Care Home: Chamber Mount

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What the care home does well The manager ensures that people are made welcome and provided with a clean and warm environment. Assessments and care plans are completed to a high standard and provide staff with clear and detailed information about meeting the needs of service users. The recruitment and selection process is robust and so ensures that staff employed are suitable and the welfare of people at the home is protected. The providers continue to refurbishment and re-decoration the home. People receive excellent quality personal and health-care, and feel they are well looked after. Meals and drinks provided at Chamber Mount are of good quality, plentiful and nourishing and enjoyed by those living there. People are content living at Chamber Mount and effective action is taken to promote the wellbeing, safety and independence of the residents. The staff are well trained, supervised and kept up to date with new ways of working. People have opportunities to comment on the quality of the service. All people spoken to were complimentary about staff, food and the running of the home. Positive comments about the home in general included: `When our relative was in hospital he kept talking about Chamber Mount as home and saying how much he missed the girls and wanted to return.` and `They go all out to do what is best for the service user for example planning activities and involving the service user.` What has improved since the last inspection? The manager has introduced an activities program that people enjoy. The manager has redeployed staff so that there are more on duty at busy times, therefore peoples needs are met in a relaxed manner at all times, particularly in respect of carrying out the activities program. The manager has introduced a quality assurance system and is able to demonstrate the changes she had made in the home in response to listening to what people have told her. What the care home could do better: The manager needs to make sure that the relevant codes are always used when staff fill in the medication administration record sheet (MARS) so that an accurate record is kept about all the medication given in the home. The manager should increase the frequency of auditing service users money so that disparities are quickly identified and looked into. The registered person should analyse the accident records so that any common risk factors can be identified and dealt with so that falls and accidents can be reduced if possible. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chamber Mount 197 Chamber Road Werneth Oldham Lancashire OL8 4DJ     The quality rating for this care home is:   three star excellent service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Haller     Date: 1 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Chamber Mount 197 Chamber Road Werneth Oldham Lancashire OL8 4DJ 01616653185 01616653232 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Elizabeth Knight,Anthony Knight care home 23 Number of places (if applicable): Under 65 Over 65 6 23 dementia old age, not falling within any other category Additional conditions: 0 0 The home is registered for a maximum of 23 service users to include: * up to 23 service users in the category of OP (Older people not falling within any other category). *up to 6 service users in the category of DE(E) (Dementia over 65 years of age). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Chamber Mount is a residential home providing 24-hour personal care and accommodation for up to 23 service users over the age of 65 years. The home is situated approximately one mile from Oldham?s town centre and is close to local shops and amenities. Bus services are available close by providing access to Oldham town centre or Manchester city centre. Chamber Mount has a small flagged area to the rear and gardens to the front and side Care Homes for Older People Page 4 of 28 Brief description of the care home of the property. The home was originally two Victorian houses that have been converted to one, and the front faces onto Chamber Road. A ramp has been installed at the side entrance to the home providing level access. Bedroom accommodation is provided on three levels including lower ground floor, ground floor and first floor. A passenger lift and a chair lift are available for the use of service users. Chamber Mount provides nine single bedrooms and six twin rooms. Bedrooms are pleasantly decorated with complementary curtains and bedding. Bathing facilities include one assisted bath, one unassisted bath and two shower rooms. There is a choice of lounge and dining areas all of which provide comfortable well-furnished accommodation. The home charges #360 per week. The Commission For Social Care Inspection report is on display at the entrance of the home. Care Homes for Older People Page 5 of 28 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this inspection without informing the manager before hand and looked at all of the most important or key Care Homes for Older People National Minimum Standards (NMS). This is called a Key Inspection. The inspection involved looking at the information we had received about the service during the previous year and before visiting the home. This included notifications or events that the manager has told us about, information from other sources such as social services, health workers or people using the service. We also considered the outcome of the Annual Service Review (ASR) which we conducted in 2008. The ASR includes reviewing all the information received about the service to check that it continues to be well run. We do not visit the service for the ASR. All the information Care Homes for Older People Page 6 of 28 received prior to this key inspection indicated that outcome for people using the service continued to be good. We received four completed Care Quality Commission (CQC) surveys from staff. We visited Chamber Mount and we looked around the home, checked through written information including service user care files and staff employment records. We read through policies, guidelines and other documents concerned with running the home. We also talked to residents, their relatives and staff working at the home. We interviewed a health care professional who was visiting the home at the time of the inspection. We observed the interactions between service users, staff and others at the home. We interviewed manager and one of the registered providers. The manager returned to us the CQC Annual Quality Assurance Assessment (AQAA). The information requested included data about staff training, development of policies and procedures and compliance with health and safety checks when applicable. The information also influenced the outcome of the inspection. What the care home does well: What has improved since the last inspection? The manager has introduced an activities program that people