Care Home: Brookside

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What the care home does well Staff were observed to be kind and attentive to the people living at the home. Positive comments were received from people spoken to during the visit. One visiting professional said `this is a fabulous home, the staff are very caring and they always put people`s care first`. Comments from some visitors include `the staff are kind and patient` and `everybody gets good care, there are no staff favorites`. When asked they all said they thought their relative was well looked after. The atmosphere in the home felt relaxed and happy. One member of staff said `we have a good staff team and work well together to give a high standard of care`. The manager and staff spoken to had a good knowledge of people`s individual needs and personal preferences. All comments received in the completed staff surveys relating to to care delivery was positive. Some of the comments include that the home `offers a high standard of care` and ` the home looks after each client as an individual and tries its up most to cater for their needs` Staff said that where possible people are encouraged to make their own choices around their day-to-day lives. People spoken to were all complementary about the quality, quantity and choice of food provided. Staff confirmed that people can have drinks and snacks whenever they want. All of the comment cards from people living a the home indicated that they always liked the food provided. Visitors spoken to said that they were made to feel welcome when they visited and staff were good at keeping them informed of anything to do with their relative. People spoken to said they knew how to make a complaint but nobody had wanted to. Staff spoken to said that the manager and the staff team were very supportive of each other and there was plenty of training. What has improved since the last inspection? Since the last inspection visit some bedrooms have had new carpets fitted and work has been undertaken on the passenger lifts. As recommended in the last inspection report a daily menu is now displayed in each dinning area so that people can see what meal is being served. What the care home could do better: The manager and staff spoken to all confirmed that activities were limited mainly due to a lack of staff. People are asked about their social interests and hobbies but staff often do not have the time to undertake the activity. Staff said it would be nice if people could sometimes go on trips out of the home. Risk assessments must be undertaken to ensure that any potential risk to people are identified and as far as possible minimised. Medicines record keeping needs to improve to better support and evidence the safe administration of medication. There did not appear to be a lot of staff particularly at night to meet the needs of everybody living at Brookside. Some of the patio doors within peoples bedrooms were misted so that people would not be able to see out. This was discussed with the manager as the previous inspection report also identified this. Some parts of staff recruitment need improving to ensure all the necessary safety checks are carried out on people before they start to work at Brookside. Key inspection report Care homes for older people Name: Address: Brookside Sinderland Rd Broadheath Altrincham WA14 5JA     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: Geraldine Blow     Date: 2 6 1 0 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 29 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 29 Information about the care home Name of care home: Address: Brookside Sinderland Rd Broadheath Altrincham WA14 5JA 01619289320 01619415586 Joan.massey@trafford.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Trafford Metropolitan Borough Council care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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 categories: Old age, not falling within any other category - code OP (36). Dementia - Code DE (18). The maximum number of service users who can be accommodated is 36. Date of last inspection Brief description of the care home Brookside is a care home providing accommodation and personal care to a maximum of 36 people. The home is owned and managed by Trafford Metropolitan Borough Council. In addition, Brookside has a day care centre in a separate section of the building. This is where people who live in their own homes come for the day and spend time in the centre. The day care centre was not inspected as part of this visit. Care Homes for Older People Page 4 of 29 Over 65 0 36 18 0 0 4 1 1 2 0 0 8 Brief description of the care home In addition to providing residential care, Brookside has allocated some beds to accommodate people for assessment. This means that they come to Brookside either from hospital or from their own home and stay at Brookside when an assessment is undertaken to see if or how they can be supported to return home and retain their independence. This could, for example, be with home care support, which is assessed while they are staying at Brookside. There are up to eighteen people who are accommodated temporarily this way but this is currently under review. Brookside is located in a residential area of Broadheath, Altrincham, close to public transport routes and local green belt. There is parking space for visitors. It was reported that the statement of purpose, the service user guide and the last inspection report are available for people to look at. A copy of the service user guide, statement of purpose and an overview of the last inspection report is placed in all of the bedrooms. The fees charged by Brookside for accommodation is £417.48 per week. Care Homes for Older People Page 5 of 29 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 report is based on information gathered by the Care Quality Commission (CQC) since the last inspection visit on 4 October 2008 and supporting information received in the Annual Quality Assurance Assessment (AQAA) submitted prior to this visit. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Some staff and people living at the home were sent comments cards so that we could get their views on how the home is run. At the time of writing this report we had received eight completed comment cards from staff and some of their comments are included in the body of the report. This visit was unannounced, which means that the manager and staff were not told that we would be visiting. The visit took place on Monday 26 October 2009 and was undertaken by a regulation inspector and a pharmacist inspector. This report is an Care Homes for Older People Page 6 of 29 overview of what we found during the visit. References to we or us in this report represent the CQC. As part of the visit we spent time examining relevant documents and files. We also spent time talking with some people living at the home, several members of staff, some visitors and a visiting professional. We also walked round the home and looked at the communal areas and some bedrooms. Feedback was given to the manager during the course of the visit. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The manager and staff spoken to all confirmed that activities were limited mainly due to a lack of staff. People are asked about their social interests and hobbies but staff often do not have the time to undertake the activity. Staff said it would be nice if people could sometimes go on trips out of the home. Risk assessments must be undertaken to ensure that any potential risk to people are identified and as far as possible minimised. Care Homes for Older People Page 8 of 29 Medicines record keeping needs to improve to better support and evidence the safe administration of medication. There did not appear to be a lot of staff particularly at night to meet the needs of everybody living at Brookside. Some of the patio doors within peoples bedrooms were misted so that people would not be able to see out. This was discussed with the manager as the previous inspection report also identified this. Some parts of staff recruitment need improving to ensure all the necessary safety checks are carried out on people before they start to work at Brookside. 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 9 of 29 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 29 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 moving into the home are given information about the home and have their needs assessed so they will know if their needs can be met there. Evidence: The completed AQAA identified and the manager confirmed that in each bedroom, the lounge areas and the entrance hall have a file which contains a service user guide, the statement of purpose and a summary of the most recent inspection report to give people all the information they need about Brookside. These files were seen during this visit. Copies of the full inspection report are available from the office on request. Admissions to the assessment unit only take place on the basis of a full assessment of needs completed by the social worker in conjunction with the person to be admitted and their representative. The aim is for them to be admitted for up to six weeks for rehabilitation and an assessment of their needs with a view to them going back to their own home or requiring a residential or nursing placement. Care Homes for Older People Page 11 of 29 Evidence: All other admission to the home are made following an assessment by the care manager, the person to be admitted and their representative. The manager said once they have the care managers assessment they go out and undertake their own assessment to make sure they can meet that persons needs. However this assessment visit is not a formalised process and is not documented. The manager and the AQAA confirmed that people, where possible, are encouraged to visit the home, have look round, meet people and possibly stay for a meal. Care Homes for Older People Page 12 of 29 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. Not all of the care plans were detailed enough or contained risk assessments to make sure sure peoples needs woudl be met at all times. Evidence: We looked at a selection of care plans to see if care needs were clearly identified and what support was needed to meet those needs and encourage Independence. The plans of care were well organised and easy for staff to follow. Some parts of care plans contained details of peoples needs, personal choices and preferences. For example some care plans detailed exactly what specific help the individual person needed at meal times or help to mobilise. However other parts of the plans were a bit vague. For example in one care plan relating to personal hygiene the plan stated staff to assist with the things he cannot do himself and encourage to clean his dentures/teeth. There was no details relating to what help was required or if the person had dentures or teeth. Care Homes for Older People Page 13 of 29 Evidence: It was seen that care plans were being reviewed. However in one file the care plan relating to continence had been signed as being reviewed but up to date information had not been included in the care plan so it was giving out of date information to the care staff. This was discussed with the manager during the visit. Risk assessments were in place for moving and handling, however this was the only risk assessment that had been completed