Care Home: Cameron House

What the care home does well The service is homely and warm and there is a refurbishment programme in place. Comments from the service user were that `this is lovely home.` There is a good pre admission process in place that staff follow to ensure that the home can meet the service users` needs prior to admission. The service users are provided with wholesome meals that meet with their satisfaction. What has improved since the last inspection? A number of the bedrooms and communal areas have been renovated. A new system of care planning has been put in place since the last inspection. The excess stock medicines have been reviewed and cabinet purchased for the storage of controlled drugs. What the care home could do better: Risk assessments and care plans need further development to ensure that these are detailed and reflect the current and assessed needs of people. The records for fluids need to improve to show that people are receiving their care safely. Medicines management need developing to include as required medicines, variable dosages and ensure that accurate records are maintained and these are available as required. People living at the home would benefit from an activity programme and designated staff with skills to deliver activities for people with dementia. The responsible person need to ensure that a part of their audit a regular environmental assessment is completed to ensure that all areas that the service users have access to are free from hazard. Mandatory training for the staff in health and safety and moving and handling must be developed to ensure that people are not put at risk of harm. Key inspection report Care homes for older people Name: Address: Cameron House 78 Pellhurst Road Ryde Isle Of Wight PO33 3BS     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: Anita Tengnah     Date: 1 0 1 1 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 30 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 30 Information about the care home Name of care home: Address: Cameron House 78 Pellhurst Road Ryde Isle Of Wight PO33 3BS 01983564184 01983811798 aqua2583@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Make All Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 18 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) Date of last inspection Brief description of the care home Cameron House is registered to provide care for up to 18 older people who have a dementia. The home is one of two care homes owned by Make All Ltd and is managed by a registered manager. The home is a detached period property that has been converted to provide accommodation on the ground and first floors and is situated in a residential area of Ryde. The bedrooms are mostly single with some double rooms, and access to the first floor is via a stair lift. There is off road parking at the front of the house with level access to the home. 0 1 1 2 2 0 0 8 18 Over 65 0 Care Homes for Older People Page 4 of 30 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: An unannounced inspection visit was undertaken over one day on 10 November 2009 as part of our inspection process. This is the first inspection visit since the change of their registration. We sent out the Annual Quality Assurance Assessment (AQAA) to the registered person at the service. This is one of the means of collecting data from the service. We looked at the environment,service users records and care plans and some staff records as maintained at the service and we observed care practices. We have used information as supplied by the home in their AQAA and other information that we have received since the last inspection. We spoke to a number of the service users and we sent out our surveys that gave people the opportunity to share with us their experiences of the service. We have received four completed surveys that contained input from the service users relatives. These tell us that they are satisfied with the care that they are receiving and some of these comments will be reflected in the body of the report as appropriate. Care Homes for Older People Page 5 of 30 Care Homes for Older People Page 6 of 30 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. 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 7 of 30 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 8 of 30 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. There is a good process in place to ensure that people needs are assessed prior to them moving into the home. There is no intermediate care provided at the service. Evidence: We looked at the process that the home has in place in relation to pre admission assessment. The records showed that a detailed pre admission assessment was completed prior to the service users admission to the home. Assessment recorded the persons ability of their daily living and identified the support that was needed. A list of their medication was recorded on admission and other information included mobility needs of the person. It was evident that the care managers assessment is sought as part of the pre admission assessment and for one of them this was received the following day and other information seen included a discharge summary from hospital. Care Homes for Older People Page 9 of 30 Evidence: The manager reported that the service users family usually visited and are provided with information as required. Information from the AQAA states that they have developed a statement of purpose and service users guide with photos of various rooms of the service. This was available at the home at the time of the visit, the manager said that they would be updated again as the rooms are refurbished. The statement of purpose must be reviewed so that it reflects the registered name of the responsible person as required. The manager has confirmed that the home does not provide intermediate care, only short term respite care. Care Homes for Older People Page 10 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff have developed care plans and assessments since the last visit. However these are not always adequate to meet all the assessed needs of