Care Home: Camelot Care Homes Ltd

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What the care home does well A resident reported to us "oh yes, I`m comfortable". A newly admitted resident reported that the staff were "quite good". Another resident reported that staff were "extremely willing". A resident was observed to be having a late breakfast. They reported to us that this was at their request, as they did not like to eat early. Another resident reported that it was "entirely" up to them how they spent their day. A visitor reported to us that the home were "very good" at informing them of any change in the resident`s condition and that staff were "very approachable". A resident reported that the food was "grand" and that there was "plenty" of it. Another resident reported that the food was "not bad at all, they give me too much". A resident told us that they particularly enjoyed the home`s Macaroni Cheese. Another resident reported that they were "well satisfied" about the meals. The cook reported that they were in the process of reviewing menus, aiming to develop a more balanced approach to meals and more choice for residents. Where a resident needed to be given a liquidised meal, we observed that the meal was attractively laid out on the plate. Residents who needed a liquidised meal were given a choice of what they preferred to eat. We observed a member of staff coming to assist a resident who remained in bed to eat their meal. They came cheerfully into the residents` room, addressing them by their first name, got a chair to sit next to the resident, lowered the resident`s safety rail and assisted them to eat, chatting and engaging the resident in conversation, as well as encouraging them to eat. In one of the dining rooms, we observed that a resident`s attention had wandered during the meal, this was observed by a member of staff who came and sat next to the resident to support them in eating. We observed as good practice that where residents ate in their room, they were given their first and second course separately, so that their dessert was fresh when they came to eat their second course. The new manager reported that they had successfully managed to change some of the culture in the home and that staff were happy to approach them and whistleblow about matters which concerned them. Residents commented on the new manager. A resident pointed the manager out to us saying "there`s [the new manager`s first name] they`re good" another resident reported "if we want [the new manager] they`ll come and have a word with us." A resident reported to us that they appreciated the manager being visible across the home when they were on duty. Staff also commented on the new manager. One member of staff commented that they were "really good", another that the new manager "deals with issues" and another "I think [the new manager] will be a good manager". Another member of staff reported that they felt able to raise matters with management and that management would take action when needed. Staff we met with showed a cheerful and relaxed manner with residents and each other. We met with a volunteer who reported "I really enjoy it" about supporting the home. What the care home could do better: Most records relating to nursing and care were signed and dated by the person drawing up the record, however there were certain exceptions to this, which we discussed with the new manager. They reported that this related to certain individuals, who they were working with to try and improve performance. While most care plans showed a marked improvement, some needed more development. During the safeguarding investigation, we observed records relating to pressure ulceration for two residents. While records earlier in the year were clear, subsequent records made by a different registered nurse were not and an opportunity was missed tomake referrals about management of these two residents` wounds to the tissue viability nurse. A resident was fed artificially via a tube. Their care plan did not state, and there was no evidence in their records to show, that the tube for the feed was regularly rotated, as is advised. A residents` care plan stated that they needed "assistance to go to the toilet", without stating what the assistance needed was. The resident had difficulties in communicating. so would not have been able to inform staff themselves. A resident had had a short-term care plan relating to an infection which had recently been put in place. A standard care plan had been used, which did not indicate any matters specific to the resident, which a different registered nurse was able to inform us about. Most evaluation of care plans were clear and provided evidence of an active review process. However some were not to this standard. One person`s evaluation about their confusion was generalistic and did not report on the situation for the resident as observed and reported by staff. Another person`s evaluation about how their communication needs were to be supported had an evaluation which indicated that their needs had improved, but their care plan had not been re-written and improvements were not reflected in the person`s daily record or what we observed, so it appeared that the care plan evaluation was not accurate. Again the manager reported that this related to individuals who needed more support in care planning and evaluation of care plans. Nearly all the care plans had been drawn up by two of the registered nurses. We discussed with the deputy manager and new manager that more staff should be supported to draw up care plans, particularly care assistants who would be involved in daily care provision and knew residents well as individuals. We considered that carers were ready