in all of the files looked at. This was discussed at length with the manager. Risk assessments must be in place to assess and minimise all potential risks to individual people. There was no formal assessment for continence or oral hygiene needs. To ensure that peoples needs are appropriately met it is recommended that a continence and oral hygiene assessment is undertaken on admission and then any specific care needs are incorporated into the care plan. As part of this visit the pharmacist inspector looked at the homes medication arrangements. Medicines were mostly administered by trained staff but people wishing to self-administer medication were supported to do so, helping to retain their independence. However, it was of concern that written assessments and care plans were not completed. This is important to help ensure that people receive any support they may need to manage their medicines safely. We looked at medicines record keeping. Records showing the administration of medication were generally up-to-date but there were some areas that could be improved to ensure their completeness and clarity: Complete records were not made to show the application of prescribed creams. And, it was not always possible to account for (track) the handling of medicines in the home because where quantities of medication were brought forward from a previous months delivery the quantity was not recorded. It was of concern that pre-printed records sometimes showed the wrong start date and this was not always clearly amended by care staff, reducing the clarity of the record keeping. In one case this meant it was not possible to tell whether changes to someones medication had been properly carried out. Most administration records were pre-printed by the pharmacist but where handwritten entries were made these were not always signed and countersigned. This is recommended to help reduce the risk of errors. We found that there was a lack of individual information about the use of medicines prescribed when required and about the use of prescribed creams. This could be usefully included within peoples care plans to help ensure they are used correctly, when needed. We found that medicines including controlled drugs were stored securely. However, it Care Homes for Older People Page 14 of 29 Evidence: was not evident that the controlled drugs cupboard complied with current law, this needs to be checked by the manager and addressed as needed. We saw that some medicines were supplied in a compliance aid where different types of tablet are put into one blister. The packs had not been fully completed at the pharmacy to include information to help staff administering medicines identify each tablet. The pharmacist should be approached to see if this information can be included. Comprehensive in-house audits (checks) of medication handling were not completed; this is recommended to help ensure medicines are safely handled and that should any weaknesses arise, they will be identified and quickly addressed. People spoken to during the visit were complimentary about the staff and the care received. Staff were seen to be kind and patient when helping people. They seemed to have good relationships with the people living at the home and approached people with respect and sensitivity. The visiting professional said that staff were 100 cooperative with any recommendations she made about peoples care and if she asked them to do anything it was always done. Care Homes for Older People Page 15 of 29 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. There is a lack of provision of social activities that means people do not have opportunities to participate in stimulating and meaningful activities of their choice. Evidence: The manager and staff spoken to all confirmed that only limited activities are provided. There is no designated hours or person responsible for arranging social or recreational activities. Staff said they try to facilitate activities on their units but these are limited as they are often busy with other things. Staff said it would be nice if they had enough staff to take people on visits out of the home because apart from an occasional visit to the local shop people do not get to on visits out of the home. Staff confirmed that they they have not had any outside entertainers or trips out for quite a while. One comment received in the returned staff surveys was that they could offer more out of house activities and another comment was that they would like more outings for the people living at the home. A physiotherapist comes into the home every two weeks to do exercises with people. Regular services and communion are also held in the home for people wishing to Care Homes for Older People Page 16 of 29 Evidence: attend. A copy of the menus was seen, which were varied and nutritionally balanced. The menus evidenced that a choice of meals are available at each meal time and if people do not want what is on the menu any reasonable alternative can be provided. Staff and people spoken to during this visit confirmed this. Staff stated that drinks and snacks are available on request or if people are able they are encouraged to make themselves a drink in the satellite kitchen on each unit. Each dining are has a menu on display so that people can see what meals are available for that particular day. The dinning areas are bright and attractive areas for people to enjoy their meals. Staff and visitors spoken to confirmed that visitors are made welcome and can visit whenever they like, although visitors are requested to avoid meal time if at all possible. Visitors spoken to all said that staff are very welcoming and they are good at keeping them informed of any issues relating to