Care Home: Brenalwood Care Home

What the care home does well One relative responding to our survey question about what the home did well told us Brenalwood did "everything" well. Another relative who completed the survey said "On the whole all very satisfactory. The care and kindness is wonderful. The meals are very good". A member of staff considered that "staff and residents have good relationships with each other. Staff and residents all appear happy and there is a family atmosphere. There are very good training courses available and all staff are encouraged to further their knowledge". Another member of staff said that the home "Welcomes people. Listens. Gives good care and values people". What has improved since the last inspection? Staff interaction with residents had improved considerably and there was a more relaxed atmosphere in the home. A number of bedrooms and en-suite rooms had new flooring fitted. Radiator covers had been fitted to radiators in order to make the home safer for residents. A member of staff told us "We`ve been through a difficult time recently and the home now appears to be flourishing". A relative told us "general care is pretty good and has improved greatly since the home has reduced the number of residents. This has also resulted in an improved morale amongst staff and a much happier atmosphere for residents and staff alike". What the care home could do better: The computerised care plans needed to be more personalised with information about the individual resident, in order to identify residents specific needs, interests, abilities and preferences and encourage consistency of care practices. The monitoring of residents who were at risk of malnutrition or dehydration needed to be improved in order to identify when a referral to an outside agency was required. Stimulation, activities and outings for residents were very limited and more was needed in order to increase residents` sense of well-being and their quality of life. One relative told us "There is a lack of activities. Although there are some, too often residents sit looking bored, listless, sitting in front of the TV all day and evening. Residents very rarely go out at all, not even in the garden, so eventually they are terrified about even going on to the decking in the garden. Much more could be done". Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brenalwood Care Home Hall Lane Walton On Naze Essex CO14 8HN     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: Francesca Halliday     Date: 0 9 0 6 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 28 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 28 Information about the care home Name of care home: Address: Brenalwood Care Home Hall Lane Walton On Naze Essex CO14 8HN 01255675632 01255850356 manager.brenalwood@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 (WON) Ltd care home 38 Number of places (if applicable): Under 65 Over 65 38 dementia Additional conditions: 0 Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 38 persons) Date of last inspection Brief description of the care home Brenalwood is a home providing care and accommodation for 38 individuals over the age of 65 who have dementia. The premises consists of a large detached property, offering accommodation on two floors, with a passenger lift to the first floor. There are three double rooms and thirtytwo single rooms, all rooms offer en-suite facilities. The home has a large communal lounge with a dining area. The home is situated within walking distance of all the local amenities of Walton-onthe-Naze. Adequate parking spaces are provided to the side of the property. The weekly fee at the time of inspection in June 2009 ranged from £390 to £550. More up to date information about fees can be obtained directly from the home. Additional charges were made for private chiropody, toiletries, newspaper, telephone bills, some Care Homes for Older People Page 4 of 28 Brief description of the care home outings and hairdressing. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was carried out on 9th June 2009. The term resident is used throughout this report to describe people living in the home and the term we refers to the Care Quality Commission (CQC). All the key national minimum standards (NMS) for older people were assessed during the inspection. The report was written using evidence accumulated since the last key inspection on 11th June 2008, as well as using evidence found during the site visit. This included looking at a variety of records and inspecting parts of the premises. The report was written using evidence provided by the manager of a sister home, who was providing management cover for the home at the time, and this included the annual quality assurance assessment (AQAA) sent to us prior to the inspection. The Care Homes for Older People Page 6 of 28 AQAA is a self assessment document required by law and it gave us information about how the service met the standards and data about the service. During the inspection we had chats of various lengths with five residents and four members of staff including the new manager, the head of care, the activity coordinator and a member of the care staff. We spoke with the manager of their sister home who had been providing management support. We also had a telephone conversation with the community matron for residential homes. We sent out surveys prior to the inspection and we received three from residents, that had been completed with the assistance of a member of staff, five from relatives and eight from staff. Comments from the surveys and conversations have been included in the report where appropriate. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have assurances that their needs can be met before moving into the home. Evidence: The home had a range of information for prospective residents and their representatives. This included a statement of purpose and a service user guide. There was also a pictorial service user guide, which was briefer and had pictures to aid understanding. However, some of the wording could have been simplified further in order that more people with dementia could understand it. The majority of relatives told us that they had received enough information about the home to help them decide whether it was the right place for the person who needed care. All of them told us that they had received a written contract about the homes terms and conditions. The manager said that they always carried out an assessment prior to offering a place Care Homes for Older People Page 10 of 28 Evidence: at the home. They told us that they or the manager of their sister home carried out the pre-admission assessments. We looked at three pre-admission assessments. They were detailed and gave a very good indication of the prospective residents needs. The prospective resident and their representatives were encouraged to visit and spend time in the home before making a decision about taking up permanent residency. A months trial was offered in order to ensure that the home could meet the new residents needs and that they and their representives were satisfied with the placement. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good care and are treated with respect but limited personalisation of care plans does not encourage consistency of care practices. Evidence: Three relatives who responded to our survey told us that residents always received the care and support they needed and two relatives told us the resident they visited usually received the care and support they needed. One relative said Care, on the whole, and kindness under difficult circumstances is wonderful. Staff told us that they generally had up to date information about the needs of residents but that occasionally the communication could be improved. We observed that the staff interaction with residents had improved since the last inspection. Staff were more attentive to residents individual needs and approached them in a caring and respectful manner. We looked at the care documentation for three residents. The care records were very lengthy and some of the care plans would have benefited from being condensed or amalgamated for ease of staff use. The home used standard care plans that were Care Homes for Older People Page 12 of 28 Evidence: computer generated and then adapted by staff for each resident. However, in the files we looked at it was sometimes difficult to establish which sections were the individual needs of the resident and what were general good practice guidelines from the standard care plans. This problem was compounded by the fact that some computer generated documents were written in the first person which gave the misleading impression that they had been personalised. Some parts of the care plans were well personalised and demonstrated a good understanding of residents individual needs. However, other parts that had not been appropriately edited from the standard care plans and were sometimes incorrect. For example the care plan stated that a resident who was bed bound should be escorted to the toilet. The daily care records were of a variable standard and did not always contain sufficient detail to demonstrate that staff were monitoring residents needs on a day to day basis. There was not sufficient detail on residents health, mood, care given and how they had spent their day. For example statements such as personal care given were regularly used in the care records we sampled. There was a section of boxes in the daily care records for staff to tick to specify the actual care given but these were not being completed in a consistent manner. Residents were being weighed on a monthly basis and this was increased to weekly when there were any concerns about unplanned weight loss. Food diaries were being completed for residents who were losing weight. However, they were not always being completed at each mealtime and the records we sampled did not give sufficient detail to enable staff to establish whether the resident was receiving sufficient calories to maintain or increase their weight. One resident was on a liquid diet due to swallowing problems. They had lost weight and had suffered from repeated pressure sores, however, their food was being liquidised without the addition of extra calories and they only had two fortified drinks each day. Staff had charts to monitor residents who were at risk of dehydration. However, they were not being completed on a regular basis. According to the records we sampled one resident only drank a total of 100 mls on one day and 250 mls on another day over two 24 hour periods. This residents care plan stated that they needed to have fluids offered to them every hour. Approximately half the care staff had received some training in the prevention and management of pressure sores but none had received training on the importance of nutrition and hydration in older people with dementia. A new accident record had been introduced since the last inspection that encouraged staff to record more specific detail about the accident. It included a section on the outcome and action plan and a section for monitoring the resident for 48 hours following the accident. The accident records we sampled had been well completed, a record of the accident had also been made in the care records and the falls assessment tool had been updated. Moving and handling risk assessments gave clear instructions Care Homes for Older People Page 13 of 28 Evidence: to staff on the assistance required to help residents move in different situations. Pressure sore risk assessment and fall risk assessments had been completed. The manager told us that they were trying to