the service users safely. The access to health care is well managed and there is good support from the community nursing team. There is a procedure in place for the management of medication, however this is not currently adequate to ensure people receive all their prescribed medicines safely and effectively. The service users are treated with kindness, however care practices show a lack of autonomy and choices for the service users. Evidence: The care records of three service users were looked at as part of our visit. These show that some risk assessments such as personal care needs, nutrition and fall assessments had been completed. The service has been developing a new care Care Homes for Older People Page 11 of 30 Evidence: planning system since our last visit. There were also turn charts and fluid and food record charts that have been put in place for some of the service users. Staff maintained details of care given in the daily record sheets. The manager discussed that turn charts had been introduced since the last inspection and one of them was seen showed that staff were maintaining records of care as required. The last inspection report required that care plans and food and fluid records are maintained appropriately to demonstrate how the service users needs would be met. The nutritional assessment for a service user has been completed to show that they required liquidised or soft diet. The food record chart as maintained for this person showed that they had received cereal, sandwiches and toast. This may put the persons at risk of choking, this was brought to the attention of the manager as monitoring of people diet is needed to ensure that staff follow care plans and assessments and care is delivered safely. The manager stated that this had been wrongly recorded. The nutritional assessment seen did not contain the service users weights as required and this should be developed as this forms part of the risk factor to inform the assessment. We looked at three of the service users fluid balance records that were maintained at the service. These showed that they were poorly completed and did not contain adequate information of fluids administered. These show that people were not receiving adequate fluids and put them at risk of dehydration. On the day of the visit we observed that the staff offered hot and cold drinks to the service users during the day. The records for moving and handling showed that people required the assistance of staff such as records stated two carers needed for all care. Another record said weight bear with two carers for their mobility. The records for moving and handling lacked clear assessments and action plan to ensure that these are carried out safely. It did not show how the risks were assessed/ tool used in order to formulate appropriate care plans and inform the staff practice. There was a lack of fall assessment and care plan in relation to one of the service users who had recently fractured their hips following falls. The assessment record for a recently admitted service user showed that they were dependent on two carers for their mobility and identified them as high risk of falling. However there was a lack of moving and handling assessment and care plans in place Care Homes for Older People Page 12 of 30 Evidence: to demonstrate how the service users needs personal care needs would be met. The records contained a detailed transfer information from the hospital. Care plans were not available to show how the home was planning to meet this persons needs. The manager stated that care plans were being developed. The service users were supported to access external health care support as required. The manager stated that they were all registered with the local doctors surgery and receive care/ visits as requested. One record seen showed that a medication review had been completed in October 2009. The staff reported that they have a good relationship with the local primary care trust and felt supported by the district nurses team. The record for a service user who was receiving treatment for a pressure ulcer was looked at. The home has referred to the district nurses team and detailed assessment and care plans were in place to show how this was being managed. The plans contained details of the treatment such as cleaning of the wound and the type of dressing applied in order to inform the staffs practise and ensuring that the needs of this person are met appropriately. Another service user has been identified as risk to pressure ulcer. We found that pressure relieving equipment was available to prevent the risk of skin breakdown. Comments from our surveys show that the people say that the home always make sure they receive medical care they need. We looked at the medication management that the home undertook on behalf of the service users. The AQAA states that every member of staff has been trained by this year in safe handling of medications. This includes senior carers, junior carers and night carers to ensure a full understanding by all. The home was using the monitored dosage system of dispensing medicines. The staff maintained records of the medicines on the medication administration record (MAR) charts. Medicines were stored securely at the time of the visit and the manager stated that only the staff who had completed medicines training were responsible for the service users medications. Following the last inspection the registered person was required to ensure that the controlled drug cabinet met with the current regulation. A new cabinet has been put in place that the manager confirmed met with regulation. There was no controlled medicine maintained at the service at the time of this visit. Care Homes for Older People Page 13 of 30 Evidence: A random check of the MAR records showed that these were completed and there were no gaps. Other records included a medication list that gives the dosage, usage and possible side effects. There were no care plans/ procedures in place for medicines that are prescribed to be given as required. There is a risk that people may receive medication when they do not