Care Home: Brookfield

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What the care home does well The home provides people with a safe and homely environment, with plenty of space for people to move around. There is large gardens which people have access to all year round, with plenty of cover and appropriate furniture. Some people spoken to, spoke of their enjoyment of planting flowers in the pots around the patio area. The home has good contacts with professionals in the area, one health professional visiting on the day confirmed he had a good working relationship with the home. Care plans give an accurate picture of how a persons needs should be met and include peoples preferences. A wide range of social activities take place with people having the choice to join in or not. Three visitors confirmed they are always made welcome and always find the home clean. People also confirmed their rooms are always kept clean and stated the home was comfortable and met all their needs. The home has a choice at meal times and people were pleased with the choice of home cooked meals. What has improved since the last inspection? The home has improved the recruitment procedure, ensuring the safety of people living in the home. All the necessary checks and references are now taken up before anyone works in the home. What the care home could do better: Medication procedures in the home must be improved to as they are currently putting people at risk. Care plans must be developed for each person on `take when necessary` medication to give guidance for staff to ensure people are given this when necessary. Any substance which could be deemed harmful to a person must be kept locked away and not be left out on public display. Where necessary window restrictors should be fitted to keep the environment safe for people living in the home. The records held for the personal allowance for people must be maintained accurately with all receipts maintained to ensure there is clear accountability. Formal supervision needs to be offered to all staff to ensure they feel supported and have the opportunity to discuss any areas of concern. Key inspection report Care homes for older people Name: Address: Brookfield 1 Clayhall Road Alverstoke Gosport Hampshire PO12 2BY     The quality rating for this care home is:   two star good 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: Michelle Presdee     Date: 0 3 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Brookfield 1 Clayhall Road Alverstoke Gosport Hampshire PO12 2BY 02392581103 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs J A Filsell care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category 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 category: Dementia (DE) Mental disorder,excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Brookfield is a twenty-nine bedded home, set in attractive grounds in a residential area of Alverstoke with local amenities close by. The home has been extended over the years to provide accommodation for twenty-nine older people, including those with dementia or mental health problem. Accommodation is arranged over three floors, Care Homes for Older People Page 4 of 31 29 29 0 Over 65 0 0 29 Brief description of the care home with a passenger lift providing access between floors. Communal areas include a large comfortable lounge, pleasant dining room and two smaller conservatory lounges. Two communal assisted bathrooms are available, and many rooms benefit from an en-suite WC. The home is well screened from the road, and the grounds provide additional seating areas, including a sensory garden Care Homes for Older People Page 5 of 31 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place on 3rd July 2009 between 9:30AM and 3:30PM. The Commission (we) were assisted by the provider/registered manager, Mrs Filsell and the care manager. All the staff on duty in the home were part of the inspection. The majority of people in the home, were involved with the inspection, some in more depths than others. Three visitors to the home and one health professional visiting have also contributed to this inspection. Surveys prior to the inspection were sent to some people living in the home, health and social care professionals and staff members. At the time of writing this report two surveys had been received from people living in the home and eight staff members had returned surveys. The home sent us their Annual Quality Assurance Assessment (AQAA) back on time, which detailed information on the home. The home has sent us notifications Care Homes for Older People Page 6 of 31 appropriately regarding the welfare of people. Paperwork including assessments, care plans, menus, staffing records and safety checks were seen A tour of the home including all communal areas, the kitchen and some bedrooms chosen at random was taken on the day. All this information has helped form judgements in this report. The last key inspection was completed on 1st August 2007. Care Homes for Older People Page 7 of 31 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 on page 4. Care Homes for Older People Page 8 of 31 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident the pre admission assessment will give an accurate picture of their needs and the home will be able to meet these identified needs. Evidence: In the AQAA we were advised we ascertain brief details of the potential resident and their current care needs. Having established this we would provide an information pack containing details of the home and the services we provide together with details of fees and a copy of our statement of purpose, aims and objectives and brochure, and summary from our last inspection