gradually establish with residents and relatives what residents last wishes and preferred priorities for care would be should they become terminally ill. A record was made of GP and district nurses visits but staff did not always include information on instructions or changes to care that had been given to care staff. Four relatives told us that the resident they visited always received the medical care they needed and one relative considered that they usually received the care they needed. Staff told us that they received good support from the GPs, the nurse practitioner from the surgery and from the district nurses. The home had the services of a physiotherapist for half a day once a week to assist residents with mobility and exercises when needed, for example following a stroke. The medicines cupboard was well organised and the medicine administration records we sampled were well completed. A system for recording the balance of medicines that were not in the blister packs had been brought in since the last inspection. This was accurate in the two records we sampled. We checked the controlled drugs in use; the records were accurate and the balances were correct. The head of care told us that the primary care trust pharmacist had reviewed all residents medication and that residents on anti psychotic medication had a care plan with guidance for staff on its use. Staff were not always recording the date of opening on medicines with a limited shelf life, such as liquids and creams. This could mean that the medicines might be used beyond the date by which they were safe to use. The medicines fridge temperature was being monitored and was seen to have been maintained between the safe temperatures of 2-8c. The monitoring records of the medicine room temperatures indicated that they were below the safe maximum of 25c. However, the recordings were taken at night and not at the hottest time of the day (or with a minimum and maximum thermometer). On the day of inspection the temperature was recorded at 26.8c, which is above the safe maximum for the majority of medicines. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect nutritious meals but activities and stimulation are limited. Evidence: In the statement of purpose it stated that the home had the objective To provide stimulation and encouragement (to residents) to maintain as many previous skills, interests and activities as possible and in the service user guide it stated We arrange regular outings in our minibus. However the member of staff who carried out some activities was mainly rostered as a carer. They told us that they generally only managed to provide one hour of activities on their shift and said that there were not many chances to take residents out. On some weeks of the rotas we looked at they were only on duty two or three days a week. The activities they provided included games, quizzes, crafts and karaoke. Movement to music was held once a month. The manager told us that residents had particularly enjoyed the entertainers who brought snakes, parrots and reptiles into the home. The library visited the home and the carer who provided some activities said that they tried to obtain books to suit residents different tastes and interests. A member of staff told us that residents could do with more activities, they said Residents look a bit bored sometimes. One relative told us There is a lack of activities. Although there are some, too often residents sit looking Care Homes for Older People Page 15 of 28 Evidence: bored, listless, sitting in front of the TV all day and evening. Residents very rarely go out at all, not even in the garden, so eventually they are terrified about even going on to the decking in the garden. Much more could be done. The activity records were amalgamated for all residents who attended an activity session and did not identify how the individual resident had enjoyed or responded to different activities. Visiting to the home was not restricted and relatives told us that they were made welcome when they visited. A relative told us that about five or six residents usually went to a church service in the church next door to the home. People from the church escorted residents and brought them back to the home. The home offered a range of diets and choices at every meal. Staff told us that snacks, for example sandwiches, cereal and fruit were available throughout the 24 hour period. One member of staff said There is a varied diet and residents have choices at all meal times. Our cooks are excellent and all the residents enjoy their meals. We observed residents being asked about their choice of food at lunch time. The manager told us in the AQAA that menus had been updated in consultation with residents and input had been provided by the chef from another home who was a nutritionist. Four relatives told us that residents always liked meals at the home and one said that the resident they visited usually liked the meals. Two residents told us that the food was good. However, one relative commented Food quality and presentation remains pedestrian. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their complaints will be addressed and they will be protected from abuse. Evidence: The home had a complaints procedure. A copy of the procedure was available in the statement of purpose and service users guide. A copy of a pictorial complaints procedure was on display on a notice board in the entrance hall. However, it was situated in a position with numerous other notices and was not in an area that residents usually frequented. It would also have benefited from being developed to make it accessible to residents with different degrees of dementia. We did not see the full complaints procedure, that relatives might wish to refer to, on display. Three relatives who responded to our survey told us that they knew how to make a complaint but two told us they did not know how to make a formal complaint. All the staff who responded to our survey told us they knew what to do if someone had any concerns about the home. The home had a procedure on safeguarding adults and the prevention of abuse and a whistle blowing procedure (the reporting of abuse or poor practices). There had been three safeguarding referrals since the last inspection that were dealt with under Essex County Councils safeguarding protocols. Additional training had been provided to staff in the home following the safeguarding referrals. The manager of a sister home had Care Homes for Older People Page 17 of 28 Evidence: provided considerable management support over a five month period. We saw evidence in the form of a number of statements from staff that they were now promptly and appropriately reporting concerns that potentially impacted on residents safety. The majority of staff had received safeguarding of vulnerable adults training and three additional training sessions were booked. One member of staff we spoke with had a good understanding about the different types of abuse that could occur and what to do if they suspected abuse or poor practices. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and comfortable home. Evidence: The home had thirty two single rooms and three shared rooms. The manager told us that all the beds in the home were gradually being changed from divan beds to ones that could be used with a hoist. The manager told us that eight bedrooms had new carpets fitted and twelve en-suites had new flooring fitted since the last inspection. The manager was aware that some of the bedrooms and bathrooms needed to be redecorated. She said that quotes were being obtained for the work to be carried out. She said that six new beds and some new chests of drawers were on order and they were awaiting the delivery of new curtains and matching curtains for some bedrooms. She also said that she was obtaining quotes to redecorate the first floor corridors and make the dark brown wood lighter and brighter for residents. The home had one very large communal room with dining and seating areas. There was no separate quiet room. Two relatives commented at the last inspection that they felt the home needed a quiet area so residents could be away from the noise and the television in the main sitting room. A number of staff commented on the fact that residents would really benefit from a quiet room that could be used as a sensory room and an area where activities could take place. Care Homes for Older People Page 19 of 28 Evidence: The laundry room door was not locked when staff were not in attendance and chemicals in the room were not in a locked cupboard. This could pose a potential risk to mobile residents with dementia. The room was not clean and the walls had flaking paint that could not be kept in a hygienic condition. The manager confirmed that the room was cleaned, chemicals were locked away and a bolt was put on the door to prevent access to residents following the inspection. The laundry room was very small but staff generally only washed residents clothes, the majority of bed linen was sent to an outside laundry. Residents clothing that we looked at was clean and free from stains but some very creased items that needed ironing were found in residents cupboards. Protective aprons and gloves were available for staff use when carrying out personal care. The parts of the home we inspected were clean and free from offensive odours on the day of this unannounced inspection. Three relatives told us that that the home was always fresh and clean and two considered that it was usually fresh and clean. A relative told us that the lack of a cleaner recently caused some problems. The manager told us that they were appointing to the housekeeping vacancy on the day following the inspection. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by an adequate number of well recruited and trained staff. Evidence: Three relatives who responded to our survey told us that staff were always available when needed and two said that staff were usually available when needed. The majority of staff considered that there were usually sufficient staff. The manager said that some of the staff had been working more than seventy hours a week when she started working at the home. She told us that she was now recruiting more staff so that they did not have to work such long hours. There were 24 residents at the time of inspection. The staffing levels were adequate for the numbers and dependency of residents at the time of inspection and the manager confirmed that numbers would be adjusted if dependency levels increased. Staff all who responded to our survey considered that the appropriate checks had been carried out before they started work. We looked at the records for three staff and they demonstrated that a sound recruitment procedure was followed. All staff had a criminal records bureau (CRB) and protection of vulnerable adults (POVA) list checks. We saw references and identification on file. The manager confirmed that two staff carried out the interviews and that they used set interview questions. They also asked the person interviewed to sign the interview record. The manager told us that she was Care Homes for Older People Page 21 of 28 Evidence: planning to carry out an audit of all the staff files in order to ensure that all the required information had been obtained. Half the staff surveyed told us that their induction covered everything they needed to do the job when they started work in the home but the other half felt that it did not cover all they needed. Five staff considered that they had enough support and meetings from the manager, three other staff felt that they only had enough support sometimes. In the AQAA the