require or not receiving it when they need. These medicines included pain tablets and apperients. This is particularly important as the service users due to varying degree of dementia may not able to communicate their needs. The manager maintained a record of medicines received and returned as required. It was not possible to carry a random audit of the service users medicines as the manager reported that the most recent MAR charts could not be located. There was a lack of accurate record when variable dosages are administered and an audit could not be completed. Staff must ensure that records of variable are recorded in order to inform practice and medicines are managed safely. The registered person must ensure that all records as required by regulation are maintained safely and are available as required. MAR charts also contained medicines that the staff said had been discontinued about a year ago . Staff must ensure that MAR charts only contain accurate record of current medicines and a record of when medicines are discontinued and on whose authority. One of the shared bedroom contained an ointment that was not labelled with the service users name as required. This poses infection control risk and may be used as communal. The care record seen showed that a different cream was to be applied, however this was not available. Care plans must contain accurate records of prescribed creams/ ointments. The service users spoken with and interaction observed showed that the staff and the service users had developed and maintained good relationship with each other. The service users were spoken to with respect when they were supported in the lounge and the dining room. Comments from our surveys show that people were satisfied about the care that they were receiving and included: Very friendly staff, always ready to talk and help. Care Homes for Older People Page 14 of 30 Evidence: The home is well run. Provides a friendly family like setting. Overall the home treats them well and with respect. Appears happier since moving t this home. On what the home could do better comments were: Provide more manual lifting aids. Concerns were related to the stairlift as the homes residents suffer from dementia are at risk when transported up and down the stairs in domestic stair lift. These comments were shared with the manager at the time of the visit. We observed that the night staff are instructed to get a number of the service users up, washed and dressed in the morning. Staff we spoke to indicated that this was the normal care practice. This however does not promote autonomy and choices for the service users and is task orientated and not service users led. The registered person must ensure that care is provided in a manner that respects the autonomy and choices of people living at the home. One of the shared bedrooms that we looked at did not have a screen. The manager reported that one of the service users used the en suite facility, however the other person used the commode by their bed. The bedroom was partially separated, however it did not provide adequate privacy. Care Homes for Older People Page 15 of 30 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 an activity programme in place. However further development is needed to ensure that they meet the social needs of the service users. The service users are supported in maintaining contacts with their family and friends. The meals are satisfactory and meet with the service users satisfaction. However support is not always provided as required. Evidence: The AQAA states that there is a planned activities programme that included board games, bingo, skittles, music for easy listening or watching films and going through and talking about photos that they may have. We found that there was appropriate music throughout the day and the service users appeared to enjoy. The carers stated that they were responsible for activities and sometimes played games and skittles that the service users enjoyed. There were no activities on the day of the visit and the service users remained in the lounge and dining room. Development of an activity programme appropriate for Care Homes for Older People Page 16 of 30 Evidence: people with dementia and allocated time/staff for this to happen through the day should be looked into. Staff we spoke to said that there are external people who come in about once or twice a month to provide some activities. Staff reported that the local priest visited two of the service users on monthly basis for Holly communion. The home has an open visiting policy and the staff said there is no restriction on visiting.There was a record of visitors as required that the home maintained, evidence from this supported the view that people visited at various times. We observed the lunchtime meal during our visit and found that the meals looked well presented, wholesome and balanced. One staff was in lounge offering support to one of the service users with their meal in a sensitive manner. We observed that people appeared to enjoy the lunchtime meal. The people we spoke to and comments received showed that the food was well managed. Comments were The food is good. I like the food . Another service user was served a hot meal and we observed them in the dining room in need of support. This was brought to the attention of the manager who stated that they had eaten their meal later on. The chef said that there is a menu that is rotated on a regular basis and was aware of the service users likes and dislikes. She stated that they preferred old fashioned meals and soft and pureed meals were available as required. Care Homes for Older People Page 17 of 30 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. There is a satisfactory process for raising concerns at the service. The staff have completed training in safeguarding and were aware of their responsibilities to report to the manager . Evidence: The home has a policy and procedure on how to make a complaint. The manager said that this information is made available to the relatives as required. The responses to our survey showed that they know what to