Care Home: Bethesda House

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What the care home does well People are assessed before being offered a service so they can be assured their needs will be met. People have well cooked traditional, home cooked food. People benefit from dedicated provision in order to meet their spiritual needs. People have regular access to health care services and receive good support from local GPs and District Nurses. A clear record of all medical intervention people receive is maintained. Visitors are encouraged and hospitality is evident. People are clear about how to raise a concern or make a formal complaint. People are able to personalise their rooms and undertake housekeeping tasks if they wish. The home is light, comfortable and well maintained. People benefit from a good standard of cleanliness within the home. What has improved since the last inspection? Personal information such as care planning documentation is now stored in the office rather than in the dining room. `Sit on` scales have been purchased enabling each person`s weight to be monitored accurately. A choice of meal at lunchtime for three days a week has been introduced enabling people greater variety and choice. Staff observe people taking their medicines rather than leaving them in front of the person, thus reducing the risk of error. People who manage their own medication have been assessed as safe to do so. The homely remedies policy has been updated and signed by a GP. New carpet has been fitted in one person`s bedroom. Two bedrooms have been redecorated. As part of the staff recruitment procedure, a written reference is gained from the person`s current employer. Prospective staff members complete their own application form and sign it, authorising it is an accurate account. Information regarding the safe use of harmful substances, such as cleaning products, is available for staff reference. Specific records are now maintained in relation to the monitoring of hot water temperatures. An investigation into the level of falls has been undertaken with medicine reviews, greater supervision and referrals to the falls clinic, made as a result. What the care home could do better: When a person receives on going intervention for the management of a wound from a district nurse, the wound and its healing process should be identified within the person`s care plan. The home should not solely rely on the district nurse`s notes. All medicines must be securely stored at all times. Staff should not engage in any other activity while administering medicines to people so that the risk of error is minimised. Staff must always sign the medicine record to show they have administered medicines to people. Handwritten medicine instructions should be consistently dated and countersigned by another member of staff. The controlled drugs book must comply with legislation and contain numbered pages to ensure a clear audit trail. Triggers which promote an administration of prescribed `as required` medicine must be clearly identified within the person`s care plan. Regular review of the cupboard which stores medical dressings must be undertaken so that items do not pass their expiry date and are therefore safe to use. People should have their own nail clippers and pumice stones to minimise the risk of infection. Consideration should be given to ways in which the bathrooms could be made more homely and inviting. Staff must ensure that they date and appropriately cover any food that is placed in the freezer. Any packages of food should be dated when opened. This is to ensure that the `shelf life` of food can be monitored so all items are safe to use. All food items should be stored above floor level so that there is not a risk of contamination. All tests of the fire alarm systems should be demonstrated at the time by handwritten entries within the fire log book. This ensues that a clear, contemporaneous monitoring system is evidenced, which safeguards people using the service. Regular fire drills must take place to ensure that staff have the knowledge to competently follow procedures in the event of a fire. Staff must ensure that they follow procedures accurately, when managing any transaction with people`s personal monies. The shortfall of monies identified must be reimbursed. The manager should not be considered an integral part of the working roster and should concentrate more fully on management and administration systems. There should be greater organisation so that work is evidenced and can be located efficiently. The manager should update her training to ensure her professional qualifications meet the up to date requirements of managing a care home. This would enable further personal development and give additional skills and knowledge to manage the home effectively. Key inspection report Care homes for older people Name: Address: Bethesda House Derry Hill Bethesda House Calne Wiltshire SN11 9NN     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: Alison Duffy     Date: 0 4 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 40 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Bethesda House Derry Hill Bethesda House Calne Wiltshire SN11 9NN 01249816666 01249758877 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Gospel Bethesda Fund Name of registered manager (if applicable) Miss Rebecca Wheeler Type of registration: Number of places registered: care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: No more than 1 male service user with physical disability No more than 12 service users over 65 years of age The Registered Person will continue to provide personal care and accommodation to service users, who whilst at the home are diagnosed with Dementia, until such time that their care needs cannot be met. Date of last inspection Brief description of the care home Bethesda House is registered to provide care to thirteen older people, one of whom may have a physical disability. The home is one of a number of homes managed by the Gospel Standard Bethesda Fund. One of the conditions of residency is the continued Care Homes for Older People Page 4 of 40 Over 65 12 0 0 1 2 8 0 1 2 0 0 9 Brief description of the care home attendance at a Gospel Standard chapel unless prevented by frailty or illness. In such circumstances, services are relayed to the home and people using the service, are able to participate, within the lounge or their own room. Miss Rebecca Wheeler is the registered manager. Bethesda House is a purpose built detached property. It has one twin and eleven single rooms on the ground floor. All except one of the rooms have en-suite facilities. There is a comfortable lounge and separate dining room. Pleasant, well maintained gardens surround the property. Staffing levels are maintained at a minimum of two care staff on duty during the waking day. At night one member of staff undertakes a waking night and another provides sleeping in provision. Catering and housekeeping staff are also deployed. Care Homes for Older People Page 5 of 40 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: Before visiting Bethesda, we sent the home an Annual Quality Assurance Assessment (AQAA) to complete. The AQAA is the homes own assessment of how they are performing. The AQAA tells us about what has happened during the last year and about the homes plans for the future. We sent surveys, for people to complete if they wanted to. We also sent the home surveys to be distributed to staff and health/social care professionals. This enabled us to get peoples views about their experiences of the home. We received surveys from five people using the service, three members of staff and two health/social care professionals. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home. This visit took place on the 8th December 2009 and 4th February Care Homes for Older People Page 6 of 40 2010. Miss Wheeler was on annual leave on our first visit but was available throughout on the 4th February 2010. Miss Wheeler received feedback at the end of our visit. During our visit, we toured the accommodation and met with people who use the service. We spoke to staff members on duty and observed how they interacted with people. We saw people having lunch. We looked at care-planning information, staff training records and recruitment documentation. We also looked at documentation in relation to health and safety and complaints. The last key inspection of this service took place on 28th January 2009. All key standards were assessed on this inspection. Observation, discussions and viewing of documentation gave evidence, which showed whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? Personal information such as care planning documentation is now stored in the office rather than in the dining room. Sit on scales have been purchased enabling each persons weight to be monitored accurately. A choice of meal at lunchtime for three days a week has been introduced enabling people greater variety and choice. Staff observe people taking their medicines rather than leaving them in front of the person, thus reducing the risk of error. People who manage their own medication have been assessed as safe to do so. The homely remedies policy has been updated and signed by a GP. New carpet has been fitted in one persons bedroom. Two bedrooms have been redecorated. As part of the staff recruitment procedure, a written reference is gained from the persons current employer. Prospective staff members complete their own application form and sign it, authorising it is an accurate account. Information regarding the safe use of harmful substances, such as cleaning products, is Care Homes for Older People Page 8 of 40 available for staff reference. Specific records are now maintained in relation to the monitoring of hot water temperatures. An investigation into the level of falls has been undertaken with medicine reviews, greater supervision and referrals to the falls clinic, made as a result. What they could do better: When a person receives on going intervention for the management of a wound from a district nurse, the wound and its healing process should be identified within the persons care plan. The home should not solely rely on the district nurses notes. All medicines must be securely stored at all times. Staff should not engage in any other activity while administering medicines to people so that the risk of error is minimised. Staff must always sign the medicine record to show they have administered medicines to people. Handwritten medicine instructions should be consistently dated and countersigned by another member of staff. The controlled drugs book must comply with legislation and contain numbered pages to ensure a clear audit trail. Triggers which promote an administration of prescribed as required medicine must be clearly identified within the persons care plan. Regular review of the cupboard which stores medical dressings must be undertaken so that items do not pass their expiry date and are therefore safe to use. People should have their own nail clippers and pumice stones to minimise the risk of infection. Consideration should be given to ways in which the bathrooms could be made more homely and inviting. Staff must ensure that they date and appropriately cover any food that is placed in the freezer. Any packages of food should be dated when opened. This is to ensure that the shelf life of food can be monitored so all items are safe to use. All food items should be stored above floor level so that there is not a risk of contamination. All tests of the fire alarm systems should be demonstrated at the time by handwritten entries within the fire log book. This ensues that a clear, contemporaneous monitoring system is evidenced, which safeguards people using the service. Regular fire drills must take place to ensure that staff have the knowledge to competently follow procedures in the event of a fire. Staff must ensure that they follow procedures accurately, when managing any Care Homes for Older People Page 9 of 40 transaction with peoples personal monies. The shortfall of monies identified must be reimbursed. The manager should not be considered an integral part of the working roster and should concentrate more fully on management and administration systems. There should be greater organisation so that work is evidenced and can be located efficiently. The manager should update her training to ensure her professional qualifications meet the up to date requirements of managing a care home. This would enable further personal development and give additional skills and knowledge to manage the home effectively. 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 10 of 40 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 11 of 40 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. People are assessed before being offered a service, so are assured that their needs will be met within the home. Evidence: The AQAA stated in relation to what the home did well pre-admission visits with home brochures. We try to ensure they have a trial stay beforehand. Everyone is provided with a contract. At the last inspection, we saw that there was a strict admission criterion in place. Miss Wheeler told us that changes had not been made to this process. To be eligible for a placement within the home, the prospective person must be a member of the Gospel Standard Churches or have regularly attended Gospel Standard chapels. People completed an application form, which was then presented to members of the Bethesda Fund Committee. Identifying the persons church and Minister, formed part of the assessment documentation. As part of the process, contact was made with the Care Homes for Older People Page 12 of 40 Evidence: prospective persons GP. Information about medication and past and present health conditions was requested. Miss Wheeler generally visited people in their home environment to complete an assessment of their health and personal care needs. Following this, a decision to offer occupancy was made. This took into account individual need and spiritual aspirations. Within their surveys, five people told us that they received enough information about the home to help them decide if it was the right place for them, before they moved in. Health/social care professionals said that the services assessment arrangements always ensured that accurate information was gathered and the right service was planned for people. Care Homes for Older People Page 13 of 40 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. People benefit from a care plan that generally reflects their needs. People have good access to health care provision. People are at risk through staff not consistently following procedures in relation to the storage and administration of medicines. Peoples privacy and dignity is maintained. Evidence: People told us that they were very happy with the care they received. Within their survey, one person told us that meeting their needs was something the home did well. They could not think of anything the home could