Care Home: Blair House

What the care home does well The menus show that residents are offered a good varied, and nutritious menu, and that where possible fresh meat, vegetables and fruit are available daily. Menus are produced in pictorial format which makes it easier for residents to relate to. Where residents require assistance with feeding this is carried out discreetly by care staff. Any complaints received by the home are appropriately recorded, investigated and feedback is given to the complainant within the timescales given in the complaints policy and procedures. Staff have received training in the Safeguarding of Vulnerable Adults, and know what they must do if they witness any form of abuse. The accommodation offered by the home is comfortable and is relatively well maintained. The communal lounges and dining room are bright and airy. Staffing levels in the home are good, and staff are keen to gain a NVQ qualification in Social Care. Staff recruitment procedures are robust and ensure that prospective staff are vetted appropriately prior to being offered employment. Many of the staff have received mandatory training in health and safety issues and medication. At the present time all care staff are booked onto distance learning courses relating to Mental Capacity Act and Dementia Awareness. There are safe procedures in place for looking after residents personal allowances and ensuring they are kept safely and securely within the home. All appliances used in the home have up to date maintenance certificates. The handyman carries out regular checks on the fire points, hot water outlets and emergency lighting. What has improved since the last inspection? There was one requirement made at the last inspection but due to change of management within the home, this requirement has not been met. What the care home could do better: The management must ensure that full and detailed pre-admission assessments are completed for each prospective resident, and that when a resident is funded by a Local Authority, the management ensure they receive a completed copy of the prospectives residents plan of care. Care plans must be based on the pre-admission assessments obtained, and reflect the residents wishes, likes and dislikes, equality and diversity in relation to the personal, health and social care. Care plan reviews should take place each month and reflect even minor changes in the residents plan of care. It is also important that the home records, where residents have received visits from health care professionals, and this should include, continence nurse, chiropodists, opticians, dentists etc. The manager must ensure that staff record on a daily basis what personal hygiene tasks have been carried out or supervised for each resident and this should include oral hygiene. The manager must ensure that residents are consulted about activities in the home,and that suitable activities are offered on a daily basis, including one to one if this is the residents preference. The responsible individual must ensure that a manager is recruited to manage the home and to ensure stability for the residents and the staff. At the present time the home is being managed on a part time basis by a manager from a sister home within the group. Where accident forms are completed these should be kept safely and available for reference and inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Blair House 24 Pevensey Road St Leonards-on-sea East Sussex TN38 0LF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: June Davies     Date: 0 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Blair House 24 Pevensey Road St Leonards-on-sea East Sussex TN38 0LF 01424437608 01424442667 manager.blair@regalcarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Regal Care Homes Ltd care home 29 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 29 The maximum number of service users to be accommodated is 29. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Blair House is a residential home providing care for up to twenty-nine older people with failing mental capacity. It is a large detached property situated in a residential area of St Leonard?s on Sea. The registered providers are Regal Care Homes. The manager, Miss Emma-Louise Ashton, has been in post for the last six months. She is in the process of preparing her application for registration with the Commission for Social Care Inspection (CSCI). The home has plenty of communal space. There are two goodsized lounges on the ground floor. There is a newly built conservatory overlooking the garden at the rear. At present this is a designated as the residents? smoking area. There are two dining rooms, one on the ground floor and a larger one on the lower ground floor. Most of the residents are accommodated in single rooms but the home also has three double rooms. There is a shaft lift that gives access to all levels of the home Outside there is pleasant, safe, enclosed rear garden. The front door is accessed Care Homes for Older People Page 4 of 32 Brief description of the care home by a flight of steps but level access can be gained via the side and rear of the building. A limited amount of car parking is available at the front of the building and there is unrestricted on-street parking nearby. Both the town centre and the seafront are within walking distance. However, the home is situated on a hill and the return walk might present some difficulty for those who are not good at walking up hill. Fees are currently #410 - #445. Additional charges are made for certain items such as hairdressing and a full list of these is contained in the home?s Service User Guide. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on Thursday 7th May 2009 over a period of 8 hours. During the inspection the inspector spoke with two service user, five members of staff and a manager present from a sister home. The inspector also carried out an audit of medication, made a tour of the building in the presence of the domestic employed at the home, and viewed documentation relevant to the key standards inspected. Some information in this report was also gained from the Annual Quality Assurance Assessment sent into the Commission by the home. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The management must ensure that full and detailed pre-admission assessments are completed for each prospective resident, and that when a resident is funded by a Local Authority, the management ensure they receive a completed copy of the prospectives residents plan of care. Care plans must be based on the pre-admission assessments obtained, and reflect the residents wishes, likes and dislikes, equality and diversity in relation to the personal, health and social care. Care plan reviews should take place each month and reflect even minor changes in the residents plan of care. It is also important that the home records, where residents have received visits from health care professionals, and this should include, continence nurse, chiropodists, opticians, dentists etc. The manager must ensure that staff record on a daily basis what personal hygiene tasks have been carried out or supervised for each resident and this should include oral hygiene. The manager must ensure that residents are consulted about activities in the home, Care Homes for Older People Page 7 of 32 and that suitable activities are offered on a daily basis, including one to one if this is the residents preference. The responsible individual must ensure that a manager is recruited to manage the home and to ensure stability for the residents and the staff. At the present time the home is being managed on a part time basis by a manager from a sister home within the group. Where accident forms are completed these should be kept safely and available for reference and inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not move into the home knowing that their needs can be met as not enough information is gained at pre-admission assessment. Evidence: At present the home does not have a manager, a registered manager from a sister home is managing Blair House until such time as a new manager is appointed. At this key inspection she had problems finding the location of pre-admission assessments. Eventually two pre-admission assessments were found, and the inspector viewed these. Neither pre-admission assessment gave sufficient information to ensure that prospective residents needs could be met by the home or that the staff had the qualifications, skills or experience to meet their needs. There was no evidence that the prospective residents have been consulted in regard to their needs, expectations or preferences. Information contained in the pre-admission assessment not sufficient on which to base a care plan. Care Homes for Older People Page 10 of 32 Evidence: A requirement is being made that prospective residents have a full pre-admission assessment carried out that obtains detailed information on all aspects of prospective residents needs. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is not clear and consistent to provide staff with the information they need to meet residents needs. The systems for medication are good but further improvement is needed to ensure residents are not placed at risk. Personal support in the home respects the residents rights to privacy and dignity, but does not consider there rights to equality and diversity. Evidence: The two care plans viewed did not show they were person centred for each resident. There was no evidence to show that residents or their representatives had been consulted when drawing up the residents plan of care. For one care plan there was no evidence that this had been reviewed on a regular monthly basis. Another care plan had a date to show that it had been reviewed, but no evidence to show that it had been updated, or that the residents needs had changed. Risk assessments were vague Care Homes for Older People Page 12 of 32 Evidence: and did not give clear guidelines as to what steps staff need to take to reduce the possible risk. There was no evidence in either care plan in regard to the residents oral health care. While both care plans had a risk assessment for pressure sore, these had not been completed. During a tour of the home the inspector did notice pressure relieving cushions had been placed in some armchairs. While it was evident that some residents require continence aids there was no reference in the care plans that the services of the continence nurse had been sought or that she had visited any of the residents. One care plan did show evidence that the Community Psychiatric Nurse had visited, and provided guidance to staff as to how a specific issue should be managed. An external Motivation Exercise person visits the home fortnightly to provide exercises for the residents. There was evidence on a seperate file that residents are weighed on a regular basis, but it was noted that names of all residents are kept on the weighing list, and this contravenes the Data Protection Act 1998. Care plans viewed did show that residents have access to their General Practitioners as and when necessary, but daily reports did not reflect the outcomes of these visits. There was no evidence seen in care plans or on daily reports that residents have regular visits from chiropodists, opticians, dentists or other external health care professionals. Requirements are being made in regard to care plans being explicit in the assessed health, personal and social care needs of the residents, that all health care visits are recorded and that identified risks have a full risk