Care Home: Briar House Care Home

What the care home does well The home has a core of staff who have worked in the home for a number of years who know the residents well and understand their care needs. Residents who are admitted to the home are assessed prior to them being offered a place to ensure the home can meet their needs. The meals are enjoyed and offered with choice, with residents who are able to comment stating the meals are good. The records held by the Administrator are checked regularly by Senior Managers and are up to date. The servicing and maintenance in the building is recorded appropriately. What has improved since the last inspection? Since the last inspection the improvement in the stimulation and activities is very noticeable. Throughout the building there are areas in corridors and pictures/posters on walls that stimulate and show what activities, entertainment and outings have been taking place. Staff designated to carry out this role have been employed and people were noted to be far more occupied. The company has introduced a far more detailed format carried out by other Managers or Senior Managers on the quality of the service provided, which triggers the improvements required and helps the ongoing monitoring of the quality of the service. The care plans have started to improve. More detailed person centred care is being introduced. Within the new model of care planning there is the introduction of pictorial cards that show what people prefer when choosing meals etc. This is to be expanded upon further to show how choices are made throughout the service. What the care home could do better: The home does need to improve the service within areas where residents present challenging behaviour. This may be due to unsuitable staffing levels or to competencies within the staff team. The home has a high record of staff sickness which does not help the staffing situation and is to be addressed by the Manager. The meal time experience could be improved upon with staff being aware of how they should be assisting with this meal, what should be on the table such as napkins and how the lunchtime medication is offered. People who are no longer able to voice clearly their choices should have care plans that identify what is suitable for them. Did they wear tights/socks previously, how often did they have their hair cut, did they wear make up etc. Although care plans are improving more detail on how choices are to be made need to be written clearly that ensure dignity is considered at all times. There is a concern that is being addressed quickly over the ill fitting fire doors that are at the top of the stairs. The Manager has been contacted by us again and action is taking place to renew the doors. The home does need to concentrate on areas in the home where odours are detected and ensure enough domestic staff are available to maintain a high standard of cleanliness. Key inspection report Care homes for older people Name: Address: Briar House Care Home Losinga Drive Kings Lynn Norfolk PE30 2DQ     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: Ruth Hannent     Date: 2 6 0 4 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 27 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 27 Information about the care home Name of care home: Address: Briar House Care Home Losinga Drive Kings Lynn Norfolk PE30 2DQ 01553760500 01553760510 briarhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Wendy Elizabeth Doreen Dellaway Type of registration: Number of places registered: care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Briar House is a care home providing residential care for up to 62 older people. Within its registered numbers the home offers services to 50 people with dementia. The home is situated in a residential area in the North of Kings Lynn approximately one mile from the town centre. The home was purpose built in the late 1990?s. The accommodation is provided on two floors serviced by stairs and shaft lift. All rooms are built for single occupancy and there are only two rooms that do not have integral en-suite facilities. The home is situated in its own grounds and provides ample parking space. The home provides information about the services it provides and a copy of the most recent inspection report in the entrance foyer. Care Homes for Older People Page 4 of 27 Over 65 50 62 2 0 2 8 0 5 2 0 0 9 Brief description of the care home Briar House is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for care at the home is £358 to £565. Care Homes for Older People Page 5 of 27 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: We completed this report following a visit to the home which took place over 7 hours. The Manager had completed and returned within the timescale the AQAA ( Annual Quality Assurance Assessment) document that gave us some details of how the service has been running over the past twelve months and what is to improve over the next twelve months. We received some comments prior to the visit from residents and staff. We looked at information we had received in the past year such as notification on accidents and incidents. We spent time talking to staff, residents and management. Some records were seen that included care plans, staff training and servicing records. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The home does need to improve the service within areas where residents present challenging behaviour. This may be due to unsuitable staffing levels or to competencies within the staff team. The home has a high record of staff sickness which does not help the staffing situation and is to be addressed by the Manager. The meal time experience could be improved upon with staff being aware of how they should be assisting with this meal, what should be on the table such as napkins and how the lunchtime medication is offered. People who are no longer able to voice clearly their choices should have care plans that identify what is suitable for them. Did they wear tights/socks previously, how often did they have their hair cut, did they wear make up etc. Although care plans are improving more detail on how choices are to be made need to be written clearly that ensure dignity is considered at all times. There is a concern that is being addressed quickly over the ill fitting fire doors that are at the top of the stairs. The Manager has been contacted by us again and action is Care Homes for Older People Page 7 of 27 taking place to renew the doors. The home does need to concentrate on areas in the home where odours are detected and ensure enough domestic staff are available to maintain a high standard of cleanliness. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 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 27 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. Potential residents are encouraged to make an informed choice and are given the opportunity to see if Briar House is the home to meet their needs. Evidence: On the day of this visit the home had no vacant rooms having admitted a number of residents recently. The Manager informed us that the home has a waiting list and that enquiries are coming in regularly. In the AQAA, completed by the Manager, we are told that each potential resident is assessed, by either herself or the Deputy Manager, prior to being admitted. This was noted on the day of the inspection when two recently admitted residents assessment paperwork was seen. We are also told in the AQAA that the home aims to assist prospective residents to make an informed choice about their future accommodation and feel that their needs and wishes can be met and fully supported. A recently admitted resident was spoken to who told us that she felt the move to the home had been the right thing for her and Care Homes for Older People Page 10 of 27 Evidence: that the home cared for her well. The home does have information that any interested person may read about the home and the Deputy Manager told us that any visitors are welcome to look around Briar House when trying to choose the correct home for their relative. Care Homes for Older People Page 11 of 27 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 home does not always meet all care needs for the individual that is person centred as care plans are not always detailed and the information not always accurate. Evidence: The 62 residents at Briar House vary greatly in the support they each require. The range of care needs appears vast. There are a number of people requiring assistance who remain in bed for all their care needs, some residents who are able to voice their requirements and support needs to those who are unable to communicate fully their needs. The information written in each care plan is not always clear and although the Deputy Manager has started to complete new care plans for residents, which are showing a format that is person centred, this does not always appear to be what is delivered. Through observation and what information is seen in the care plans there appears to to be conflicting information, or no information at all. Where residents are able to communicate and voice their opinions the service appears to be caring appropriately for them. They were smart in appearance, some ladies had jewellery on and were wearing make up. Where there are residents who are unable to express their choices the care needs do not appear to be fully met. For example many residents Care Homes for Older People Page 12 of 27 Evidence: were noted to not be wearing any socks, stockings or tights. (This was mentioned on the last inspection report). A number of residents had not have their hair brushed and some gentlemen looked in need of a hair cut. The care plans of some of these residents were looked at. The information in the care plan does not state how they would like to be dressed or how often they like to have a hair cut nor in the daily records does it state the person has refused this support or what methods of persuasion should or have been tried. Some information was conflicting and difficult to find in what are very complex care formats. In one care plan it stated that this person had no allergies and then stated a named antibiotic that the person reacts to. Another care plan was confusing regarding the administration of Lactulose medication. One piece of information said it should be given when required and another stated daily. More information from families where residents who are unable to contribute to their own care plans would build a more person centred focused care plan and the detail much more personalised. What has improved are the pictures added to the care plans to help residents make some choices of their likes and dislikes such as the food preferred. The risk assessments have also improved with more detail in the most recently completed care plans noted. The care plans looked at were not signed by the people who may have contributed towards them. They need to be improved and signed to ensure the correct care is written on the person centred care plans and these should be in place for all residents. The home has a good relationship with local surgeries and each resident is registered with a GP. District Nurses visit the home as and when required with notes written of such visits in the daily recording by care staff members. It was noted in two care plans the involvement of the specialists from the Mental Health team with dates and outcome of visits recorded. Medications audits have recently been carried out and an in depth document showing the outcome of the audit was seen during this visit. A high percentage scored shows the home is managing medication well which was noted during this inspection, therefore a full inspection of medication did not take place during this visit. The staff were observed throughout the day being polite and respectful as they carried out their duties. Any personal care task was carried out in the persons private room and behind closed doors. Staff knocked on each door before entering. One concern regarding dignity was shared with the Manager around the medication Care Homes for Older People Page 13 of 27 Evidence: that is administered at meal times. On the day of this visit the dining room was full of residents who could all overhear the questions and medication needs of residents as they were sat at the table. All in the room would know that one person had a sore throat and that another had a pain in their knees. Care Homes for Older People Page 14 of 27 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. Although the activities and daily life has improved for the majority there is still room for improvement for those who may challenge the service and a mealtime experience that is more pleasurable for dining room users. Evidence: The home has improved the support offered to residents regarding occupation, stimulation and activities. There is now designated activities staff members with 56 hours allocated to the residents to enable the needs for daily activities to take place. Throughout the home there is evidence of art work, photographs and wall paintings that offer stimulation and show events that have taken place. The staff member on duty during this inspection visit was noted to be occupying many residents in