do better. Within surveys, people told us that they always received the care and support they needed. In relation to what the home did well, the AQAA stated encourage independence. Individualised care planning. Good end of life care. In relation to equality and diversity, the AQAA stated we treat all staff equally and all residents equally irrespective of beliefs, ability etc. We do not have a great range of diversity within the residents as the home is for a specific group of Christians who hold similar beliefs. Care Homes for Older People Page 14 of 40 Evidence: Staff told us that they believed the standard of care provided to people was very high. They said that staff were committed to ensuring peoples wellbeing. One member of staff told us how they had supported a person who wanted to have their hair washed and set, despite being poorly and being cared for in bed. The staff member told us said that having immaculate hair had always been important to the person. Staff said they were therefore aiming to ensure the persons hair was maintained as they would have liked, for as long as possible. At the last inspection, we made a requirement to ensure that all personal information such as care plans, be stored securely. We saw that the care plans had been removed from the dining room and were stored in a filing cabinet in the office. The cabinet was not locked. Miss Wheeler told us that this was for staff to have easy access to the documentation. The AQAA stated that over the last twelve months, care planning had been improved upon. We looked at three care plans in detail. We saw that the plans generally reflected peoples needs and the support they required. The plans had been reviewed on a monthly basis. Miss Wheeler told us that one persons needs had recently changed and an end of life plan had been put in place. At the last inspection, we advised that greater detail and more specific information be recorded in the care plans. There remained some entries which were not specific. This included for example, help XX get comfortable in bed and XX to participate in all activities, as much as possible. We advised that the statements be clarified to explain the exact support the person needed. There was good information about a person being susceptible to urinary tract infections. The care plan clearly informed staff what they needed to do to minimize the risk of this. The plan also identified signs and symptoms of a possible infection. Within the AQAA we saw that specific tasks e.g. weighing, monitoring blood pressure, nutrition assessments etc are each given to one person to do. People had a manual handling assessment in place. Their risk of developing a pressure sore had been assessed. We saw that people had a pressure relieving mattress in place when needed. However, there was little information in one care plan about ensuring that the persons position was regularly changed. The persons pain management was also not clearly stated. We saw that a district nurse was visiting one person on a regular basis. Staff told us the reasons for this. There were no details of this within the persons care plan. Miss Wheeler told us that such information would be detailed within the District Nurses own records. We said that the information should also be documented in the persons Care Homes for Older People Page 15 of 40 Evidence: care plan. This was identified at the last inspection so has not been addressed. At the last inspection, we made a requirement that where a risk of dehydration or malnutrition was identified, clear control measures to minimise the risk, must be in place and be regularly monitored and evaluated. We saw that this had been addressed in part. The person had a food and fluid chart in place yet it had not been totalled and evaluated at the end of each day. Staff told us that since the last inspection, sit on scales had been purchased. They said they had been invaluable in enabling everyone to be weighed rather than only those who could stand on ordinary scales. We saw that people had been weighed regularly and a record of their weight was maintained. Staff told us that if there was concern about a persons weight, the GP would be informed. They said that one person had supplement food drinks due to their loss of appetite. Within surveys, health/social care professionals told us that peoples social and health care needs were always properly monitored, reviewed and met by the service. They said the care home always sought advice and acted on it to meet peoples needs and improve their wellbeing. In relation to what the home did well, one health/social care professional said uses GP services appropriately. I am very pleased with the standard of care there. Another health/social care professional said staff/matron at Bethesda House have always had a good working relationship with the District Nursing Service. Residents needs are always met at a high standard and staff always ask the nursing service for help/advice when necessary. Staff told us that people had good support from local GPs and District Nurses. This was confirmed in the AQAA whereby it stated good relationships with GP, awareness of problems with eating and drinking. Good relationships with district nurses, for leg ulcer care and continence management. Good relationship with pharmacist. Availability of domiciliary eye care and chiropody. We saw within peoples care plans that a record of all visits and interventions in relation to peoples health care needs was maintained. We looked at the systems in place for managing peoples medicines. We saw that staff administer medicines from their original boxes or bottles. A monitored dosage system is not used. At the last inspection, we made a requirement that all medicines must be given directly to the person instead of being placed in front of them at a meal table. We said that staff must ensure that each person took their medicine before they signed the medicines administration record. At this inspection, we saw that the staff member gave people their medicines and observed them being taken. We did not see Care Homes for Older People Page 16 of 40 Evidence: medicines being left on the table whilst people finished their meal. We saw that the staff member signed the medicine administration record after the medicine had been taken. However, whilst administering medicines we saw that the staff member also cleared plates from the tables and responded to peoples individual requests. We said that this could cause a lapse in the staff members concentration and may result in error. Whilst we saw that the staff member signed the record after each medicine had been given, it was apparent that not all staff did this. There were some gaps in the medicine administration record. Staff members had dated and countersigned some handwritten medicine instructions yet this had not consistently been undertaken. This was recommended at the last inspection. We saw that one person was prescribed a medicine as required. We advised that specific information about what triggered an administration be detailed within the persons care plan. At the last inspection, we made a requirement that a documented risk assessment be in place regarding a persons ability to safely manage their own medication, if required. We saw that this had been undertaken although the indicators used to reach the overall decision, were not recorded. One person who used the service regularly went on holiday. At the last inspection, we recommended that the medicines taken out of the home