to do this, as the quality of their daily report writing was high. The home uses monitoring charts which are set out in hourly sections, but there is space on the form to be more specific about times. Currently staff are not using this space. We observed a resident after 1:00pm and the chart did not indicate that they had received care, however when we returned later in the afternoon, their chart indicated that they had received care at 1:00pm. We advise that to enhance accuracy of records, carers document when during the hour they provided support to the resident. Where a resident was prescribed a medicine on an "as required" basis, we observed a variance. Some residents had very clear care plans to direct the registered nurses on when and how often the resident was to be administered such drugs, but some had no information at all. This included a resident who was prescribed a medication for Angina, another resident who was prescribed a medicine to support them in reducing complex behaviours and another resident who clearly had difficulties with bowel management. Care plans for medicines prescribed "as required" are needed, to ensure that the resident is given their medicines in a consistent manner and win accordance with the prescriber`s instructions. Some residents were prescribed medicines which can affect their daily lives, such as mood altering drugs, aperient or pain killers. Again there was a variance, some care plans included such prescriptions in relevant parts of the person`s care plan, but others did not. It is advised that relevant care plans should consider such prescriptions, so that staff can support doctors in making an assessment of the effectiveness of such prescriptions. We observed that a medicine was included on the homely medicines list which needs to be given regularly to be effective. This should be reviewed. On Countess Wing, the Controlled Drugs cupboard was very small and if another resident were admitted who was prescribed Controlled Drugs, the home would have difficulty in safely correctly storing such medicines.A resident used a prescribed appliance. We discussed this with the deputy manager, who reported that care staff had been trained in its application. However as this can be a complex procedure for a person unfamiliar with the appliance, the care plan needed to be more developed and specific about actions to take to support the resident. There also needed to be written evidence that only staff who ha Random inspection report Care homes for older people Name: Address: Camelot Care Homes Ltd 1 Countess Road Amesbury Wiltshire SP4 7DW one star adequate service 28/01/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susie Stratton Date: 1 0 0 6 2 0 1 0 Information about the care home Name of care home: Address: Camelot Care Homes Ltd 1 Countess Road Amesbury Wiltshire SP4 7DW 01980625498/549 01980624698 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Xcel Care Homes Ltd care home 57 Number of places (if applicable): Under 65 Over 65 57 0 old age, not falling within any other category physical disability Conditions of registration: 0 5 The maximum number of service users who can be accommodated is 57. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) - maximum of 5 places Date of last inspection Brief description of the care home Camelot is a 57 bedded care home with nursing. The home consists of two wings, Comilla Wing parts of which are listed, and Countess Wing a new-build home. The Care Homes for Older People Page 2 of 17 2 8 0 1 2 0 1 0 Brief description of the care home oldest part of Comilla Wing is on the main road into Amesbury, with a wing off this older building, leading to a linked area into the unit called the Lodge. Accommodation is provided over two floors with passenger lifts in-between. The two wings are separated by a court-yard garden. The home is owned by Xcel Care Limited, a company which owns a range of care homes, mainly in the south of England. Xcel Care Homes purchased the home in February 2009. The managers post is currently vacant. A person is acting into the role. This person leads a team of nursing, care and ancillary staff. The home is situated near the centre of the small market town of Amesbury, in the middle of Salisbury Plain. Amesbury is on the A303, which links to the M3. There is a bus station in Amesbury. The closest railway station is in Salisbury, about 20 minutes drive away. There is parking on site. A copy of the service users guide is given to all new admissions. Fees range from 600 pounds to 750 pounds per week. Additional charges are made for chiropody, hairdressing, newspapers, optical requirements and toiletries. Care Homes for Older People Page 3 of 17 What we found: This random inspection was performed on Thursday 10th June 2010, between 8:50am and 4:30pm. It was unannounced. The inspection was performed by a regulatory inspector. This person is referred to as we throughout this report, as it was performed on behalf of the Care Quality Commission (CQC). This inspection was performed to assess the homes progress towards meeting a range of requirements identified by us, some of which had been unmet for more than one inspection. During the inspection, we toured the home, met a range of different residents and received their comments about care provision. Where residents could not discuss how the home met their needs with us, we observed nursing and care provision. We also met with different staff across all levels of the organisation. We observed a lunchtime meal and a medicines administration round. We reviewed medicines administration records and systems for storage of medicines. We also reviewed a range of records, including records relating to different residents, staff