enjoy. The manager has redeployed staff so that there are more on duty at busy times, therefore peoples needs are met in a relaxed manner at all times, particularly in respect of carrying out the activities program. The manager has introduced a quality assurance system and is able to demonstrate the changes she had made in the home in response to listening to what people have told her. Care Homes for Older People Page 8 of 28 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 set out 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 28 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 28 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 at Chamber Mount benefit from having their needs fully assessed before moving into the home so that staff know what support is needed to meet their needs and help them to settle in. Evidence: We found that all files examined contained a pre-admission assessment that had been completed prior to the date of admission and a more detailed assessment had been completed very soon after admission. We found that the assessments included all aspects of physical and emotional wellbeing. Risk and other specialist assessments such as nutritional status, pressure area care, moving and handling or falls prevention were also on file. We found that assessments information also included a persons interests and hobbies. Care Homes for Older People Page 11 of 28 Evidence: We found that people were involved in the assessment process as they had signed the assessment documents. We saw that needs were re-assessed following any significant changes in a persons situation. We discussed the admissions process with people using the service, their relatives and the manager. People confirmed that they were able to spend time in the home before making a decision to move in. The manager confirmed that she usually visited people before they moved if they could not come to the home. Three out of four staff told us that they always had enough information about how to meet peoples needs. One member of staff felt that there was usually the case. Comments included: Our manager always gives us information. And When we came we just felt there was something nice about the home- it was a Sunday and there were newspapers around it was like home. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Chamber Mount residential home receive health and personal care that helps to keep them healthy and comfortable for as long as possible, and also promotes their independence and maintains their self esteem. Evidence: We found that files examined contained care plans that provided detailed information and instructions to staff about the support needs of each person. These plans were clearly written. They were easy to follow and made it easy for staff and others concerned to monitor how people had progressed. We assess that the care plans relating to pressure area care were excellent. These provided staff with a reason why following the plan was important and identified the positive outcomes that this would have for the resident. The plans were personalised and took the personality and abilities of the individual into account. The care provided was also effective as records confirmed that pressure sores had Care Homes for Older People Page 13 of 28 Evidence: healed through staff following the care plans and the instructions provided by the district nurse. We saw that care plans and additional records confirmed that people received routine health checks such as opticians, podiatrist, dietitian, GP and dental care regularly. In addition other specialist health care advice was obtained as the need arose. We found that staff were provided with skills to provide effective health care for example senior staff have completed specialist training so that they can use the Malnutrition Universal Screening Tool (MUST). This means that they can make referrals direct to the dietitians without having to go through the general practitioner. We saw records that confirmed that staff continue to escort people to hospital appointments when required. We found that people were satisfied with the health care provided and feel that this is good. Comments included: Yes health care is provided. And Yes they have made sure that health care issues are fully dealt with. We were able to further confirm, through reading the daily reports, that staff provided support as stipulated in the care plans. The manner and tone in which reports were written demonstrated that staff were respectful of people and cared about their wellbeing. We could confirm through these reports that staff took steps to make sure that people remained happy and comfortable, alerting senior staff about any concerns they may have. Records and notes also confirmed that all specialist health care needs were effectively managed. We found that in one instance the care plan did not fully address the psychological needs of one person. We assessed, after further investigation, that this meant that staff did not know all the information about the person needed to provide the most effective support. We discussed this with the manager who seemed aware of the issue and agreed to prioritise spending time with the person to update the care plan. We interviewed a district nurse who was attending to people at Chamber Mount. She was very impressed with the health care and general support provided in the home. She confirmed that staff followed her instructions, kept detailed records and were knowledgeable about the conditions they had to deal with. She also told us that all health care was carried out in private. Care Homes for Older People Page 14 of 28 Evidence: We observed on the day of inspection that people were well groomed and all had been supported in achieving a good level of personal care. Checks confirmed that people were wearing their own clothes. And the laundry process continues to ensure that clothes were presentable and returned to the correct person. We observed that staff interacted with people in a gentle and respectful manner and were attentive, giving each person individual attention and listening to their responses. We also found that staff were always thoughtful and respectful in their approach to people and were always discreet and quiet when dealing with personal care needs. We looked at the medication policy and saw that this provided clear instructions to staff. Medication is stored in a locked cupboard. The medication administration record sheets(MARS) were examined, the majority of entries had been recorded however some omissions were noted. The manager dealt with these immediately, she audited the medication concerned and confirmed that this indicated that the medication had been offered. The manager was able to identify the member of staff who had not signed the record and agreed to investigate this further. We looked at the way in which medication was distributed and this appeared satisfactory in that the person