be fully documented to show an audit trail. We saw that this had been undertaken in part although the number of tablets had not been stated. As good practice we saw that staff had dated eye drops when opened. We said the same process should be applied to topical creams. We saw that there were a number of medicines in an unsecured box in the office. Miss Wheeler told us that she had taken them out of the medicine cupboard to take to the pharmacy for disposal. She had then forgotten them, so they were left out. Miss Wheeler was aware of the need to store medicines safely and admitted this was an error on her part. Within a cupboard we saw that there were a number of first aid dressings, which had passed their expiry date for use. One dressing was in an opened packet. This meant the dressing was not sterile, which presented a risk of infection. Within the cupboard, there was a box of nail clippers and a pumice stone. Miss Wheeler told us that the clippers were cleaned with antibacterial wipes before each use. While acknowledging this, we said that people should have their own items. Miss Wheeler told us that she had checked the controlled drugs cupboard in order that it complied with current legislation. We saw that the controlled drugs book was in need of updating, as it was not an official book with numbered pages. Care Homes for Older People Page 17 of 40 Evidence: At the last inspection, we recommended that the homely remedy policy be updated. During our first visit, we saw that this had not been addressed. On our second visit, the policy had been updated and had been authorised by the GP. People told us that their rights to privacy and dignity were respected. One person told us thats something thats very good here. The staff are all very good and respect us as people. They do not intrude but let us follow our daily lives. Another person said we can ask for help when we need it but they leave us to manage if we can. They enable me to be as independent as I can be, but I know they are there if I want them. We saw that staff interacted well with people. When supporting people with their mobility, there was general discussion. People were encouraged to take their time. We heard one staff member say just a minute, Ill help you with that door. Go careful. We then heard the staff member offer the person help, if they needed it. Staff told us that they had built up good relationships with people. They spoke of one person with affection, who had recently died at the home. We saw that peoples dignity was enhanced through staff members attention to personal care routines. We saw that people were well groomed with clean, well cut finger nails, brushed hair and well laundered clothing. Within the AQAA, it stated we provide quality care within a pleasant setting, that suits the religious beliefs and lifestyle of our residents. This is provided by a trained workforce endeavouring to promote the rights, dignity and choice, of each individual resident. To treat them with respect. To acknowledge their capacity to make good and bad decisions and to make the least restrictive decision on their behalf if they cannot make a decision for themselves. Care Homes for Older People Page 18 of 40 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. Significant consideration is given to meeting peoples spiritual needs, therefore enhancing their quality of life. People are encouraged to have visitors and maintain important relationships. The introduction of a choice at lunchtime has improved peoples variety of food. Evidence: The AQAA stated that meeting the religious needs of people was something the home did well. Other areas the home said they did well were provide an outside area for all to use. Social activities record. Introducing more variety of activities e.g. young peoples orchestra evening, slides and cine films. Encourage visitors. Chair based exercises. In relation to recent improvements, the AQAA stated just completing recruitment process for volunteers to set up a more structured and varied activities programme, to meet the wide range of needs we have within our current mix of residents and better involvement with the residents in the decision making within the care home. e.g. lighting choice in lounge, flooring options for dining room. Within surveys, three people told us that there were always activities they could join in with. One person said there were usually were. People told us that they generally spent their time reading, writing letters or within quiet reflection. One person said Care Homes for Older People Page 19 of 40 Evidence: they enjoyed the services within the home and the company of their regular visitors. Another person told us that they enjoyed talking to the speakers who facilitated the homes services and the homes volunteers. One person told us that they sometimes joined in with the craft activities. They showed us a Christmas card they had made. They said that many of the items made within the craft group were sold within the home. Within the entrance area of the home, we saw photographs of various activities such as jam making, a Bar-B-Que and afternoon tea in the garden. Miss Wheeler told us a photograph book of events was in the process of being developed. Staff told us that some external events were arranged for people. Earlier in the year, some people went to see the bluebells in a local beauty spot and they went to Weston Super Mare. Staff told us that spontaneous events proved more popular than planned events. They said people often changed their mind about going if they had a long while to think about it. Staff told us they felt additional activities and outings were areas the home could improve upon. They said staffing levels sometimes impacted upon social activity provision. Due to their commitment to people, one staff member told us that many staff gave their own time to take people out. Within a survey, one staff member told us it caters very well for the needs of all individuals in the home especially their faith and spiritual needs. In relation to what the home could do better they said take the residents out a bit more. A staff member told us that residents meetings were held. The meetings enabled people to express their views about the service or make suggestions about things they wanted to do. They said that staff members were not involved in the meetings. One staff member felt that staff involvement would enable people to express their views more openly. People told us that they could follow their own preferred routines. They said they could choose what they wanted to do with their time. People told us that they liked the meals, which were provided. One person said the food is very good here. We now get a choice which is better. Another person said the food, its very nice. Its well cooked and its food our generation like to eat. Within surveys, three people told us that they usually liked the meals provided. One person said they sometimes liked the meals. We saw that people were seated in the dining room and Grace was said, before the Care Homes for Older People Page 20 of 40 Evidence: lunch time meal was served. Staff told us that this arrangement was a clear routine and always followed. The cook plated all meals and kept them in the hot plate until people were ready. We saw that the food looked well cooked and appetizing. One person received assistance to eat. The staff member supporting them sat down at their side and interacted well. We saw that two family members had lunch with their relative in the