do if they were unhappy. Comments were that the staff are very friendly and always ready to talk and help. The staff stated that they would report to the manager if they had any concerns. The manager is putting in place clear procedures about recording of any complaint raised to them to ensure that this is managed appropriately. The AQAA states that all members of staff are trained in adult protection and prevention of abuse and this it is included in the in house induction pack. Information from the AQAA shows that the service has not received no complaint and no safeguarding alert has been raised since our last visit. At the last inspection the manager was accessing the updated safeguarding policy and procedure. The manager confirmed that they had contacted the island social services Care Homes for Older People Page 18 of 30 Evidence: department and according to them the current policy and procedure for safeguarding people is dated 2007. Care Homes for Older People Page 19 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are provided with a warm and comfortable home. The infection control procedures and laundry management are not adequate and put people at risk of harm. Evidence: We walked around the home and looked at a number of the service users bedrooms with the manager , communal areas such as the lounge and dining room, kitchen and laundry. The service users are provided with a clean and homely environment and action has been taken since the last inspection to ensure that the communal areas are kept clear of personal belongings and the risks of these being used as communal. The home was undergoing a programme of refurbishment at the time of the visit that included change of wall paper, entrance lobby , stairs, corridors. the manager stated that a number of the service users bedrooms have also been redecorated and the work is ongoing. The furnishing in-the communal areas were in good state of repair and appropriate to the current service users needs. It was evident hat people are supported to bring in items of personal belonging when moving in. The bedrooms that we looked at were personalised and warm. During the visit a window on the top landing was not maintained securely as it opened Care Homes for Older People Page 20 of 30 Evidence: fully. There was no restrictor and poses risk to the health and safety of people accommodated. The manager stated that this would be kept locked and immediate action taken. The manager stated that restrictors would be fitted the following day and would inform the commission in writing of their action. The AQAA states that in order comply with health and safety requirements radiators are covered for clients protection and have thermostatic valves to enable heating to be controlled as individual clients wish. Mixer valves are in place on individual water outlets to allow water flow at a temperature safe for clients in order to prevent scalding. The service has a laundry an internal laundry off one of the corridors to the service users bedrooms. The laundry room was fitted with a washer and two driers. Staff stated that these were sufficient to manage their current needs. The infection control procedures for the management of soiled linen was inadequate. We found that soiled linen were all mixed with other laundry. The staff said that they did not have red bags in order that soiled linen can be managed separately. This would eliminate the handling of soiled laundry unnecessarily and protect staff and the service users form infection control risks. The soap dispenser and the disposable towels containers were both empty at the time of the visit although the staff were using the laundry. We found that the laundry room was not maintained safely, the laundry door was open when the laundry was unattended and may pose risk to the health and safety of people living at the home. Care Homes for Older People Page 21 of 30 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 service has adequate staff to meet the current needs of people accommodated. However there are concerns about the care delivery and some of prescribed care/ routine at the home. Some checks are undertaken as part recruitment process, however these are not consistent and did not always include appropriate references as required. There is an ongoing training and induction programme in place. However evidence of training and update in health and safety, induction remain inadequate. Evidence: We looked at the staffing arrangements that the home has in place and this shows that there are three carers on the morning and on the afternoon shifts and two carers on night duty. The manager was available to offer support and was not counted in the numbers. The service has a chef who was on duty on the day of the visit. The carers were also responsible for the service users laundry and some food preparation. People we spoke to said that usually there were adequate staff , however the concerns regarding the number of people that the night staff have been allocated to get up clearly shows that this is not in the best interests of the service users. The registered person must ensure that the care hours are not eroded by non care duties such as laundry and kitchen work. The home has a number of service users Care Homes for Older People Page 22 of 30 Evidence: who are dependent on the staff for all their care and are unable to make their needs known and left unsupervised as the staff are busy dealing with other service users. Positive comments were received regarding the staff and one included: The staff know their residents well and accommodate their preferences as far as possible. Another comment was There seems to be less staff than there used to be. We looked at the recruitment records for two new staff during out visit. These showed that they completed an application form and necessary checks such a Criminal Record bureau (CRB) and POVA first were undertaken as part of the recruitment. One of the staff had their CRB prior to starting work and the other one was received a week later. The manager stated that this person was undergoing their in house