report. The next stage would be to invite the family/friend/advocate to visit Brookfield to inspect our facilities and service. During this visit we are able to ascertain more information about a potential resident. The next stage is to visit the potential resident at home or in hospital to carry out a preadmission assessment, which is carried out by the provider/registered manager and by the care manager. The second stage of the assessment will be with the potential resident we check if the resident has any special needs. The final part of the preCare Homes for Older People Page 11 of 31 Evidence: admission assessment will be to offer a visit by the potential resident. The pre admission assessment of two people who had been in the home for differing lengths of time were viewed. It was found these both detailed very clear information on the persons perceived needs at that time. Evidence was seen that other people and professionals had been contacted to gain information on the person before they moved into the home. A copy of the care managers assessment was available on the persons file. Both people were spoken to. One person who was new to the home stated she could not fault the home but at the current time was finding it difficult to think of it as her home. Whilst this person could not remember the full details of the assessment process she felt the staff had worked very hard and were very kind.The second person who had been in the home for a longer period stated, she was very happy and would not like to move from the home. One relative spoken to confirmed they had been involved in the process of moving their relative into the home. They stated they felt it had been planned very well, which had helped their relative settle into the home. They stated they had been given a lot of information on the home. They stated both their relative and all members of the family were very happy with the home and it had exceeded all their expectations. The home does not offer intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place to ensure all the needs of each person can be met. Medication procedures are not followed and put people at risk. Evidence: In the AQAA we were advised on admission an interim care plan is compiled containing basic details of the care requirements of the new resident. Over the first two weeks information is collected by the care manager and senior carers which enables them to produce a more comprehensive care plan. The care plans associated with the two assessments seen, were viewed. It was clear these gave a very clear account of a persons needs and how these should be met. Information was included on any medical diagnosis the person may have and how this may impact on the person. Personal information was recorded from the view point of the person. For example, stating the person did not want to wear certain underwear, what toilet in the home the person preferred to use. The objective of the care plan was detailed. The care plan detailed information on moving and handling, individual risk assessments, food and drink care plan, communication and mental capacity. One Care Homes for Older People Page 13 of 31 Evidence: care plan had been signed by the person and we were advised each person was asked if they would like to sign their care plan. Evidence was seen that care plans were reviewed on a monthly basis, with any change detailed. People spoken to on the day were not aware they had care plans. However all felt their needs were met at all times. One person spoken to stated, It is like being at home but i dont need to cook and clean. One relative spoken to stated, The family are happy with all aspects of care. In the AQAA we were told residents have access to external support from doctors, district nurses, chiropodist, dental hygienist, continence nurse, local mental health team and exercise classes. All people spoken to confirmed they could access health professionals when they requested. One relative spoken to stated they were always kept informed of any visits to health professionals. Details of any appointments were recorded in the monthly review notes. One health professional visiting on the day stated, I have visited for years and i am always given a warm welcome In the AQAA we were told we have laid down policies and procedures covering the ordering, storage and handling and disposal of medication which comply with current legislation. Only senior carers who have been trained are allowed to handle medication. The home currently uses a monitored dosage system, but the care manager advised us the home is soon going over to a new system, which they feel will give them less room for error. The home has three medication trolleys placed around the home for the ease of administering medication. On this visit only medication from one trolley was checked. From looking at the medical administration sheets and the medication held it was clear on some occasions medication had been administered but the records had not been signed. It was also agreed individual care plans needed to be developed for any one on take as necessary medication as there was no clear guidance for staff. It was noted for one person they were on the same medication on alternate days, but a different dose was admitted on alternate days. It was agreed with the the member of staff the way this medication was being stored and recorded did give room for error. One dosage involved the carers cutting one tablet in half and placing the other half back in the box. It was agreed this was not a safe practice. It was noted the stocks held for one dose of this medication did not match the records. One person was on controlled medication and it was found this was being