dining room. One person had their meal liquidized. The food had been liquidized together. This did not look appetizing and did not enable the person to be able to taste the individual flavours. Miss Wheeler told us that due to the persons needs, they were unable to eat foods separately. Miss Wheeler said that it had been decided to liquidise the food together so that the person would eat and maintain a good nutritional intake. We saw from the AQAA that a choice of the lunchtime meal had been introduced for three days of the week. It was expected that this would develop to a choice on each day of the week except Sunday. The AQAA confirmed this by stating not on Sundays due to the Biblical idea of not doing unnecessary work on Sundays. We spoke to the cook about this. They said people were given a menu and they chose what they wanted for the week. They said the choices had worked well although they were not aware that an alternative was to be introduced throughout the week. Miss Wheeler confirmed that she had not as yet informed the cook of this. We looked at the menus and saw there were choices of traditional meals such as steak and kidney pie or chicken casserole and pork casserole or shepherds pie. The cook told us that Miss Wheeler completed all menus. She was not involved in the menu planning process. Care Homes for Older People Page 21 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are clear about the ways in which they can make a complaint. Staff are not given enough information to protect people in the event of an allegation of abuse. Evidence: People told us that they would tell a member of staff if they were unhappy about a situation. One person said the staff are always in and out so it wouldnt be difficult to let someone know how you were feeling. Another person said well theres not been a need, but I suppose you would just sort it out with the staff who happened to be on duty. One member of staff told us that if a person raised a complaint with them, they would tell Rebecca [the manager.] They said Rebecca would talk to the person and sort it out. They told us if Rebecca was off duty, we would speak to Rebeccas deputy manager. If it was really serious we could contact someone from the Committee. They said that this process would be followed in the event of an allegation of abuse. Another staff member told us that they were not sure what would happen if they were informed of an allegation of abuse, as they had never experienced the situation. They told us if it happened on a late shift, I would need to talk to the person I was working with and we would decide together, what we needed to do. Staff members did not appear clear or confident about local safeguarding protocols. One staff member told us that they did safeguarding training a while ago. Another staff member said we havent done anything recently although Im sure Rebecca has got things booked in. Care Homes for Older People Page 22 of 40 Evidence: We are usually kept up to date with training. The AQAA stated all staff completed Safeguarding Adults training. However, due to some staff members apparent lack of safeguarding knowledge, we advised that staff training in this area be reviewed. We saw that there were two staff handbooks in the office. One contained a complaint procedure, which was in need of updating. The procedure identified the previous regulatory authority. There were no contact details for people to use when wanting to raise a concern. Miss Wheeler told us that she had recently updated the complaint procedure although had probably not updated both copies of the handbook. We saw that there was a flowchart, which detailed the contact numbers of the local Safeguarding team, on the notice board in the office. The AQAA stated that no formal complaints had been received over the last twelve months. It said we complete a niggles book for small issues e.g. someone thought the meat was always tough/not cooked properly. Within a persons daily record we saw that a family member had raised a concern. This was not detailed within the complaint log. Miss Wheeler told us that the issue had been sorted through enabling the relative to have a better understanding of the situation. Miss Wheeler told us that the person using the service did not want what the relative was expecting. As evidence of how complaints were managed, we said that the investigation, the outcome and any measures put in place as a result, must be documented. The record and how the complaint was managed would also form part of the homes quality assurance in terms of ongoing improvement. As a means of improving the service, the AQAA stated use monthly inspections by responsible person to target a particular subject for audit. Within surveys, people told us that they knew who to speak to if they were unhappy. They also knew how to make a formal complaint. Within their surveys, staff told us that they knew what to do if someone had a concern. Care Homes for Older People Page 23 of 40 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 benefit from a clean, comfortable and well maintained environment. People are able to personalise their rooms. Systems are in place to minimise the risk of infection. Evidence: The AQAA stated that providing a pleasant and clean environment within a pretty garden was something the home did well. Each person had a single bedroom on the ground floor, with an en-suite facility. The bedrooms we saw were light, comfortable, homely and well maintained. People had personalised their bedrooms with their own furniture and possessions. At the last inspection, we made a recommendation that the carpet in one particular bedroom be replaced. We saw on our first visit that this had not been undertaken. On our second visit, a staff member told us XX has got new carpet and it looks great. We saw that the new carpet had made a significant difference to the room. Within the AQAA, the improvements to the environment were stated as upgrade to nurse call system and security. Infection control. Laundry management. Got 1 more hi-lo bed. Renewed central lighting in lounge. Handwash facilities for staff in all residents rooms. It also stated general re-decoration, including dining room floor residents have helped choose carpet design and some small changes to the garden and layout with residents input. Care Homes for Older People Page 24 of 40 Evidence: People told us that they spent some time in their bedrooms. The majority of their time was spent in the main lounge. This was a well furnished, comfortable room where daily services and prayer meetings also took place. There was a well maintained garden with a summer house. We saw that the home was very clean throughout. There were no unpleasant odours. A member of staff told us that they had certain areas of the home, which they were responsible for cleaning. They said as you generally do the same persons room all of the time, you get to know them well. You can have a chat and talk about family or interests. You also see if they are not very well or if they are worried about something. It works well. They said staff also helped other staff with their particular area if needed. The staff member said they might work together to spring clean a room. The staff member said that they were provided with all of the equipment required, to do their job. There were pump action soap dispensers and paper towels in all of the communal toilets and bathrooms. At the last inspection, we recommended that the bathrooms be made more inviting. We saw