records, staff training records, maintenance records and complaints records. We fed back to the new manager and the provider at the end of the inspection. We also took into account a safeguarding meeting which was held the day after the inspection, when compiling this report. The provider and their team have sucessfully made a range of improvements in service provision since the last inspection, this will ensure that many aspects of service provision have been developed to further ensure the health, safety and welfare of residents . At the last inspection, the home had 23 requirements, 18 of which were made at previous inspections and 14 recommendations, seven of which had been recommended at previous inspections. By this inspection, the home had successfully addressed 20 of the requirements and 12 of the recommendations in full. Two of the unmet requirements showed progress, although they had not been met in full and one of the recommendations showed much progress, but had not yet been addressed in full. Admissions assessments now detail how a disability will affect a persons daily life. They also documented the persons own perception of their religious needs. The home are following relevant guidelines on assessment of clinical need when a person is admitted. The cook was given full information relating to new residents needs and preferences verbally and in writing. Where a person was assessed as having a need or a risk, a care plan was always in place. Generally these care plans included all relevant matters relating to the individual. For example, we looked at a residents care plan relating to personal choice of daily routine, it was very detailed and included small but significant details about the individual resident, such as their after-shave preferences. Another resident whose care plan showed they had difficulties in communicating had a very clear plan on how assessments of pain were to be made and actions to be taken by staff to reduce any observed pain for the resident. Where resident need topical creams applying, clear body maps had been put in place to direct the member of staff on when and where different creams needed to be applied. Generally care plans were regularly evaluated and up-dated, including when a persons condition changed. All of the staff we met with were fully aware of residents individual needs. This reflected what was set out in care plans, and we observed that staff followed directives in care plans. A carer reported that they were given a full report when they came on duty. They were able to describe a residents preferences to us in detail, and Care Homes for Older People Page 4 of 17 this was fully documented in their records. Where a resident was not able to perform activities of daily living for themselves, such as changing their position or giving themselves a drink or a meal, monitoring charts were in place. There were also monitoring systems for when residents could be at risk if their condition was not regularly checked on. Such records were now always kept in residents rooms in accordance with the homes policy. These were accurately completed, providing evidence that care plans were being followed. Where a resident was prescribed a food supplement, the amount of the fluid they had managed to drink was documented on their fluid chart. Where a person needed thickening agent to enable them to swallow safely, there were clear directives, which we observed were being followed, to direct staff on the needed consistency of their fluids. Records relating to provision of nursing and care were accurate and completed at the time care was given. The deputy manager reported that record keeping had been developed and improved and that carers had been supported in writing in individual residents daily records about the care that they had given the resident and their observations of changing needs for the resident. We observed that the quality of these reports was high. A new treatment and medicines storage room has been put in on Comilla Wing. This room is much larger than the previous one and provides ample storage space. Controlled drugs are now stored in cupboards which comply with the Misuse of Drugs Legislation. Blood testing devices used in the home were now suitable for use, in accordance with guidelines from the Medicines and Health care Regulatory Authority (MHRA). Food supplements were being appropriately stored. We observed a registered nurse performing a medicines administration round. They performed it in a safe manner, in accordance with guidelines. They were observed to check that the resident had safely taken their medication and that they were comfortable, before they left the residents room. Steps were well in progress to ensure that all parts of the home used by residents were warm enough for them to use. During the inspection, we observed workmen placing heating in the two areas of the home which had previously not had heating. A new carpet shampooer had been purchased, to remove staining from carpets. The maintenance man reported that he was gradually re-decorating rooms and areas across the home. However we did continue to see a range of areas which still needed attention. Scrapes along walls detract from the homely atmosphere of the home. All potentially infected and general laundry was now correctly managed. The laundry person reported on improvements in staff performance in handing infected and potentially infected laundry. The laundry person reported that hoist slings were sent down regularly for laundering. Systems have been put in place to ensure residents receive more continuity of care, including a key worker and named nurse system. Enough staff were on duty at key times of the day and residents were observed