administering medication made sure that it was taken before moving on to the next person. Pictures had been placed on the medication administration record sheets (MARS) to assist with identification. The manager confirmed that all the staff responsible for administering medication had completed relevant training. And we were presented with certificates to verify this. The training has been updated and provided by Oldham Metropolitan Borough Council (OMBC) since the previous inspection. The medication file also contained a copy of the Commission for Social Care Inspection pharmacy guidelines, the manager stated that these would be replaced by CQC guidelines in due course. Staff who were spoken to said Everyday we have a session about the daily routine and its always a learning process. Care Homes for Older People Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Chamber Mount benefit from being able to make choices about their lifestyle, and their cultural, dietary, social, educational and recreational activities are meet by the services offered at the home. Evidence: We noted that the activities calender and individual records confirmed that people at Chamber Mount were able to join in with group and individual activities when they wanted. And we assessed that activities were varied and in sufficient frequency to help people to remain stimulated and interested in the life and so promote their emotional and psychological wellbeing. The activities we observed during the inspection included people reading current news papers and books, people having discussions, completing arts and craft projects and manipulating light and sound therapy balls. There were pictures of people baking and decorating cakes and making pancakes. Pictures also showed people celebrating birthdays. We saw people who lived at the home looking at these photographs and enjoying the memory of the activity. We were told that routines in the home were flexible and there were no restrictions on visiting and people are supported to make Care Homes for Older People Page 16 of 28 Evidence: choices about their lifestyle. People said: Theres no problem with visiting but they try not to come during mealtimes- but everyone who comes is very welcome. And People please themselves what they do. We found that people are able to participate in acts of worship as religious minister visits the home on a monthly basis. We looked at the menu and found that the meals provided were varied, met the cultural needs of the people living at Chamber Mount and were nourishing. The lunch time meal on the day of inspection was lamb chops creamed potatoes and vegetables, followed by rhubarb crumble. The meal looked appetising and people enjoyed it. The teatime meal was soup and sandwiches or chicken nuggets and chips. We found that there was ample staff on duty to support people appropriately at mealtimes and that people were able to eat at their own pace and meal time was calm and unhurried. We found through looking at weight charts and nutritional assessments that effective steps are taken to support people in maintaining a healthy weight. There was clear evidence that quick action is taken if weight loss is noted. We found that people were very satisfied with the lifestyle they live at Chamber Mount. They said We like the atmosphere its home away from home. Care Homes for Older People Page 17 of 28 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 at Chamber Mount have their rights and wellbeing promoted as they are informed about the complaints procedure and robust adult protection training and guidelines are in place for staff. Evidence: We read through the complaints procedure and found that this provides clear information about how to make a complaint or comment about the home. We noted a copy of the procedure in each bedroom. Staff who returned surveys confirmed to us that they understood about advocacy, concerns and complaints. One person wrote I would speak to my manager or Mr and Mrs Knight (registered providers). We were told by residents and their representatives that the manager, owners and care staff were approachable and people were confident that their concerns and complaints would be dealt with quickly and fairly. People told us: The manager and owners are approachable if you mention something it will be sorted and they have a complaints procedure. We examined the complaints record and found that the home had not recorded any Care Homes for Older People Page 18 of 28 Evidence: official complaints since the previous inspection. We were told by the manager that no official complaints had been received. We discussed the need to keep a record of comments and concerns as this will demonstrate that these are dealt with fairly and openly. However there was every indication from what we were told by people, and the outcome of the home quality assurance process, that this was the case. We saw certificates that confirmed that the majority of staff have received adult protection training since the previous inspection. We noted that supervision records confirmed that Protection of Vulnerable Adults (POVA) issues was discussed as part of the core values of working at Chamber Mount. We interviewed members of staff and found that although this issue had been highlighted during supervising one person remained unclear about their responsibility in this area. It was clear from discussion with the manager that she was aware of this and planned to go over this matter again with this member of staff. Otherwise we found that staff who were interviewed were clear about behaviours and actions that were abusive and how to prevent and report concerns. Staff told us: We are given lots of advice about how to communicate for example read body language and learn what behaviours mean. Its important that service users feel safe. We found that there is a protected disclosure or whistle blowing policy and the manager stated, that this is highlighted during the induction of new staff. We were told that no adult safeguarding investigations had taken place in the home since the previous inspection. Care Homes for Older People Page 19 of 28 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 physical design and layout of Chamber Mount promotes the safety and independence of people in the home. Evidence: We conducted a tour of the home and all the communal and private areas were clean and free from unpleasant smells. We saw that some of the bedrooms have been redecorated and new bedding and curtains purchased. The rooms are tastefully decorated and homely. The hallway has also been redecorated. We noted that the furniture, fixtures and fittings in the home were clean, free from stains and pleasant to use. The lounge areas were homely and books, magazines and newspapers left out for people to pick up as they wanted. We saw that people had been supported to personalise their rooms with their own furniture, ornaments, pictures and photographs. We were