various parts of the home in a variety of different activities. Designated areas have been furnished with items such as a telephone box and coffee bar to encourage participation. Special coffee mornings are held and relatives are encouraged to be involved with and use the facilities alongside the residents. A game of dominoes was being enjoyed and another person was having a happy conversation with the Activities Organiser. Residents who may challenge the staff at the home do not appear so well supported Care Homes for Older People Page 15 of 27 Evidence: and should have a clear and planned programme of suitable stimulation/activity that will occupy and offer the correct need for that individual. For example, residents who are calling or shouting, which was witnessed during this visit, should have a programme of activities planned to address the challenges, which may be contributing to this type of behaviour, and which should have the outcomes recorded as part of the information of outcomes for the individual. Relatives are encouraged and do visit regular. The signing in register showed many names of people coming and going. One family spoken to during this visit told us they are regular visitors and that they are always offered a drink and made welcome. At lunchtime the residents were observed in the upstairs dining room. The meal was served with some choice and the three residents spoken to stated they enjoy their meals. This was also reflected in the returned surveys received prior to this inspection with comments such as, the meals are good and they cook food I like. The Manager informed us that the menus are in the process of being improved upon and evidence of the new menus were seen in the main office. During the 15 minutes observing the dining experience it was noted that one staff member was assisting 3 residents to eat their meals. This was carried out while standing and moving from one to another. Eye contact could not be achieved and it was difficult to tell if the three people were enjoying their meal. The home also had no cloth napkins or paper serviettes and one resident was using the table cloth to wipe her mouth. On discussing this with the management it appears the home has run out and no alternative was available while awaiting an order. Care Homes for Older People Page 16 of 27 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 should feel they are cared for by safe hands and that they will be listened to if they have any complaints or concerns. Evidence: Throughout this visit we noted the information on how anyone could complain if they wished to. It was on display and also in the Service Users Guide. The Manager and Deputy Manager informed us that no complaints had been received and any concerns had been dealt with straight away. The Commission has not received any complaints and no comments on pre inspection surveys have given us evidence to say complaints are not dealt with. The staff team training matrix shows a high number of staff are up to date with the training on safeguarding vulnerable adults and highlighted on the matrix is the names of staff that are due for an update. One staff member spoken to told us they would report on any concerns and understood the whistle blowing policy within the home. Care Homes for Older People Page 17 of 27 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The house and grounds should be safer and cleaner to ensure it is comfortable and suitably safe for residents at all times. Evidence: The service has improved some of the areas around the home to make various communal areas more interesting and inviting. The entrance on arrival is clean tidy and has boards displaying events and activities within the home. Throughout the tour of the premises it was noted that some areas were unclean with some stained carpets and odours noted in various areas. This was discussed with the Manager who informed us that designated days are allocated to do a deep clean but this was not evident in the upstairs areas or in the bedrooms of people who spend quite a lot of time in their rooms. The top floor corridor was marked with dirt and scuff marks and was brought to the attention of the domestic staff member on duty. At the top of the stairs a gap was noted on both fire doors between the bottom of the door and the carpet. This is seen as a high risk with the potential for fire to spread if one did occur. This was brought to the attention, and was seen by the Manager, who contacted the Southern Cross Manager responsible for building works to discuss the plans to improve the doors as quickly as possible. In the interim we requested a risk assessment to be completed and contact to be made to the fire department for advice and guidance. Following this site visit and while the report was being written contact Care Homes for Older People Page 18 of 27 Evidence: was again made with the Manager who is implementing action quickly to replace the fire doors with correctly fitting suitable fire doors. Some residents bedrooms are personalised and hold individual personal items of small furniture, ornaments and pictures making them cosy. The Maintenance Officer has all the records up to date of all areas that are serviced and audited regularly. The books looked at were briefly discussed with this officer who informed us that any concerns within the building are acted upon and maintained to a good standard. The back garden is in need of improving with borders and grass untidy and in need of weeding. Some of the pathway and patio surfaces are uneven and are a potential trip hazard. With the summer months approaching this area needs improving. This was also a recommendation at the last inspection. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not always have a full complement of competent, trained staff but they are recruited using procedures that ensure residents are cared for by safe hands. Evidence: The residents had completed a survey for the Commission prior to this inspection visit with 9 of them telling us that the care support is sometimes there when required and that they are usually listened to by staff. On the day of this inspection it was noted that residents in the majority of the home were calm and were given attention as and when required. In the Lavender Unit this was not so apparent. Two residents were heard distressed and calling out. The staffing in this area did not seem able to offer the amount of time with the level of need required. Although they were very busy helping the residents there did not appear to be enough personnel in the area to meet the needs. A set of rotas has been looked at for the week prior to this inspection that shows a number of staff missing. The Deputy Manager did inform us that agency staff would be called upon when the home staff team cannot cover. What is not clear is how the competencies and staffing numbers ensure the needs are met appropriately, especially for those residents with high needs. At the last inspection the Lavender Unit was locked and now is unlocked giving residents more access to walk around and mix with other residents which is very much an improvement and should benefit the residents. Care Homes for Older People Page 20 of 27 Evidence: The home has got a high level of staff sickness recorded. This has been identified by the Manager and in the plans for improvement in the AQAA, the aims of managing the sickness is about to be acted upon. The Manager has worked hard to build up the number of staff who have achieved or nearly achieved the NVQ qualification. The whole staff team are involved in completing this qualification and this was discussed with one domestic staff member. The Manager aims to have 98 of staff with the certificate by the end of spring. The training matrix in the home shows the number of people up to date with training, those who are due shortly for their update and those who are overdue. The Deputy Manager showed us the dates on the wall for all the planned training and staff tell us in their surveys they are often attending training sessions. The matrix showed only 29 of staff have attended the challenging behaviour training, yet this is the area where staff did not seem able to manage. Either due to possible lack of competency or numbers of staff on duty. This concern was shared with the Senior Team with lots of knowledge and plans for training of the staff team discussed. A trainer in the home is building up a big knowledge base on the care for residents with dementia which should be implemented shortly. The references and evidence of the information gathered was shared by this staff member during this inspection who hopes to implement the learning very soon. During this inspection personnel files were not inspected. The Administrator who is responsible for these files is the same person who showed us a number of files last year that were up to date and held all the relevant information to ensure safe recruitment procedures were followed. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is suitable and fairly safe with a competent manager bringing improvements in to place. Evidence: The home Manager has been employed in this service for just 12 months. Unfortunately, due to unforeseen circumstances, she has not, as yet been able to register with the Commission. This is hopefully planned for the near future. She is an experienced and knowledgeable person who has gained the NVQ 4 in care and the Registered Managers Award. Although there has not been a full quality assurance process carried out that includes all stake holders there has been an improvement in the way the company carry out monthly audits. The Regulation 26 visits that are completed by other Managers or Senior Managers were seen during this visit and of which appear more detailed and written on a format that covers all areas of the home. Both the areas to improve on and those logged as completed were discussed, as was the use of this improved Care Homes for Older People Page 22 of 27 Evidence: format that the Managers tells us is a much better and usable tool for improving the service. Time was spent with The Administrator discussing the personal monies of residents. The problems found are that families do not always give the money to the residents for items such as hair cuts, clothing and chiropody and this can mean people go without these services. The home needs to find a method to ensure people do not go without essential needs and that people will have their hair cut regularly etc. The manager and staff member spoken to tell us that supervision does take place and noted on the Managers room wall are planned dates for the future. As mentioned in the earlier part of this report the concern around the fire doors in the home does create a risk for residents living in Briar House. Since this visit the manager has been contacted by us for reassurance that quick action is taking place to ensure the home is safe from fire risk as much as possible. Staff are inducted and trained to enable them to carry out their role safely and risk assessments are in place throughout all areas of the service provided. Care Homes for Older People Page 23 of 27 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 24 of 27 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 A resident or relative should 01/06/2010 be consulted and a care plan written that is detailed in respect of the health and welfare of the resident. To ensure the details for staff to follow on care needs are person centred and focused on the individual. 2 19 23 The home must ensure the external grounds are suitably maintained. To ensure residents can use the gardens that are suitable and safe. 01/06/2010 3 19 23 The home must ensure that the fire doors fit correctly. To ensure that if a fire occurs it is contained. 20/05/2010 4 26 23 The home should be kept clean at all times. 01/06/2010 Care Homes for Older People Page 25 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that good infection control practices are in place. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The information in the care plan must be current with reviewed and updated information. Old information should be removed and filed to prevent incorrect care being offered. Consideration on how and when medication is administered to ensure residents privacy and dignity is preserved as much as possible should now be in place. Individual activities/stimulation/one to one time should be recorded, and be planned for, to assist with the management of some behaviours shown by residents that may challenge the service. It is recommended that cloth napkins or paper serviettes are available. It is recommended that staff sickness is addressed to ensure correct numbers of personnel who are competent and capable are on shift. The training for all staff on challenging behaviour needs to be actioned quickly to ensure the staff have the up to date competencies to meet the challenges they face. The home needs to have systems in place that will ensure enough money is available to allow hair cuts and essential purchases to be bought. 2 10 3 12 4 5 15 27 6 30 7 35 Care Homes for Older People Page 26 of 27 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. © 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!