manager told us that the induction process contained an initial three day induction followed by the common induction programme. New staff were supernumerary for the first three days and were allocated a senior member of staff as a mentor. Staff all told us that they were given training that improved their knowledge and understanding of health care and helped them to meet individual needs. The manager told us that she would be drawing up a personal development plan for all staff. Four staff had completed national vocational qualification (NVQ) at level 2 and two had started the course. One member of staff had completed NVQ level 3 and four staff including the head of care had started level 3. A more in depth two day dementia course was commencing in June and the manager told us that all staff would attend the course on a rolling programme. All senior care staff had received first aid training so that there was always a member of staff with first aid training on duty. The manager was aware that some staff needed additional training or updates, she was developing a training programme and had a number of training sessions booked. She told us that she was carrying out some of the training herself and said that staff completed workbooks following the training in order to check their knowledge and understanding. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe home that is run in their best interests. Evidence: A new manager had been appointed to Brenalwood on 24th April 2009. She had considerable managerial experience and had been a manager of a number of homes for the past eighteen years. She had completed a diploma in business management and a diploma in performance coaching as well as the registered managers award. She had completed two four day dementia courses and received training in the Mental Capacity Act and Deprivation of Liberty and Safeguarding. The responsible individual carried out quality monitoring visits of Brenalwood on a monthly basis and completed a report in line with Regulation 26. A number of internal audits were carried out on a regular basis including medication audits and environment audits. Surveys of the home were carried out on an annual basis and the results were analysed. Those surveyed included residents, relatives, visiting health professionals Care Homes for Older People Page 23 of 28 Evidence: and staff. The home held a small amount of money for residents personal expenses. We looked at the systems for handling residents personal monies and checked the monies for two residents. The balances were correct and receipts were available for all transactions. Receipts were given to relatives who gave money in for residents. The manager said that staff supervisions had not been done on a regular basis but confirmed that systems were being put in place to ensure that they were carried out regularly. There were systems in place to ensure that equipment that was used by residents was serviced and maintained on a regular basis and was safe for them to use. The maintenance person carried out audits in relation to fire safety, for example checking that all the exit routes were clear. They also carried out checks on wheelchairs and bed rails used by residents. However, it was not clear whether they had any standards or guidelines against which they should check to ensure they were safe for residents to use. Monthly tests were carried out of the water temperature at outlets used by residents, to ensure that they were kept at a safe level for residents to use by themselves. The home also ensured that the taps or showers that were not in use were flushed through on a regular basis to reduce the risk of Legionella. Care Homes for Older People Page 24 of 28 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 9 13(2) Staff must ensure that medicines with a short shelf life are dated when first opened, so that medicines are not given to residents beyond the time that they are safe to use. 11/06/2008 2 30 18(c) Staff must be given the 01/12/2008 training to enable them to care safely and appropriately for residents. This refers to training in the prevention of pressure sores. Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be fully personalised to the individual residents needs. In order that staff are given sufficient information to enable them to give care of a consistent standard to each resident. 17/08/2009 2 8 12 Sufficient detail must be recorded in the food diaries and fluid charts must be completed accurately. In order to establish whether residents nutritional needs are being met and they are not at risk of dehydration. 27/07/2009 3 9 13 The temperature in the 31/08/2009 medicines cupboard must not exceed 25c, which is the maximum temperature for safe storage for the majority of medicines and medicines with a limited shelf life must be dated on first opening. Care Homes for Older People Page 26 of 28 In order to ensure that medicines are not given to residents when they are no longer fit to be used. 4 12 12 Residents must be offered 10/08/2009 stimulation, activities and time in the garden on a daily basis and the opportunity for trips out of the home. In order to improve residents well-being and quality of life. 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 All care staff should receive training on nutritional support and the importance of hydration for older people with dementia and on the prevention and management of pressure sores. The full complaints procedure should be displayed in a prominent position and relatives should be made aware of how to make a formal complaint. The pictorial complaints notice should be made more accessible to a wider range of residents with dementia. 2 16 Care Homes for Older People Page 27 of 28 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). 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