assessment drawn up with good guidelines for staff as to how the level of risk can be reduced. The inspector carried out an audit of medication. The home has a Policy and Procedure in place for the receipt, storage, administration, recording and return of medication. A Policy and Procedure is in place for PRN as required medication. There was an up to date list of medication trained staff together with their signatures and initials. The inspector did note that medication brought into the home mid cycle or for respite residents is not always signed onto the Medication Administration Record properly by giving the date it was received, how much medication had been received or which member of staff had received the medication into the home. Medication Administration Records had been signed off after each administration and there were no gaps. It was noted that specific instructions written onto a Medication Administration Record for one medication had not been followed. Further improvements need to be made to the receipt of medication and in ensuring medication is administered at the correct time and in accordance with the General Practitioners prescription. During the course of this inspection the inspector observed that staff spoke to residents in a friendly and professional manner, and when staff were giving assistance with personal hygiene they respected the residents rights to privacy and dignity. Care Homes for Older People Page 13 of 32 Evidence: Care Homes for Older People Page 14 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities in the home are arranged when the staff have time, and there is no evidence that residents are able to choose what activities are offered and how often. The meals in the home are good and offer a nutritious and varied diet and special diets can be catered for. Evidence: There was no evidence in the care plans viewed that residents are able to make daily living choices. The inspector did note that when arriving on the day of the key inspection staff were busy helping residents to get up and have breakfast. At the present time there is no activity coordinator in the home, and activities are only available when staff have the time. There is no activities rota on display. During the morning of this inspection there was a hairdresser in the home doing some of the lady residents hair. Two residents said that there were not many activities going on in the home. One resident said that staff sometimes play carpet bowls with them. Another resident said that she enjoys singing along to music. Both residents said that there are not daily activities in the home. An external motivation company comes into the home to do exercises with the residents on a regular basis. The manager explained that staff Care Homes for Older People Page 15 of 32 Evidence: do not always have time to do activities with the residents. Due to the decrease in residents in the home staffing levels have been dropped accordingly. There was no evidence in the care plans that the equality and diversity of residents is considered in the home. Requirements are being made to ensure residents are able to access a range of activities on a daily basis and that the residents rights to equality and diversity are being upheld. The manager said that one resident is able to go for walks in the local community when staff have the time, but there was no evidence that other residents are given this opportunity. The Annual Quality Assurance Assessment sent to the Commission by the home stated that cultural, social, religious interests are identified on the initial assessment but from evidence seen in two initial pre-admission assessments and care plans this is not the case. The home has a visiting policy and relatives and friends are able to visit at any time. There was no evidence in the home on the day of this inspection that residents and their relatives are offered access to external advocates. During a tour of the home there was evidence that residents are encouraged to bring personal items into the home with them when they move in. Bedrooms had photographs, pictures, ornaments, and small items of furniture. Residents are offered three meals a day, and menus viewed showed that varied, wholesome and nutritious food is offered to the residents. Menus are presented in written and pictorial format, and the chef said that many of the residents due to their levels of dementia are able to relate to pictorial menus, and that they find it easier to make choices. Four residents all have their meals liquidised and this is presented in appealing manner, with vegetables, potatoes and meats being liquidised and presented seperately. One resident needs assistance with eating and this was observed as being carried out in a sensitive manner by the carer. At the present time no specialised diets are catered for, but the chef said specialised menus could be catered for as and when required. The inspector did note that orange juice was served as drink for residents with their lunch, but there is no choice of different flavoured juices. Care Homes for Older People Page 16 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives know that their complaints will be listened to and acted on. Arrangements for protecting residents is good and helps to ensure they are not placed at risk. Evidence: The complaints policy and procedure is up to date. There have been two complaints made to the home since the last key inspection, from viewing the complaints file the inspector evidenced that all complaints are recorded, an appropriate investigation is carried out, and the complaintant is informed of what the outcomes are within the timescales set out in the complaints policy and procedure. Two residents told the inspector that they would know how to complain if the need arose. The