however, that they remained functional rather than being comfortable and homely. They also remained cluttered with items such as wheelchairs and commode chairs. Within the AQAA, bathrooms updated was identified as an improvement for the next twelve months. The laundry was clean and ordered. The equipment was well maintained. People told us they were happy with the laundry service they received. We saw that peoples clothing was well laundered and ironed. Care Homes for Older People Page 25 of 40 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. People benefited from the support of a committed staff team. People were better protected through improvements to the staff recruitment processes. Greater organisation and commitment to ongoing staff development would further enhance the skills and knowledge of the staff team. Evidence: A member of staff told us that there were generally two care staff on duty during the waking day. Sometimes this increased to three carers in the morning. At night, there was a waking night staff member. Another member of staff provided sleeping in provision and were called upon for advice or assistance as required. During the day, there were domestic staff and a cook. We saw that the staffing roster confirmed this. Miss Wheeler told us that if she was on an office day, she could also be called upon to support people, as required. Two staff members told us that they felt there were sufficient numbers of staff on duty to meet peoples physical needs. They said that staffing levels during the evening could be tight. This was particularly apparent if a person was unwell or if there had been an accident. At the last inspection, we saw that in addition to caring duties, staff members cooked and served the evening meal. We recommended that this be reviewed. Staff told us that there had been no changes to the staffing arrangements. Care Homes for Older People Page 26 of 40 Evidence: During this inspection, we saw that care staff assisted in the kitchen after lunch. Staff members told us that there was not a kitchen assistant so they helped where ever they could. Miss Wheeler told us that that staffing arrangements had never been any different. She believed the levels were adequate to meet peoples needs. She said this was particularly so while the home was not operating at full occupancy. People told us, within their survey, that there were sufficient staff on duty to meet their needs. Two people told us that they staff always listened to what they said and acted upon it. One person said staff usually listened. Another person said they sometimes did. Two members of staff within their survey, told us that there were always enough staff to meet the needs of people. One staff member told us that there were usually enough staff. Within discussion, it was evident that staff were very committed to their role. They were aware of peoples needs and wanted to do the best for individuals. One staff member spoke of peoples rights and how it was important to respect their individually and enable them to have a good quality of life. Another staff member spoke of Bethesda being the persons home whereby choices and new opportunities were important factors. Staff members told us that they felt the quality of care given to people was excellent. They said the staff had a good team approach, which impacted positively upon people using the service. Staff members told us that access to staff training was good. They told us that Miss Wheeler always ensured that they were up to date with information. One staff member told us that they had recently completed first aid, fire safety and dementia care training. Another staff member said they had completed infection control, first aid and manual handling. Within surveys, two staff members told us that they had training relevant to their role. One staff member did not agree. They said the training did not help them to meet the needs of people they supported or give them enough information about health care and medicines. Miss Wheeler told us that staff were up to date with their mandatory training. This included first aid and manual handling. She said that two care staff had enrolled on the National Vocational Qualification (NVQ) level 2 in health and social care. The cook told us that they had recently completed NVQ level 2 in catering. Miss Wheeler told us that training in infection control, nutrition, oral health, safeguarding adults, the safe handling of medicines and continence promotion, was planned. We looked at staff training records and found that documentation was disorganized. There were many certificates that had not been filed on staff members individual files. Care Homes for Older People Page 27 of 40 Evidence: Not all records of training had been completed. One file showed that the staff member had undertaken training in safeguarding, dementia awareness, first aid, infection control and medication in 2009. Another training record consisted of loose paper which showed dementia care training, as the only subject which was up to date. Due to the disorganization of documentation it was not clear what training staff had undertaken and when refresher training was required. At the last inspection, we recommended that further consideration be given to more external training provision. We did not see evidence that this had taken place. However, the AQAA stated continue with formal qualifications and internal and external training to promote and further staff development. The AQAA also stated looking at raising potential for higher qualifications in care and management. Within their survey, one health/social care professional told us that they believed managers and staff always had the right skills and experience to support peoples social and health care needs. Another health/social care professional said they usually had the right skills. The AQAA stated that training and supervision. Supervision of ancillary staff by deputy manager and staff recruitment processes were areas the home had improved upon. We saw that the home was supporting a college student. The organisation which introduced the person had undertaken all recruitment checks such as references and a Criminal Record Bureau disclosure. Information showed the organisations expectations of the work placement. There was little information however, regarding the persons induction. The organisation had developed risk assessments which Miss Wheeler had signed and adhered to. We advised that in addition, risk assessments devised by the service, should be in place. At the last inspection, Miss Wheeler told us that all applicants applying for a position in the home were requested to attend an interview. During this time, Miss Wheeler would complete the application form with the applicant, based on their answers, during the interview. We made a requirement that applicants must complete their own application form and sign the document accordingly. We saw that this practice was now being undertaken. There were details of the applicants medical health, which ensured they were fit to do the job. They had been checked against the Protection of Vulnerable Adults register before commencing employment. They also had a Criminal Record Bureau (CRB) certificate in place. There were two written references in place, one of which was from a present employer. The AQAA confirmed that the home was in the process of recruiting a bank worker. Care Homes for Older People Page 28 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Undertaking shifts as part of