induction, however records of any type of supervised practice was not available. One of the staff did not have a reference from the last employer as required. Although staff completed the in house induction there was no evidence that carers have completed induction as per the skills for care programme. The manager reported that she would be looking into this. One of the staff records seen did not contain evidence that they had completed moving and handling training. The manager stated that the home was looking at training their own staff to deliver this training. The registered person must ensure that all care staff complete mandatory training in health and safety including moving and handling when they start work to ensure that the service users are not put at risk of poor practice. The information from the AQAA states that the home has seventeen carers , five of them have completed their national vocational qualification (NVQ) at level 2, four others are in the process of completing their level 2 and 4 staff are undertaking NVQ at level 3. The manager confirmed that there is an ongoing training programme to support the staff including dementia care and medications. Care Homes for Older People Page 23 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a registered manager with day to day management responsibility for the service. The financial arrangements for the service users money is satisfactory. The health and safety of the service users are not always protected through lack of risk assessments and health and safety training, fall risks management. Evidence: The service has a registered manager who is responsible for the day to day management of the service. and has completed her NVQ 4 in care and the Registered Managers Award (RMA). Staff and response from our surveys all said that they would approach the manager if they have any concerns. Interaction observed showed that they have developed a good relationship with each other. We looked at the process that the home has in place for the management of the service users money. The home did not look after any of the personal allowance and the manager confirmed that she was not an appointee for any of the service users. Care Homes for Older People Page 24 of 30 Evidence: Invoices are raised for items such as chiropody, hairdressing and these are sent out to the person responsible for the bills. Receipts of transactions are maintained and form part of the services own auditing. Following the last inspection the responsible person was required to carry out unannounced visits and maintain records of these at the service. Records that we looked at showed that these have been completed as part of the internal audit as required. Some of these reports were available, although those for July and October 2009 were missing. Information from the AQAA shows that policies and procedures are reviewed on a yearly basis. There is a programme for the servicing of essential equipments such as fire extinguishers, emergency lighting, hoist and stair lifts have been completed in the last six months. We receive reports of incidences that are detrimental to the health and safety of people. The manager must ensure that these include un planned admission to hospital as required, as these are not always sent to us. There is a lack of mandatory training in health and safety and infection control processes that put the services at risk of harm. There is a lack of risk assessments and clear action plan to demonstrate how these would be managed in order to protect people living at the service. These are in particular in relation to moving and handling and fall risks. Care Homes for Older People Page 25 of 30 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 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 30/12/2009 ensure that following assessments, written care plan are put in place to show how the service users needs in respect to their health and welfare are to be met. So that staff have the information and the service users can receive consistent care to meet their needs. 2 8 14 The registered person must ensure accurate records are maintained of how the nutritional needs are met to include accurate records of fluids. To ensure that people are not put at risk of harm. 30/12/2009 3 9 13 The registered person must ensure that arrangements are in place for the safe management of medicines, including procedures for as required medications. 30/12/2009 Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that people receive their medicines safely at all times. 4 10 12 The registered person must ensure that care is provided in a manner that promotes autonomy, choice privacy and dignity of the service users. To ensure that they receive care in a respectful manner and according to their wishes. 5 12 16 The registered person must ensure that appropriate activities are developed that support the current service users needs To ensure that their needs are met. 6 26 13 The registered person must ensure that arrangements are in place to prevent the spread of infection at the care home. To ensure that people are not put at risk of harm to their health and safety. 7 29 19 The registered person must ensure that all checks and information are available prior to staffs employment 30/12/2009 30/12/2009 30/01/2010 30/12/2009 Care Homes for Older People Page 28 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that people are not put at risk of harm. 8 30 18 The registered person must ensure that required induction and training programme are in place for all staff. To ensure that staff have the skills to deliver care safely. 9 38 13 The registered person must 30/12/2009 ensure that risk assessments and arrangements by training staff and other measures to ensure the health and safety of the service users are protected. To ensure that systems and staff training are in place to protect people from risk of harm. 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 30/12/2009 Care Homes for Older People Page 29 of 30 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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