told by the manager that the refurbishment program will continue until all the rooms have been redecorated and the carpets replaced. We observed people using handrails and ramps as they moved around the home. Care Homes for Older People Page 20 of 28 Evidence: We noted that staff used moving and handling equipment correctly and in keeping with the instructions in peoples risk assessments and care plans. We noted that the bathrooms, toilets and shower areas were clean, warm and easy to access. People we talked to told us that a good thing about Chamber Mount is that it is Cosy and homely and clean and fresh. There are a high proportion of shared bedrooms and no en-suite facilities at Chamber Mount. Although people were content with the facilities they are limited in terms of best practise in relation to the Care Standard Act 2000 National minimum standard. Care Homes for Older People Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Chamber Mount benefit from skilled staff, who are available in sufficient numbers to provide good care and enable the smooth running of the home. Evidence: We found on the day of inspection there were 23 people living at Chamber Mount and the manager, three care-staff, the cook, domestic staff and the two owners, working at the home. We discussed the deployment of staff and the manager informed us that since the previous inspection there had been a change in the shift pattern for staff so that there is more of an overlap between shifts at the busiest times of the day. We observed staff interaction and we found that this change improved the way in which staff met peoples health and social care needs. We found that staff felt that there was almost always sufficient staff on duty. One person commented We have changed shift patterns and it is working very well. We looked at the staff files and found that the recruitment and selection process was effective. Each file contained a Protection of Vulnerable Adult (POVA) first check, a Criminal Record Bureaux (CRB) check and two references. People also confirmed to us Care Homes for Older People Page 22 of 28 Evidence: that the recruiting process was robust and that they did not start working in the home until the necessary checks had been completed. One person said: I had a CRB and POVA before I started. We found that staff received excellent opportunities to participate in induction and training. We found that the training prepared them for their jobs and kept them up to date with new ways of working. We found that there is a rolling programme of training and in the past year this has included moving and handling; nutritional support management; induction into care; first aid; stroke awareness; tissue viability; optical awareness; Protection of Vulnerable Adults (POVA); health and safety; infection control; medication and diabetes training. The manager informed us that all care staff have achieved National Vocational Qualification (NVQ) in Care level 2 and that the majority had also gained NVQ level 3 in Care. We received surveys from staff and they were pleased with the training and support provided at Chamber Mount. Comments from staff included: I had an induction which included been shown all the emergency procedures, reading the homes policies and about all the residents.; Staff are sent to training and refresher when needed. and There is training for staff new courses and refreshers and we get help to gain qualifications. Care Homes for Older People Page 23 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living at Chamber Mount because the service is run by, a manager who is fit to be in charge and effective in promoting people safety and bringing about positive changes. Evidence: We found that the manager continues to attend courses and management meetings that keep her updated with new policies and new ways of working. She also continues to work closely with Oldham Social Services training partnership to ensure that staff have access to their training calender. We found through supervision records and comments from staff that the manager is knowledgeable and supportive so that they receive appropriate information and guidance to do their jobs well. People told us: Supervision is done regularly by the manager and allows staff to improve. Care Homes for Older People Page 24 of 28 Evidence: We looked at the quality assurance questionnaires, these showed that people were satisfied with the running of the home. And the manager stated the change to the shift patterns worked by staff had been in response to the findings of the previous Care Standard 2000 inspection and the outcome of the homes quality assurance monitoring. We conducted a random check of the money kept in the home on behalf of the residents. We found that two of the three amounts checked did not quite tally. The manager stated that all transactions was evidenced though invoices and receipts. She also said that one of the registered providers audited the amounts on a monthly basis. As a result of the minor discrepancies identified at the inspection the manager should consider increasing the regularity of the audit so that disparities are discovered quickly. The registered manager provided us with information in the AQAA confirming that all equipment and services were maintained and checked in accordance with the recommendation of manufacturer or relevant regulating body. We were able to confirm this through maintenance records and reports when we visited the home. We looked at the accident records and we found that all falls and incidents had been fully document and dealt with appropriately. For example emergency medical services sought and additional input from specialist services such as the falls prevention team. We assessed that outcomes could be improved in this area if falls were analysed so that any common features can be identified and dealt with. We noted throughout the day that infection control best practise was observed and posters promoting safe working practises and infection control were seen the bathroom and toilet areas. Care Homes for Older People Page 25 of 28 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 28 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 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 9 The registered person should ensure that staff use the agreed codes when administering medication so that it is possible to confirm that medication has been offered or administered. The registered person should consider increasing the frequency of auditing service users money so that discrepancies are found and dealt with quickly which means that it will be easier to identify how an error has occurred. The registered person should analyse the accident records so that any common risk factors can be identified and dealt with so that falls and accidents can be reduced if possible. 2 35 3 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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