not to be left alone and unsupervised in communal rooms. A resident reported oh yes if I ring the bell, they come, another resident reported that they were aware that the night staff checked up on them regularly during the night and that they appreciated this, as it made them feel safe. We observed staff sitting with residents in the sitting rooms, chatting with them. Staff, including carers, were able to support individual residents in social activities. Most staff now sat down when assisting a resident to eat their meal. This supports the meal in being a more social occasion and enables the member of staff to observe if the resident is swallowing Care Homes for Older People Page 5 of 17 safely. Where a resident had preferences for particular drinks and foods, this was documented. The home are now largely following our Regulations and Standards on the employment of staff. There was also full evidence that all newly employed staff, including agency staff, were fully inducted into their role. We met with a newly appointed member of staff who was undergoing their induction. They reported that they had performed a similar role in their last employment and were impressed by Camelots induction programme, as it had covered more areas and was in more detail than their previous employers induction had been. This person also reported that they felt fully supported in their new role. The new manager has instigated a full training programme for all staff, to ensure that they are trained in relevant areas relating to meeting the range of different residents needs. The new manager reported that they were using a mix of methods, including taught sessions and learning packs. They reported that the learning packs had proved popular amongst staff some staff had found them so useful that they had approached them for more learning packs. Staff reported to us that they particularly liked the booklets given to them by the manager as they could work through them at their own pace. A member of the ancillary staff reported weve had quite a lot of training. The training matrix showed that all staff are now up-to-date with mandatory training and additional training has included pressure area care, care planning and documentation, feeding and swallowing, bed rails and protectors. The new manager has developed systems for staff supervision and is introducing annual appraisals. The new manager has put themselves forward to be the registered manager for the home and this process was fully underway at the time of the inspection. This person has begun systems to ensure that an audit of quality of nursing care provision is included in the homes quality audit processes. We observed that lifting belts to support staff in transferring frail residents were very much in evidence in sitting rooms and we observed staff to use them competently. Full and detailed records of any bruising and other injuries to residents were documented. Reports were now completed by the person who first observed the occurrence, thus avoiding records made by third parties. All records required by us for inspection were now available in the home. The home has put much work into ensuring that it is complying with directives from the Fire and Rescue Authority. Individual resident fire evacuation plans have been drawn up. The home have begun to devise environmental risk assessments. Where bed rails were used, there were now full written assessments relating to their use, which were regularly reviewed. All bed rails were observed to be used safely. There was evidence that staff who fit and use bed rails had been trained in their use. We consider that the home has made major advances in service provision. While some areas still need to be acted upon and some new areas for action were identified, we are reassured by this inspection, which shows that much action has been taken to ensure improvements in service provision and that the health, safety and welfare of residents is more assured. What the care home does well: Care Homes for Older People Page 6 of 17 A resident reported to us oh yes, Im comfortable. A newly admitted resident reported that the staff were quite good. Another resident reported that staff were extremely willing. A resident was observed to be having a late breakfast. They reported to us that this was at their request, as they did not like to eat early. Another resident reported that it was entirely up to them how they spent their day. A visitor reported to us that the home were very good at informing them of any change in the residents condition and that staff were very approachable. A resident reported that the food was grand and that there was plenty of it. Another resident reported that the food was not bad at all, they give me too much. A resident told us that they particularly enjoyed the homes Macaroni Cheese. Another resident reported that they were well satisfied about the meals. The cook reported that they were in the process of reviewing menus, aiming to develop a more balanced approach to meals and more choice for residents. Where a resident needed to be given a liquidised meal, we observed that the meal was attractively laid out on the plate. Residents who needed a liquidised meal were given a choice of what they preferred to eat. We observed a member of staff coming to assist a resident who remained in bed to eat their meal. They came cheerfully into the residents room, addressing them by their first name, got a chair to sit next to the resident, lowered the residents safety rail and assisted them to eat, chatting and engaging the resident in conversation, as well as encouraging them to eat. In one of the dining rooms, we observed that a residents attention had wandered during the meal, this was