were on duty to meet the needs of the people living there and in discussions with the manager it was apparent that if additional staff were required at anytime then this would be arranged. There is little use of agency staff and any gaps in the rota are generally covered by permanent staff. This benefits the people living there as it provides consistency of care. With the exception of three new staff all staff have achieved at least NVQ level II in care. In addition nine staff are in the process of completing NVQ in dementia and others NVQ in equality & diversity. The chef and catering assistants are also Care Homes for Older People Page 22 of 29 Evidence: undertaking NVQ training. From talking to staff and inspecting training records it was apparent that staff have the opportunity to undertake various training courses and this includes moving and handling, infection control, safeguarding vulnerable adults, health and safety and the Mental Capacity Act. Some training is arranged in house and others are external courses. There was also evidence that training is renewed and updated regularly. Staff are therefore receiving the training that they require to meet the needs of the people living at Bennetts Castle. A random sample of staff files were checked and this included staff that had started recently. Files seen had POVA (Protection of Vulnerable Adults) checks when appropriate. Also CRB (Criminal Records Bureau) checks, application forms, references and confirmation of identification. The manager contacts the Home Office to check on visas. Therefore a robust recruitment process is in place and this helps to safeguard the people at Bennetts Castle. Feedback from one healthcare professional was that people are treated with respect and that staff take the time to talk to them. Another healthcare professional said that people are treated kindly and respectfully and that staff have an acceptable bedside manner. Feedback from relatives was: it is really good here, my mother is well cared for. Mum was always complimentary about the food, the bedroom and the carers. Thank you for the care and kindness shown to Mum. She was happy in this home. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Bennetts Castle benefit from a service that is well managed and where their rights and well being are promoted. Having a full management team in place will make this more robust and enable the service to develop further. People live in a safe home. Evidence: Standards 31, 32, 33, 35, 36, 37, & 38 were tested. The manager has worked at the home for some time in a senior capacity and was appointed manager just over a year ago. She has completed the RMA (Registered Managers Award) and has applied to be registered with the Commission. Unfortunately there is not a deputy in post and at the time of the inspection attempts to recruit had not been successful. The manager does receive good support from the organisation but the organisation are not based locally. There is a formal supervision system and the manager is undertaking all of the supervision at present and covers all of the on Care Homes for Older People Page 24 of 29 Evidence: call. She does hold monthly staff meetings and this includes meetings for night staff. However this is not sustainable and arrangements need to be in place so that there is a management team to more robustly oversee the daily running of the service and to facilitate further developments. The manager does not act as appointed agent for any of the people living at Bennetts Castle. Their financial affairs are managed by their relatives or representatives. The home holds small amounts of personal money which is used for such things as newspapers, hairdressing and chiropody. The money is stored in separate wallets in the safe. The money is accessed by the administrator and the manager checks and counts cash each week. The cash held for four people was checked as part of the inspection and the amounts recorded tallied with the cash held. Peoples monies are securely stored and systems are in place to protect them from financial abuse. A representative of the organisation carries out monthly monitoring visits to monitor and report on the quality of the service being provided in the home. Copies of these reports were available at the home. The reports seen were detailed and cover the necessary areas. In addition the quality of the service is monitored by the manager and this includes monthly monitoring of accidents and incidents to establish if there are any trends or patterns. At the time of the inspection the manager had also sent out some quality assurance questionnaires to relatives and other professionals and was waiting for responses. The necessary health & safety checks are carried out regularly and records are kept of these checks. The records were up to date and accurate. Equipment and services are serviced as appropriate. A safe environment is maintained for the people living, working and visiting Bennetts Castle Care Homes for Older People Page 25 of 29 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 26 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 9 13 Protocols must be in place 28/02/2010 for the administration of PRN (as required)medication. This must include the dosage of the medication, the circumstances under which is to be administered, the frequencies/minimum period before repeating of a dose, the maximum number of doses in a time span, and the action to be taken in the event of the persons symptoms inadequately responding to the medication. This will help to ensure that staff are clear about how, when, and why to administer this medication. 2 9 13 The maximum and minimum 28/02/2010 temperatures of the medicines fridge must be taken and recorded each day. Page 27 of 29 Care Homes for Older People 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 To ensure that medicines are being stored at the correct temperature. 3 9 13 Any hand written entries to 31/01/2010 the MAR (Medication Administration Records) must be endorsed with the signature or signed initials of the person making the entry. For accountability and to provide an audit trail. 4 19 23 The first floor servery must 31/03/2010 be re-fitted and redecorated. To ensure that it is in an acceptable standard of hygiene and repair. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that care plans contain more detail so that people receive care in a consistent manner that meets their specific needs and preferences. It is recommended that the arrangements for dealing with soiled laundry be reviewed and changed if necessary. 2 26 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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