stored and recorded appropriately. Two people in the home currently manage their own medication. Details were recorded in one care plan seen, a risk assessment had also been completed. Care Homes for Older People Page 14 of 31 Evidence: In the AQAA we were advised residents are treated with dignity and respect, and their right to privacy is upheld. All staff address residents by their preferred name and knock on doors before entering. It was noted on the day staff address some people with their first names other by their surname. Preferences were recorded on peoples care plan. All people spoken to felt their privacy was respected. People stated they would always see any professional visiting in private. Relatives spoken to confirmed they could see their relative in their own room or in any of the communal areas of the home. Staff were observed knocking on peoples doors and waiting for a response before entering. Some people had phones in their own room and there was a public phone on the ground floor. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People experience a range of social activities and home cooked meals where a choice is always available. Evidence: People spoke of the many social activities offered in the home and it was clear it was their choice if they joined in or not. One person spoken to stated they were aware of the many activities but chose not to join in any and preferred to go out with friends. The home has gardens to the front and back of the home, which had suitable seats and covered areas. People spoken to enjoyed walking around the garden and explained they had been involved in planting flowers in many of the tubs surrounding the garden. An events calendar was displayed in the home and included film afternoons, hairdresser, crosswords, skittles, darts, board games, music for health, animal farm and a garden party. People were free to come and go as they please and as long as staff knew there where abouts. Two people living in the home had recently been on holiday abroad. The library visits and the date of the next visit was displayed on the bookcase. We were advised there are regular visits by local churches to take Communion , which meets the needs of the current people in the home. Details of peoples choice were recorded in care plans. Staff and people living in the home advised us people were able to choose how they spent their time. People advised us Care Homes for Older People Page 16 of 31 Evidence: they could go to bed and get up in the morning when they wanted. In the AQAA we were advised visiting is unrestricted and residents can entertain visitors in one of the two lounges, or the 2 conservatories or in the privacy of their own rooms. People spoken to all stated they looked forward to their visitors calling and all confirmed they could take their visitors to any part of the home. Three visitors spoken to stated they could call at any time and were always made welcome. In the AQAA we were advised we have a reputation for providing good, home cooked food which is all prepared fresh every day on the premises using predominantly fresh ingredients. We offer alternatives to all menus, this is documented, if any resident has particular dislikes these are noted by the staff and cooks and alternatives provided on the day. All people spoken to were very positive about the food and felt they received good meals and a choice was available. On the day fish and chips from the chip shop was for lunch, this had been requested by people living in the home. It was noted some people had sausage, others had fish and potato cooked by the home. Meal times were observed and were found to be relaxing and enjoyable for people. One person chose to eat on her own, staff explained this was their preference. The dining room is arranged so those that need assistance sit together nearer the kitchen. Assistance was given in an unobtrusive manner and independence was promoted. Menus demonstrated a choice was a available at all meal times and people are asked daily for their choices. The chief works shifts to cover breakfast, lunch and tea. The kitchen was well stocked with fresh vegetables and the smell of home baked cakes could be smelt around the home. Care Homes for Older People Page 17 of 31 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. People are confident if they make a complaint it will be dealt with appropriately. Staff have received training in the area of abuse, but need to be clearer about the procedure to ensure people are always protected. Evidence: In the AQAA we were advised we have a documented complaints procedure that is posted in the main reception, and in our welcome book. The welcome book was seen on the day of the inspection and the complaints leaflet was enclosed and displayed in the hallway. The procedure detailed all necessary information including timescales, addresses and telephone numbers. The manager reported they had received no complaints, they explained they felt this was because they had an open door policy. Relatives spoken to all stated if they had a complaint they would discuss with the management of the home and felt it would be appropriately addressed. When asked, it was clear people living in the home would discuss any concerns with the manager, but it was clear they felt there was nothing to complain about. One person stated, it is lovely here, the girls will do anything. In the AQAA we were advised we have written policies and procedures covering prevention and reporting of abuse including whistleblowing. Any suspicion or allegation of abuse would be handled by the procedure laid down in Hampshire adult protection policy. Abuse is covered in a dedicated training session attended by all staff. Staff spoken to confirmed they had received training on abuse and were aware Care Homes for Older People Page 18 of 31 Evidence: of the differing types of abuse. Staff were however unsure of which agency they would inform if they thought abuse was suspected. The home confirmed they have not made any or are aware of any safeguarding referrals. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a clean, safe and homely environment. Evidence: All communal areas and the majority of bedrooms were viewed. All areas of the home were clean and well maintained. No unpleasant odours were detected around the home. People spoken to confirmed the home was always kept clean as was their laundry. The water temperature was checked in a bedroom and this was found to be satisfactory. We were advised checks are maintained and recorded on a regular basis. Window restrictors had been fitted to some first floor windows but not all. Risk assessments had not been completed and it was agreed these would be done and restrictors fitted as necessary. Bedroom doors had large numbers on and all toilets were sign posted. Some rooms had recently been re-decorated and the style of refurbishment was discussed in relation to the registration the home. We were advised one resident had asked for their room to be repainted another colour, which we were advised this would be done. it was noted in bedrooms and bathrooms prescribed creams. shampoo, bubble bath and talc were left out. It was agreed these would be kept in locked cupboards. Flowers and bowls of fruit were around the home. In the AQAA we were told the grounds are well maintained by the homes gardener. The large secure patio is equipped with ample seating and gazebos during the summer months, and leads directly from the main conservatory which allows residents Care Homes for Older People Page 20 of 31 Evidence: with dementia and mobility problems, safe and easy access to the out doors. People on the day were seen making use of all the facilities of the home. One person was spoken with in the garden and they reported they enjoyed sitting out and regularly took a walk around the garden. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident there needs will be met staff who have been through a stringent recruitment procedure and who have received regular training to equip them to meet peoples needs. Evidence: On the day of the inspection all staff including the manager and care manager were spoken with. A duty rota was available. The care manager stated they had looked at the busiest periods and increased staffing levels at this time. All people spoken to were very positive about the staff. Comments included, They will do anything, They are always there, there are no problems. One relative stated, They are like my relatives family. All staff spoken to stated they felt there was always adequate staff on duty to be able to meets peoples needs. Staff surveys received reflected there is enough staff on duty, with three surveys reflecting there is always enough staff on duty, four stating usually and one stating sometimes. One person had stated in the survey, in What the home could do better? Have more staff available to cover those who are sick. Three visitors to the home all stated they felt there was always enough staff on duty when they visited. In the AQAA we were advised seventeen members of staff have National Vocational Qualification (NVQ) Level 2. One member of staff has NVQ Level 4. Ten members of staff have NVQ Level 3. Care Homes for Older People Page 22 of 31 Evidence: In the AQAA we were advised the home operates a programme for ensuring staff receive the mandatory training in manual handling, first aid and fire safety and additional training to meet the care needs of our residents. This additional training includes abuse awareness, food hygiene, health and safety, dementia awareness and control of medication. Staff files seen had clear records of all training undertaken. The care manager stated she had a process to ensure all training was kept up to date. Staff spoken to stated they felt training in the home was good and would be able to do any training which would be helpful to them in their job. Staff surveys all reflected they felt they were given training which was relevant and helped them understand and meet the individual needs of people. The staff files of three members of staff were viewed, who had all started working in the home in the last three months. It was noted two of these had completed the skills for care common induction standards and the third was still working through these. The three staff files had all the necessary information and checks to ensure the home had taken all steps to keep people in the home safe. All surveys received from staff confirmed the home had carried out criminal reference bureau (CRB) checks and taken up references before they started working in the home. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel the home is well managed and they are consulted on the running of the home. The home provides a safe environment for people but financial records for peoples allowance must be maintained to ensure all transactions are accounted for. Evidence: In the AQAA we were advised the registered manager/ provider and her family, have for the last 27 years monitored all operations and activities within the home and are readily available to residents, staff, relatives and visitors as and when required. We were advised by the care manager who has achieved a NVQ Level 4 registered managers award both herself and the manager are both in the home on five out of seven days. They are both responsible for the day to day running of the home, the care manager is more involved with the paperwork side and the manager has more one to one contact with people living in the home. All those spoken to made positive comments about the two managers in the home. Visitors stated they were both always available and would always be happy to discuss any aspect of any concerns they had. It was clear from observations on the day people living in the home had a Care Homes for Older People Page 24 of 31 Evidence: close relationship with the managers. One person stated, I could tell them anything. One staff member in a survey wrote, The managers are very caring and nothing is too much trouble. The home carries out its own quality monitoring system. The care manager explained the home has an open door policy, so any views on improvements or concerns are usually fed through to them directly. One health professional on the day stated they had been coming to the home for years and would feel very comfortable discussing any issues with the manager. The home also send out questionnaires to people living in the home and their visitors. They explained as a result of these there have been changes to the menu and one person wants their room painted another colour, which will be done. The home does not manage the finances of any person, but does manage the personal allowance for a few people living in the home. The records and monies held were viewed. It was noted for two of the four records looked at there were inaccuracies. Monies held did not match the records in one situation. In the other no records had been maintained, making it impossible to establish when and where the money had been received and where some of the money had been spent. The manager stated she was aware the records were not up to date and was hoping to soon organise them in a more organised fashion. In the AQAA we were informed staff are continuously supervised by both the care manager and the senior carer on their shift and their performance is reviewed each year with a view to identifying career aspirations and training needs. When staff were spoken to as a group they all agreed they felt supported by the manager. The manager did state more formal supervisions were not up to date and on the day no records of formal supervision could be found. In surveys received from staff members results were mixed to the question, Does you manager give you enough support and meet you to discuss how you are working? Three people had ticked regularly, two people had ticked often and three people ad ticked sometimes. In the AQAA we were advised we have written policies on health and safety and safety notices and information posters are displayed on the staff notice board. All services and appliances are regularly tested and serviced in accordance with current legislation and any defects rectified. There are currently no outstanding requirements on any service or appliance. All accidents and incidents are recorded and entered in the Accident Book as required and any which affect residents welfare are reported to care quality commission. Care Homes for Older People Page 25 of 31 Evidence: Whilst in the home it was noticed relevant health and safety notices were displayed around the home. Policies and procedures were also positioned so staff had access to them at all times. Staff confirmed when necessary they would consult the necessary policy. Staff confirmed they received training in the areas of moving and handling, first aid, food hygiene and from observations they were aware of issues relating to infection control. The fire log book was seen, this had records of tests on the fire fighting equipment being tested and serviced on a regular basis. The Commission has received appropriate notifications relating to peoples welfare. Care Homes for Older People Page 26 of 31 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 27 of 31 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 13 Medication must always be signed for when administered. There must be clear plans for each person who is prescribed take as necessary medication. All creams must be signed for when administered. Prescribed creams must be kept in a locked cupboard if being kept in a persons room. It is vital for peoples safety it is possible to establish when a person has received medication and what dose they have taken. All prescribed medication must be kept in lockable storage for the safety of residents. Stocks held of all medication must match the 01/09/2009 Care Homes for Older People Page 28 of 31 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 records held to ensure it is possible to know how much medication a person has taken. 2 35 17 Accurate records must be maintained to reflect all monies going in and out for each person. Records must match the monies held. Receipts must be kept on file. It is vital that it is possible to establish when a persons money came into the home and who it was from. Records should then be maintained on all monies going in and out for that person. The monies held should match the records to ensure the persons money is not going missing. Receipts need to be maintained to evidence the money has come into the home and to demonstrate where the money has been spent. 3 36 18 Staff must receive a minimum of six formal supervision sessions in a twelve month period. It is important staff are supported in a formal way and given the opportunity to discuss any areas of concern 17/09/2009 07/09/2009 Care Homes for Older People Page 29 of 31 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 they may have in a formal setting. 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 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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