their relative. Staff spoken to said, that where possible, people are encouraged to make choices around their day to day living. The manager has undertaken training on the Deprivation of Liberty (DoLs) which came into force on 1 April 2009 and forms part of the Mental Capacity Act. Information booklets are available and the manager is currently in the process of accessing training for all staff. Care Homes for Older People Page 17 of 29 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 able to raise concerns and their views are listened to. Evidence: There is a copy of the complaint procedure in everybodys bedroom, the main reception and each lounge area. There was a record of complaints and concerns made which included a conclusion. The manager said she makes herself available for people to talk to or raise any concerns they may have. People spoken to during the visit all said they knew how to make a complaint but had never needed to. All of the completed staff surveys indicated that they knew what to do if somebody had a concern and this was confirmed by the staff spoken to during the visit. The AQAA identified that since the last inspection visit there had been four complaints and all had been resolved within the 28 day time scale. There was a copy of the Safeguarding Adults in Trafford policy and procedure and the manager was able to clearly describe the correct procedure to follow in the event of an allegation of abuse being made. The manager said that 85 of staff had received safeguarding adults training and staff spoken to confirmed this. Care Homes for Older People Page 18 of 29 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. A clean and comfortable environment is provided at Brookside. Evidence: During this visit a tour of the building was undertaken which included the communal areas and some peoples bedrooms. The home was clean and tidy and people spoken to said that the home was always kept clean. The visiting professional spoken to said that the home was always immaculate. There were policies and procedures relating to infection control and the communal toilets and bathrooms had wall mounted soap dispensers in an attempt to reduce the risk of cross infection. The home is split into four units all of which have a lounge and dining area and bedrooms that lead off from the lounges. Up to nine people are accommodated on each unit. None of the bedrooms have en suite facilities but all bedrooms are single and have a wash hand basin. The two units on the ground floor have patio doors opening onto an attractive patio and garden. The garden is well maintained and enclosed so that people are safe to enjoy the garden in the warmer weather. Some of the patio doors within peoples bedrooms were misted so that people would not be able to see out. This was discussed with the manager as the previous Care Homes for Older People Page 19 of 29 Evidence: inspection report identified this. She was hopeful that the matter would be addressed in the near future by Trafford Council. Care Homes for Older People Page 20 of 29 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 recruitment procedure and practice did not full protect people living at the home. Evidence: The last inspection report identified that a high number of agency staff were employed to cover staff shortfalls. The manager confirmed that this was still the case. There is one member of care staff based on each unit from 7am to 10pm with support from the management team. There are two waking care staff on duty from 10pm to 7am and there is a senior carer who sleeps on the premises and is on call if needed. Due to the lay out of the home this would mean staff would not be present on all of the units all of the time during the night. This does pose possible risk if somebody needed a member of staff and there were on the unit at the other side of the building. The majority of returned staff comment cards indicated that there is usually enough staff to meet peoples needs. However staff spoken to during the visit said they were rushed off their feet and needed more staff. As already mentioned in this report staff had said there was not enough staff to provide adequate activities for people. One of the visitors said she thought they needed more staff. We saw a sample of staff files to check the required documentation was in place and the necessary safety checks had been made. We saw that each person had to fill in an Care Homes for Older People Page 21 of 29 Evidence: application form. However it was noticed that some references appeared to be sent to personal addresses and the contact telephone number was a personal mobile. This meant that the authenticity of professional references could not be verified. In addition there was no proof of identity or proof of address held on the files. The manager said these documents had been seen when the CRB had been applied for but copies had not been taken. The manager confirmed that peoples contracts, Criminal Record Bureau (CRB) disclosure checks and interview notes were held at their head office. Evidence was seen of CRBs being obtained before a person is employed to work in the home. All of the returned staff comment cards indicated that a CRB had been received before they started work. There was evidence of induction and the AQAA identified that they were registered with Skills for Care. The manager confirmed this. Six of the returned staff surveys said that induction covered everything very well, one said it mostly did and one said it partly did. The AQAA stated and the manager confirmed that 26 care staff are employed. Twenty two staff have successfully completed National Vocational Qualification (NVQ) Level 2 or above. Each member of staff had an