observed by a member of staff who came and sat next to the resident to support them in eating. We observed as good practice that where residents ate in their room, they were given their first and second course separately, so that their dessert was fresh when they came to eat their second course. The new manager reported that they had successfully managed to change some of the culture in the home and that staff were happy to approach them and whistleblow about matters which concerned them. Residents commented on the new manager. A resident pointed the manager out to us saying theres [the new managers first name] theyre good another resident reported if we want [the new manager] theyll come and have a word with us. A resident reported to us that they appreciated the manager being visible across the home when they were on duty. Staff also commented on the new manager. One member of staff commented that they were really good, another that the new manager deals with issues and another I think [the new manager] will be a good manager. Another member of staff reported that they felt able to raise matters with management and that management would take action when needed. Staff we met with showed a cheerful and relaxed manner with residents and each other. We met with a volunteer who reported I really enjoy it about supporting the home. What they could do better: Most records relating to nursing and care were signed and dated by the person drawing up the record, however there were certain exceptions to this, which we discussed with the new manager. They reported that this related to certain individuals, who they were working with to try and improve performance. While most care plans showed a marked improvement, some needed more development. During the safeguarding investigation, we observed records relating to pressure ulceration for two residents. While records earlier in the year were clear, subsequent records made by a different registered nurse were not and an opportunity was missed to Care Homes for Older People Page 7 of 17 make referrals about management of these two residents wounds to the tissue viability nurse. A resident was fed artificially via a tube. Their care plan did not state, and there was no evidence in their records to show, that the tube for the feed was regularly rotated, as is advised. A residents care plan stated that they needed assistance to go to the toilet, without stating what the assistance needed was. The resident had difficulties in communicating. so would not have been able to inform staff themselves. A resident had had a short-term care plan relating to an infection which had recently been put in place. A standard care plan had been used, which did not indicate any matters specific to the resident, which a different registered nurse was able to inform us about. Most evaluation of care plans were clear and provided evidence of an active review process. However some were not to this standard. One persons evaluation about their confusion was generalistic and did not report on the situation for the resident as observed and reported by staff. Another persons evaluation about how their communication needs were to be supported had an evaluation which indicated that their needs had improved, but their care plan had not been re-written and improvements were not reflected in the persons daily record or what we observed, so it appeared that the care plan evaluation was not accurate. Again the manager reported that this related to individuals who needed more support in care planning and evaluation of care plans. Nearly all the care plans had been drawn up by two of the registered nurses. We discussed with the deputy manager and new manager that more staff should be supported to draw up care plans, particularly care assistants who would be involved in daily care provision and knew residents well as individuals. We considered that carers were ready to do this, as the quality of their daily report writing was high. The home uses monitoring charts which are set out in hourly sections, but there is space on the form to be more specific about times. Currently staff are not using this space. We observed a resident after 1:00pm and the chart did not indicate that they had received care, however when we returned later in the afternoon, their chart indicated that they had received care at 1:00pm. We advise that to enhance accuracy of records, carers document when during the hour they provided support to the resident. Where a resident was prescribed a medicine on an as required basis, we observed a variance. Some residents had very clear care plans to direct the registered nurses on when and how often the resident was to be administered such drugs, but some had no information at all. This included a resident who was prescribed a medication for Angina, another resident who was prescribed a medicine to support them in reducing complex behaviours and another resident who clearly had difficulties with bowel management. Care plans for medicines prescribed as required are needed, to ensure that the resident is given their medicines in a consistent manner and win accordance with the prescribers instructions. Some residents were prescribed medicines which can affect their daily lives, such as mood altering drugs, aperient or pain killers. Again there was a variance, some care plans included such prescriptions in relevant parts of the persons care plan, but others did not. It is advised that relevant care plans should consider such prescriptions, so that staff can support doctors in making an assessment of the effectiveness of such prescriptions. We observed that a medicine was included on the homely medicines list which needs to be given regularly to be effective. This