the working roster is impacting upon the managers ability to effectively manage the administrative and management systems within the home. Fire precaution systems are currently insufficient to ensure people are safeguarded in the event of a fire. Evidence: Miss Wheeler has been the registered manager of Bethesda since 1995. She qualified as a nurse from the University of Surrey in 1992 and has completed NVQ level 4 in Management. Within the AQAA, it stated manager remains up to date with skills/ competence/knowledge. While maintaining her nursing registration, Miss Wheeler has not undertaken any recent professional training in relation to her role as registered manager. She does not have the Registered Managers Award or the Leadership Care Homes for Older People Page 29 of 40 Evidence: Course for Registered Managers. We strongly advised Miss Wheeler to review her professional qualifications, as any shortfalls could potentially affect her application to register under the Health and Social Care Act 2008. The staffing roster showed that Miss Wheeler regularly worked as part of the staffing roster. This often involved working with one carer on a late shift and then an early shift the next morning. In between she usually completed sleeping in provision. If staff were on annual leave, Miss Wheeler would do additional shifts. Miss Wheeler also prepared meals as required, generally at weekends. We identified at previous inspections that Miss Wheeler should not be part of the integral working roster. We saw that the administration of the home was disorganised. Miss Wheeler had a high level of paperwork which was in need of filing. As stated earlier in this report, records such as staff training, supervision and recruitment documentation was not easy to find. We saw that one file containing policies and procedures had been updated. The other file contained out of date information. Miss Wheeler told us that having sufficient time to undertake her management role was a challenge yet she was governed by the organisations remit of how her time was deployed. Staff members told us that they were aware Miss Wheeler was very busy. They said they tried to help out where ever they could and felt that they could accept some delegation of responsibilities. One staff member told us that staff meetings had been introduced. They said this had been positive and they were looking forward to more flow of exchanging information. In relation to what the home did well, the AQAA, stated annual quality audit. Annual development plan. Utilising monthly inspections by responsible person to be part of audit cycle. Periodic 1 to 1 discussions with residents. Some group discussions with residents. Miss Wheeler told us that quality assurance had been developed within the home. Miss Wheeler gave us a summary of the findings of the years quality assurance system. She said surveys had been sent to people yet there was a limited return. She said there was a compliments and concerns box in the hallway yet it was never used. Miss Wheeler said she had also left pieces of paper and pens out in the lounge following a service, to enable further feedback. This also proved unsuccessful. We recommended that systems, which engaged people in discussion, be considered. The AQAA stated that direct observation of staff performance - supervision was something the home did well. We saw that other senior staff were to be involved in care staff supervision. We spoke to one staff member who told us that they did not have formal supervision. They said they were not involved in staff meetings. They felt Care Homes for Older People Page 30 of 40 Evidence: communication was something the home could improve upon. We looked at a selection of formal staff supervision records. There was no follow up of information. We saw that the sessions were generally used to share information rather than concentrate of staff members personal development. Miss Wheeler told us that she worked with staff on a daily basis. There were therefore regular exchanges of information and discussion about peoples individual roles. The AQAA confirmed that giving people more opportunities for involvement in running Bethesda was something the home could do better. The AQAA stated that there was now a monthly random inspection/audit by manager around the home. Miss Wheeler told us that the home continued to hold small amounts of peoples personal monies safely. Within the AQAA, [managing] service users money was something the service said they did well. We checked the system for managing this and found that one cash amount was different than that stated on the balance sheet. Miss Wheeler was asked to look into why this was so. We made a requirement to ensure that the shortfall in the persons money was reimbursed. The balance sheet showed that two staff members had authorised each transaction made. When doing this, staff must ensure that they count the remaining balance. This would ensure an accurate transaction and would identify any errors at an early stage. Documentation showed that all equipment such as the bath hoist, portable electrical appliances and the fire alarm systems had been serviced, as required. On the first day of our visit, the fire log book was not up to date so it appeared that not all fire safety checks had been completed as required. We saw that the weekly fire alarm checks had been completed yet the visual checks of the means of escape and the fire extinguishers had not been undertaken. The testing of the emergency lights had not been done until later in 2009. There was a note stating that due to this, additional checks had then been undertaken. There was no evidence that recent fire drills had taken place. Staff had signed to acknowledge that they had received fire instruction. The fire risk assessment showed limited detail and had not been recently updated. There was no information about individual fire evacuation procedures. On the second day of our inspection, Miss Wheeler told us that all checks had been documented on the computer. She printed off a list of these. We said that all checks must be demonstrated at the time by handwritten entries. This would ensure a clear, contemporaneous monitoring system. The fire log book contained a large amount of out of date information. We advised that this information be archived. During our visit, we saw that staff moved wheelchairs away from a fire exit. We said the storage of wheelchairs must be reviewed so that peoples safety was assured in the event of an Care Homes for Older People Page 31 of 40 Evidence: evacuation. At the last inspection, we made a requirement to update the information available to staff regarding the control of hazardous substances (COSHH.) Miss Wheeler showed us a file containing this information. Each substance used within the home had a data sheet showing its safe use. We asked a staff member about using substances safely. They said they had received training so they knew not to mix cleaning materials. They also commented upon what to do if an accident occurred such as a spillage or splashing something in their eye. At the last inspection, we saw that the temperature of the hot water was regularly checked to ensure it was not too hot. We recommended that the actual temperature be documented as a form of monitoring. A clear record was now in place. Staff told us that all hot water outlets were fitted with regulators to ensure the hot water was maintained at a safe temperature. We saw that one outlet was very hot to the touch. We asked