home has a policy and procedure in place for the Safeguarding of Vulnerable Adults. The majority of staff have attended Safeguarding Vulnerable Adults training, and for those staff who have not received training, this is in the process of being arranged. Six staff are doing a distance learning course for Understanding the Mental Capacity Act. There has been one Safeguarding Vulnerable Adults issue since the last key inspection, this was reported appropriately to the East Sussex County Council, Social Services, Safeguarding Team, appropriate investigations took place and the Care Homes for Older People Page 17 of 32 Evidence: issue is now closed. All new staff are appropriately vetted prior to taking up employment in the home, with Criminial Records Bureau, Protection of Vulnerable Adults Register checks taking place and two reference being sought prior to employment. Care Homes for Older People Page 18 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment is good providing residents with a homely place to live. Evidence: Blair House provides comfortable, homely accommodation for the residents who live there. All communal rooms and bedrooms are decorated and furnished to a good standard. A communal sensory room is provided within the home and on the day of this inspection was being used by the hairdresser. There is a conservatory on the first floor, that has a ramp from an external door leading into the back garden. On the day of this inspection it was noted that the conservatory door was locked and therefore residents could not have free access either to the conservatory or to the garden area, the manager explained this was due to a problem with one of the residents, who had broken one of the security gates. The grass is rather long in the back garden, and is in need of attention. The laundry room is situated in a building to the side of the home. This is supplied with an industrial washing machine with sluicing facility and an industrial tumble drier. Staff adhere to infection control procedures. The home is clean throughout, there are no offensive odours and infection control procedures are good. Care Homes for Older People Page 19 of 32 Evidence: Care Homes for Older People Page 20 of 32 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. Staff are multi skilled ensuring a good quality of care and support. Staff recruitment practices are good and ensure that staff are appropriately vetted prior to taking up employment in the home, this helps to ensure that residents are not put at risk of abuse. The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. Evidence: Staff duty rotas showed that sufficient care staff are employed in the home, to meet residents needs. Two residents said that there are is always someone around to help them if needed. There is one chef on duty for most days, and a cook to cover when the chef has time off. One domestic is employed for cleaning, and this will be monitored should more residents be admitted to the home. A maintenance man is employed to carry out repairs and checking fire safety, hot water, and health and safety in the home. At the present time five care staff have achieved NVQ level 2 or 3 and a further two staff are waiting to sign onto a NVQ course. The percentage levels of qualified staff at Care Homes for Older People Page 21 of 32 Evidence: the time of the inspection is 41 percent, but once two other staff have achieved their NVQ the percentage will then be 58 percent. The inspector viewed staff personnel files for two members of staff, from these files it is evident that prior to employing staff to work in the home the appropiate vetting is carried out. All files had Criminal Records Bureau, and Protection of Vulnerable Adults checks carried out and there were two written references, one for each member of staff from their previous employer. From talking to staff, viewing staff personnel files and the training matrix it is evident that most staff have completed their mandatory training in moving and handling, fire safety, first aid, food hygiene, infection control, medication and protection of vulnerable adults. The manager was able to confirm that further training is in the process of being booked, and that staff at the present time, are doing distance learning course for Understanding the Mental Capacity Act and Understanding Dementia. All new staff complete a initial induction programme as well as Skills for Life induction. Care Homes for Older People Page 22 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The managment of the home is unstable and is having a detrimental effect on the staff team. Quality assurance systems are in place but these need to be developed further to ensure that residents are receiving the best quality of care. Residents personal allowances are well managed and kept securely in the home. While staff supervision does take place, further improvement could be made to ensure that staff have the skills and knowledge to meet individual residents needs. Health and safety assessments are appropriate, but the manager must ensure that accident forms are accessible and appropriately filed. Care Homes for Older People Page 23 of 32 Evidence: Since the last key inspection there have been two managers in the home, both have left and at the time of the inspection a registered manager from a sister home is providing some management input into Blair House. Staff spoken to said that at the present time they feel unsettled and would like a manager in the home who stays long enough to get to know the residents and the staff. The manager was able to show the inspector some of the quality assurance checks carried out. Questionnaires are sent out to residents, relatives, respite residents, and to check of the quality of meals provided by the home. There is not a