individual training record. There was evidence of some staff training which included moving and handling, fire training and first aid. However some shortfalls were identified with particular reference to Dementia Care and managing challenging behavior training. This is of some concern as the home is registered to care for people with Dementia. Care Homes for Older People Page 22 of 29 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. Systems are in place to enable people living at Brookside to express their views about the quality of the service they receive. Evidence: Staff and people spoken to confirmed that the manager was approachable and supportive. Evidence was seen of regular staff supervision and the majority of returned staff surveys identified that the manager gives them enough support and meets with them to discuss how they are working. As already mentioned in this report there was some concerns about the lack of risk assessments and some areas of the recruitment and selection process as these shortfalls do not fully protect people. There was a policy and procedure folder available for staff to access. All policies and procedures are developed and reviewed by Trafford Council. Care Homes for Older People Page 23 of 29 Evidence: A quality assurance questionnaire is sent out to people on an annual basis to obtain their views about the service. The results of the questionnaires had been analysed and a report generated. A copy of the report has been sent out to peoples relatives and representatives. This is seen as good practice. In addition the manager has recently developed a questionnaire for people who have been on the assessment unit to complete. It is the managers intention to send these out to people on a more frequent basis as the turnover of people staying on the assessment unit is obviously higher. In addition to the questionnaires there is a focus group meeting every three months where peoples views are obtained. A suggestion box is also going to be put in the main reception for people to use. The responsibility for peoples finances is managed by the homes head office. However small amounts of money can be used to purchase items for a person such as toiletries or hair cuts. There were no agreements in place setting out permission for the staff to purchase personal items on behalf of a person. Receipts are given and signed by two members of staff when people are given money or staff receive money from a relative or representative. It was discussed that all parties concerned should sign the receipt. The information provided in the AQAA demonstrated that the homes maintenance certificates and records were up to date. Fire safety checks were looked at and found to be up to date. Care Homes for Older People Page 24 of 29 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 25 of 29 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 Risk assessements must be undertaken. To ensure that any unnecessary risks to people are identified and as far as possible minimized. Where people selfadminister medication risk assessments and care plans need to be completed To help ensure people receive any support they may need to safely mange their own medicines. 20/11/2009 2 9 13 30/11/2009 3 9 13 Complete clear and accurate 30/11/2009 records of medication administered (including external preparations) must be maintained To support and evidence the safe handling of medication. Care Homes for Older People Page 26 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 27 19 Staff files must include all 20/11/2009 the details listed in Schedule 2. To ensure the recruitment procedure protects the people living at the home. Staff must receive 30/11/2009 appropriate training. To ensure they have the skills and knowledge to meet the needs of the people accommodated. 5 30 18 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 2 3 7 It is recommended that the homes own pre admisison assessement of needs is formalised and notes are taken. To ensure all peoples needs, personal choices and preferences are met it is recommended that the care plans include all of those details and that care plans are promptly updated to reflect and any changes in care needs. To ensure that peoples needs are appropriately met it is recommended that a continence and oral hygiene assessment is undertaken on admission and then any specific care needs are incorporated into the care plan. It is recommended that where quantities of medication are carried forward to the next months paperwork the quantity is recorded to enable medicines handling to be clearly tracked (audited). To ensure peoples medication needs are appropriately met it is recommended that care plans include individual guidance about the use of prescribed creams and the administration of medicines prescribed when required to Page 27 of 29 3 8 4 9 5 9 Care Homes for Older People 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 help ensure they are used appropriately when needed. 6 12 It is recommeded that some considertion is given to providing designated staff hours to facilitate peoples leisure and social interests. To ensure the home is maintained to a good standard it is recommend that the misted double glazed windows within some peoples bedrooms are replaced. It is recommended that the number of staff are reviewed to ensure they are adequate due to the layout of the home and to meet the needs of the people living there. It is recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person and the receipt be signed by the person purchasing items. 7 19 8 27 9 35 Care Homes for Older People Page 28 of 29 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). 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