staff for a thermometer to test the water temperature yet one could not be found. Miss Wheeler told us that a thermometer was stored in the bathroom. We advised that staff be informed of this so they would be able to check the temperature of the water when supporting a person with their bath. Within the kitchen store cupboard we saw that there were large packages of food items on the floor. These were at risk of contamination. Some food items such as dried fruit had not been dated when opened. There were items in the freezer which were inadequately covered. They did not show a date when they were originally placed into the freezer. We said that dates were required on food items so that their shelf life could be monitored. The menus were used as a record of food consumed. We advised that a more detailed record which included alternatives people had should be maintained. On the first day of our inspection, we saw that generic risk assessments were in place yet they were dated December 2008. Miss Wheeler told us that she had been in the process of updating them at home. Miss Wheeler showed us those she had completed. At the last inspection, we made a requirement that a risk assessment was in place for any person who left the building unsupported. Miss Wheeler showed us one assessment yet it was dated 2004. To ensure the persons safety, we said the assessment must be updated. The assessment must also include the procedure to follow to ensure the persons safe return. At the last inspection, we recommended that staff recorded greater detail within accident reports. We saw that this had been addressed. We also made a requirement that an investigation into the high number of falls be undertaken, with control measures taken to minimise the risk of further incidents. Miss Wheeler showed us that Care Homes for Older People Page 32 of 40 Evidence: she had collated information about the falls and had undertaken a falls analysis. She said that in response, medicine reviews, greater supervision and referrals to the falls clinic had been made. We saw that there had been another increase in falls in October and November 2009. We advised that an ongoing accident audit be undertaken in order to minimize potential risks at all times. Care Homes for Older People Page 33 of 40 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 34 of 40 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 8 13 Regular review of the cupboard which stores medical dressings must be undertaken. So that items do not pass their expiry date and are therefore safe to use. 30/03/2010 2 9 13 The controlled drugs book must be updated to ensure it complies with current legislation. So that a clear audit trail of the controlled drugs in use is maintained. 30/04/2010 3 9 13 Staff must ensure that they sign the medicine record appropriately when they administer medicines to people. So that there is a clear audit trail and people are not at risk of medication error. 30/03/2010 Care Homes for Older People Page 35 of 40 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 9 13 Triggers which promote an administration of prescribed as required medicine must be clearly identified within the persons care plan. So that people are given their medicines at a time which is critical to their wellbeing. 10/04/2010 5 9 13 All medicines must be securely stored. So that people are not at risk of harm through the mis-management of the medicines. 30/03/2010 6 16 22 Any concern raised and its investigation and outcome must be documented. So there is evidence that when a person expresses a concern, their views are listened to and acted upon. 30/03/2010 7 18 13 The depth of safeguarding training provided within the home must be reviewed. To ensure that each staff member has sufficient knowledge to safeguard people from harm. 30/04/2010 8 30 13 In the event of supporting a student in the workplace, risk assessments and an induction must be fully 30/03/2010 Care Homes for Older People Page 36 of 40 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 completed. So that the student does not put people at risk through unclear responsibilities of their role and they have sufficient knowledge, to work effectively. 9 35 13 Staff must ensure that they follow procedures accurately, when managing any transaction with peoples personal monies. The shortfall identified must be reimbursed. So that peoples personal monies are managed efficiently without a risk of potential financial abuse. 10 38 13 A review of the safe storage of food products must be undertaken. So that food is not contaminated and its use by date can be monitored. 11 38 23 Regular fire drills must take place. So that staff have the knowledge to competently follow procedures in the event of a fire. 30/03/2010 30/03/2010 30/03/2010 Care Homes for Older People Page 37 of 40 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 12 38 13 The fire risk assessment 30/03/2010 must be kept up to date and be sufficiently detailed to meet the organisations responsibility of fire safety. So that peoples protection from harm is maximised in the event of a fire. 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 8 When a person receives on going intervention for the management of a wound from a district nurse, the wound and its healing process should be identified within the persons care plan. The home should not soley rely on the district nurses notes. Staff should ensure that people have their own items such as nail clippers in order to minimise the risk of infection. When a person goes on holiday, an exact record, including the number of tablets they take with them and bring back, should be maintained. The evidence which is used to judge that a person is safe to manage their own medicines, should be documented within the risk assesment process. Staff should not engage in any other activity when administering medicines to people. Staff should ensure that any handwritten medicine instruction is dated and countersigned by another member of staff. When a person has their food liquidized, each food item should be liquidized separately to enhance the taste and give variety. 2 3 8 9 4 9 5 6 9 9 7 15 Care Homes for Older People Page 38 of 40 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 8 30 Training records should be better organised so that it is clear exactly what training staff have undertaken and when refresher training is needed. The manager should have sufficient time to effectively fulfil her management responsibilities and not be an integral part of the staffing roster. The manager should review her professional qualifications so that they meet the requirements of being a registered manager under the Health and Social Care Act 2008. Staff supervision should be reviewed so that staff receive regular time to formally discuss their work and ongoing personal development. The session should conclude with measurable action points that are discussed at the following supervision session. An ongoing review of accidents should take place in order to minimise further occurrences. The checks regarding the emergency lighting and all visual checks of the fire alarm systems should be recorded as part of a running handwritten log. Staff should have easy access to a thermometer, so when supporting a person to have a bath, they can be assured the water is of a safe temperature. 9 31 10 31 11 36 12 13 38 38 14 38 Care Homes for Older People Page 39 of 40 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. 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