questionnaire at the present time for stakeholders. Some monitoring also takes place of systems used in the home. This monitoring is carried out by the manager and the Area Head of Care when carrying out Regulation 26 visits to the home. An independent Fire Safety Check and Risk Assessment is carried out annually. Health and Safety throughout the home is risk assessed every 6 months. Some improvements could be made to the quality assurance system to ensure that other monitoring checks are carried out in the home and the views of stakeholders are sought. At the present time the home looks after all residents personal allowances, this money is either brought into the home by relatives, requested from East Sussex County Council or requested from solicitors who act on behalf of the residents. Each resident has their own seperate account sheet, where incoming and outgoing monies are recorded. Where purchases are made on the residents behalf a receipt is requested and kept with the residents finance sheet. Staff were able to confirm that while they do not always receive six supervisions annually, they do receive formal supervision from time to time. Once a new manager has been appointed to the home staff supervision must be carried out at least six times per year. Fire point checks, hot water taps, emergency lighting are all checked on a regular basis. Inspector viewed the record books to confirm this. All windows are fitted with window opening restrictors. A number lock is fitted to front door, and other external doors are conected to nurse call system. From information given in Annual Quality Assurance Assessment all appliances used in the home have up to date maintenance certificates. The inspector found that accident forms are completed for accidents, incidents, or injuries in the home, but did note that accident form numbers 2, 5, 6, 7, 8 and 10 are missing. One particular resident had thirteen falls, between 15/03/09 and 16/04/09 a falls assessment is in place and this occurs after the first three falls as a matter of Care Homes for Older People Page 24 of 32 Evidence: routine. Care Homes for Older People Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 31 9(2)(b)(i) Application for registration of 30/09/2007 the present manager to be made to CSCI. (NB: Although a requirement was placed to this effect in the last report, it referred to a different manager.) Care Homes for Older People Page 26 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so needs of the service user have been assessed by a suitably qualified or suitably trained person the registered person has obtained a copy of the assessment there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. Pre-admission assessments must obtain sufficient information to ensure the home can meet the prospective residents needs. This pre-admission assessment must then be 15/06/2009 Care Homes for Older People Page 27 of 32 used as a basis for a care plan. 2 7 15 Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service users needs in respect ofhis health and welfare are to be met. The registered person shall where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service users plan;l and notify the service user of any such revision. Care plans must give staff detailed information in respect of the residents health, personal and social care needs, which should be agreed with the service user and or their representative, so that staff are given full knowledge of all care needs of the service user. 3 8 12 The registered person shall 13/07/2009 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users; to make proper provision for the care and, where appropriate, treatment, 13/07/2009 Care Homes for Older People Page 28 of 32 education and supervision of service users. The registered person must ensure that all health care visits are recorded in the service users plan of care. 4 12 12 The registered person shall 13/07/2009 make suitable arrangements to ensure that the care home is conducted; with due regard to the sex, religious persuasion, racial origin, and cultural and linguistic background and any disability of service users. The manager should ensure that service user have their rights to equality and diversity upheld and that staff have full information on how to meet needs of equality and diversity. 5 12 16 The registered person shall 13/07/2009 having regard to the size of the care home and the number and needs of service users; consult service users about their social interests, and make arrangements to ensable them to engage in local, social and community activities and to visit, or maintain contact or communicate with, their families and friends; consult service users about the programme of activities arranged by or on behalf of the care home, and provide Care Homes for Older People Page 29 of 32 facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. The home must offer a variety of activities, that have been chosen by the service users and allow service users access to the local community. 6 31 8 The registered provider shall 26/06/2009 appoint an individual to manage the care home where: there is no registered manager in respect of the care home; and the registered provider is an organisation or partnership. A registered manager must be employed to manage the care home to ensure continuity for residents and staff. 7 38 17 The registered person shall; 12/06/2009 maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user; ensure that the record referred to in sub paragraph (a) is kept securely in the care home. All accident forms should be kept securely in the home. Care Homes for Older People Page 30 of 32 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 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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