should be reviewed. On Countess Wing, the Controlled Drugs cupboard was very small and if another resident were admitted who was prescribed Controlled Drugs, the home would have difficulty in safely correctly storing such medicines. Care Homes for Older People Page 8 of 17 A resident used a prescribed appliance. We discussed this with the deputy manager, who reported that care staff had been trained in its application. However as this can be a complex procedure for a person unfamiliar with the appliance, the care plan needed to be more developed and specific about actions to take to support the resident. There also needed to be written evidence that only staff who had been appropriately trained put the appliance on the resident. While we observed that some staff always called residents by their own preferred name, others used generic terms of endearment such as darling, my dear or love. This does not up-hold a residents dignity. Residents who have dementia care needs particularly need to be addressed by their own name to ensure that they are fully supported. This is a matter which was observed at previous inspections, the situation improved, but has now lapsed. We observed one occasion when a member of staff was assisting two people to eat their breakfast, standing up to feed them. This does not foster the meal as being a social occasion and means that the member of staff is at an incorrect height to check if the resident were swallowing safely. Environmental risk assessments need to be drawn up in relation to corridor areas, the lifts, the conservatory in Comilla Wing and the basement in Countess Wing. This is particularly the case as action had not yet been taken to ensure that lift alarms were fully audible or appropriate warning systems were in place if the lift becomes stuck. The homes fire risk assessment has been completed, including individual evacuation plans for residents. The home now needs to draw these plans together and review how residents can be supported to evacuate in the event of a fire, according to where they are in the building(s) and their individual needs. We inspected a range of full body hoist slings and observed that none were named. Communal use of hoist slings can present a risk of cross infection, particularly fungal infection, therefore they need to be named and only used for the named individual. We observed that an assisted bathroom had tablets of used soap in them. Communal use of soap presents a risk of cross infection and all tablets of soap need to be returned to the person or if the person cannot be identified, disposed of. We observed that some sluice walls were in need of decoration and were not fully wipable. We recommend that this matter would be addressed before it deteriorates further. Staining remained visible on a range of carpets across the home. This is planned to be addressed now that the home have purchased a carpet shampooer. Many of the rooms, corridors and door frames showed signs of scraping, which detracts from the homely atmosphere. One of the the bath hoists in an assisted bathroom was loosing its coating and as such would not be easy to wipe down, to ensure that risks of infection can be reduced. The hoist was clean but this matter needs attending to, before it becomes a cross infection risk. We observed residents being moved in wheelchairs. Some wheelchairs were in a good condition, however others were not. Some wheelchair foot plates had deteriorated or lost straps. This means that the resident could be at risk of their feet coming off the foot plates. Some wheelchairs were old, with deteriorating surfaces. One had a tear in the seating under the wheelchair cushion. We looked at the wheelchair maintenance log and observed that it had been correctly performed and areas of deficit identified by the Care Homes for Older People Page 9 of 17 maintenance man, however action had not been taken by management to ensure the safety of wheelchairs for residents. Staff continue not to perform safe manual handling at all times. We observed two members of staff support a resident to move from their easy chair to a wheelchair, using a standing hoist with a sling. The members of staff did not engage the breaks of the aid, so when the resident reached out for it, the aid tilted towards them. When the staff put the sling on the resident, they did not put it on safely and one of the residents arms was placed incorrectly. When the resident was assisted to their wheelchair, again the breaks of the aid were not engaged, so there was a risk of instability. We observed a second similar transfer of a resident to a wheelchair with the aid not having its breaks applied, but the hoist slings were correctly placed. Staff need to use breaks when using manual handling aids as there is a risk of instability in the hoist, which could lead to risk to residents or staff. We also observed more than one member of staff manoeuvre a wheelchair by tilting it forward on the small front wheels. The residents were not wearing lap belts. This could put the resident at risk of coming out of the chair. The need for safe manual handling has been identified for several inspections. We are aware that all staff have been trained in their responsibilities, so the home needs to take action to ensure that all staff understand their responsibilities in this area. Staff files showed much improvement. Some staff are employed who are not British or European nationals. In such cases, the home needs to have written evidence that the member of staff is able to work in the home. This was not the case for all such staff. Staff files need to be audited and relevant documentation obtained. The new manager was personally aware of some informal complaints and concerns which had been raised, and actions taken. We advised that as part of audit of quality of service provision that such matters be documented, to identify any trends. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 10 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 37 17(1) The home must ensure that records required by us are always available in the home. Records relating to nursing and care must be dated and signed by the person completing the record. Requirement addressed in part. Not all records were signed and dated. All records required by us were available in the home. As such records may be considered legal documents, they need to be dated and signed. 31/03/2010 2 38 13(4) The home must develop full 31/03/2010 environmental risk assessments for practice and management of the home. Where risks are identified, a plan must be put in place to demonstrate how risks presented by the home environment have been reduced to a minimum. Requirement in progress. Managers have a duty to identify any risks associated with the home environment Care Homes for Older People Page 11 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action to document how risk to residents, visitors and staff is to be reduced. 3 38 13(4) All staff must perform safe manual handling practice at all times. Requirement not addressed. If staff do not perform safe manual handling, residents, themselves and other members of staff may be put at risk of injury. 4 38 13 Lift alarms must be fully audible or appropriate warning systems must be in place if the lift becomes stuck. Requirement not addressed. This is to ensure the safety of people using the lift. 31/03/2010 30/09/2009 Care Homes for Older People Page 12 of 17 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, 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 All care plans must include all matters relating to the individual and be actively evaluated to include all matters relevant to the individual resident. This is to ensure that residents receive the care they need, in a consistent manner. 30/07/2010 2 9 13 All residents who are prescribed a medicine on an as required basis must have a care plan or protocol in place to direct staff on their use. This is to ensure that residents receive the medicines that they need, in a consistent manner. 30/07/2010 3 29 19 Where a member of staff is 31/08/2010 not a British or European National, the home needs to be able to evidence that staff are able to work in this country. Care Homes for Older People Page 13 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 This is to ensure that all staff employed to work in the home are able to do so. 4 38 13 Wheelchairs must not be used for residents unless they are safe for use. This is to ensure the safety of residents. 5 38 13 Tablets of used soap must be 30/07/2010 kept with the resident and not left in communal bathrooms. If the resident cannot be identified, the tablet of soap must be disposed of. Communal use of tablets of soap presents a risk to cross infection. 6 38 13 Full body hoist slings must be named and used only for the named person. This is to prevent risk of cross infection, particularly fungal infections and does not uphold residents dignity. 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 30/07/2010 30/07/2010 1 2 7 7 Carers should be trained to draw up and evaluate care plans When completing monitoring records, care staff should document when during the hour they provided the resident with support. Page 14 of 17 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 3 8 Where a resident receives nutrition via a tube, there should be directives in their care plan in relation to rotation of the tube and evidence that this is taking place, in accordance with current recommendations. Where a resident is prescribed a medicine which can affect their daily lives, this should be considered in their care plan, to support assessment of the effectiveness of the medicine. A larger Controlled Drugs cupboard should be provided on Countess wing. The homely medicines list should not include medicines which need to be given regularly to be effective. Generic terms of endearment should not be used when addressing residents. This is a matter which was recommended at previous inspections. It improved, but has now lapsed. 4 9 5 6 7 9 9 10 8 15 Where residents need assistance to eat their meals, the member of staff should always sit with the resident, to foster the meals social occasion and also to be able to observe that the resident is swallowing safely. This recommendation has been made for the past two inspections. It shows some progress. 9 10 16 26 Informal complaints and concerns should be documented, as well as formal complaints, to identify any trends. All hoists in bathrooms should have intact surfaces so that they can be effectively cleaned after use and reduce risk of cross infection. The scraped walls of corridors, rooms, door frames and sluice rooms should be redecorated, to improve the appearance of the home and to ensure that they are fully wipable, before they deteriorate further. Where carers are placing a prescribed appliance on a resident, there should be written evidence to show that all carers have been trained in how to do this and that only carers who have been trained perform the role. The fire risk assessment should be further developed, by Page 15 of 17 11 26 12 30 13 38 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 reviewing the results of individual fire evacuation plans and setting out how residents in different parts of the building will be supported in evacuation. Care Homes for Older People Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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