Care Home: Cherry Orchard

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What the care home does well Generally the home was found clean warm and residents were found relaxed and some were seen accessing the communal area without restriction. Staff were noted interacting with the residents in informal and sensitive manner. A Comprehensive service users guide is given to prospective residents to enable them to make an informed choice about living at Cherry Orchard. Prospective residents are informed on admission of a one-month trial to enable them to make an informed decision whether to stay. Good meals are provided for the residents and staff ensure that meals are not hurried and residents who have difficulties are assisted in a respectful, sensitive and dignified manner. A robust complaint procedure is in place and all complaints are investigated properly and action taken where required. There are ongoing training courses to enable staff to meet individual residents needs and ensure residents are protected from harm and abuse. What has improved since the last inspection? The home manager told us that the health and safety policy has been reviewed to ensure that the residents are adequately protected. The home stated in the Annual Quality Assurance Assessment (AQAA) that staff have gained better understanding of issues in regards to protecting vulnerable adults. The AQAA also stated that medication policy has been reviewed and all staff responsible for administrating medication have attended training to update their knowledge. What the care home could do better: Whilst generic risk assessments were undertaken, in different areas of the home, it was agreed that the risk assessments should include the lounges and bedrooms. To ensure that care needs of identified service users are met it would be better to provide appropriate care plans for identified needs and to provide adequate protection. We recieved copies of satisfactory care plans in relation to the identied needs before this report was completed however the requirement remains in place to enable us to monitor the effectiveness of the care plans in our next visit in relation to meeting those needs It could be better if there are risk assessments in place following accidents to service users to minimise falls. The home sent us a satisfactory copy of risk assessments in relation to preventing further falls and for reasons mentioned above the requirementremains in place. All handwritten additions to the Medicines Administration Record Sheets(MARS) must be signed and dated and checked by a second person. This is to reduce the risks of mistakes being made which could lead to medicines being given incorrectly. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cherry Orchard Cherry Avenue Clevedon North Somerset BS21 6HT     The quality rating for this care home is:   two star good 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: Grace Agu     Date: 1 3 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Cherry Orchard Cherry Avenue Clevedon North Somerset BS21 6HT 01275875418 01275349173 cherryorchard@shaw.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shaw Healthcare (North Somerset) Ltd care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate up to 36 persons aged 65 years and over requiring personal care only. Date of last inspection Brief description of the care home Cherry Orchard is a care home offering residential, respite and day care to older people in the Clevedon area. It is well sited in the community for local amenities and is also well known by local residents. The home offers single bedrooms over two floors. The upper floor is accessed via a passenger lift. There are a number of communal spaces including a large dining area and lounge with additional smaller lounges situated throughout the building. 0 Over 65 36 Care Homes for Older People Page 4 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that took place over eight hours to review the requirements made at the last inspection and also the care practices to ensure that they are in line with the legislation and that current good practice is followed at the home. At the last inspection, three requirements and one recommendation were made in relation to different areas of service provision at the home. It was pleasing to note that the home had made considerable effort to ensure all the requirements had been met and the recommendations had been considered. This is commendable. We met with the Home manager Mrs Sara House, the home admiinistrator spoke with Care Homes for Older People Page 5 of 28 eight residents on the day. We also had an opportunity to speak with five staff members. A tour of the building was undertaken and a number of records were reviewed. What the care home does well: What has improved since the last inspection? What they could do better: Whilst generic risk assessments were undertaken, in different areas of the home, it was agreed that the risk assessments should include the lounges and bedrooms. To ensure that care needs of identified service users are met it would be better to provide appropriate care plans for identified needs and to provide adequate protection. We recieved copies of satisfactory care plans in relation to the identied needs before this report was completed however the requirement remains in place to enable us to monitor the effectiveness of the care plans in our next visit in relation to meeting those needs It could be better if there are risk assessments in place following accidents to service users to minimise falls. The home sent us a satisfactory copy of risk assessments in relation to preventing further falls and for reasons mentioned above the requirement Care Homes for Older People Page 7 of 28 remains in place. All handwritten additions to the Medicines Administration Record Sheets(MARS) must be signed and dated and checked by a second person. This is to reduce the risks of mistakes being made which could lead to medicines being given incorrectly. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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. The process of admission of prospective residents is comprehensive, detailed and well planed to enable the resident to make a positive choice of moving to the home with the assurance that their needs will be met. Evidence: The home has a Service Users Guide that is given to prospective residents and their relatives or representatives when they visit the home to enable them to make an informed choice about moving to the home. The care file of a recently admitted resident showed that the resident was assessed before being admitted to the home. Some of the information noted in the care file included, Activities of Daily Living, and other relevant information to enable staff to meet the residents needs. Care Homes for Older People Page 10 of 28 Evidence: There is evidence of one -month trial to enable the resident to decide to stay. One resident stated I came here for one month trial and chose to stay because the place is good. Individual contracts are provided to self-funded and local authority funded residents. Care Homes for Older People Page 11 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. The home offers care and support to residents throughout their life and towards the end it provides appropriate care plans to meet the needs of residents. The process of medicine administration, recording and disposal is satisfactory. Evidence: On the day of site visit two care files were reviewed. There was evidence of preadmission assessment before admission of one new resident to the home. This assessment was to determine whether the home is suitable and able to meet residents needs.The residents are reassessed on admission before care plans are provided detailing how the assessed needs are to be met. This is followed up by monthly reviews and intervention as needs change. However, we noted that one individual with short term memory and speech difficulties had no care plans in place to support staff in order to provide appropriate care for the resident. Care Homes for Older People Page 12 of 28 Evidence: The home has completed care plans for the identified needs and the copies sent to the Commission for Social Care Inspection are satisfactory. The requirement we issued remains in place to enable us to monitor the effectiveness of the care plan. In regard to how residents perceive their care at the home, one resident stated, I am happy here, the girls are very kind, they look after me well. I get up when I like and I go to bed when I like. Another resident stated, staff are very kind, they dont bother you here you go to bed and get up when you like. Another resident stated Staff are caring and I have always been well cared for over the years. Staff were noted knocking on the doors before going in to the residents rooms to assist them with personal care. The care files viewed had evidence of visits from the health professionals to include General Practitioners (GP), Chiropodists, Opticians and Dentists. Medication administration was reviewed and we noted that the medicine policy was in place, there was evidence of receipt and disposal of medication, Controlled drugs were properly recorded and signed by two staff members and balance was correct. Risk assessments were found when a risk had been identified, and showed how staff should manage the risk. For example one resident is responsible for taking her own medication, a risk assessment was in place to identify the risk and policies put in place, such as resident locks medication away in the drawer in theeir bedroom. The last inspection visit from the supplying pharmacist was on 13th October 2008. All issues identified had been remedied by the home. The requirement made at the last inspection in relation to medication was met, however noted that some hand written medication on the Medication Administration Record Sheet (MARS) were not signed and dated after alteration by the individual making the entry to prevent medication errors. Furthermore some medication had as directed labels. This has the potential to cause medication error due to lack of specific instruction. It was agreed that the home contact the General Practitioner and the supplying pharmacist to remedy the situation in order to protect the residents. The home sent us a Notification (Regulation 37) in regards to serious injury sustained following accident to an individual on 23/07/08. We looked at the persons care file at this inspection and we noted that the individual also had another fall on 28/09/08 and knocked their nose on the shelf in the bedroom. We noted that there was no risk assessment in relation to preventing falls/further falls and no specific care plan in place Care Homes for Older People Page 13 of 28 Evidence: to support staff in providing appropriate care to this individual. Whislt the home sent us copies of the risk assessment put in place after the inspection and we find them satisfactory, the requrement we issued remains in place to enable us to monitor the effectiveness at the next visit. We have issued a requirement to ensure that this happened. The home sent us satisfactory documentation in relation to the above requirements before this report was completed. One Staff member spoken with was aware of measures to be taken if a resident became terminally ill and in the event of death. The individual explained that family and friends are involved and supported throughout this time, all staff are made aware of the situation, and treat the resident and family with care, sensitivity and respect. However we noted that an individual that recently lost a relative had no care plan in place to enable staff to support the persons low mood during the period of bereavement. We have issued a requirement for the the home to put in place a care plan detailing how staff are to support this person in dealing with their grief. We recieved a satisfactory care plan documentation from the home in relation to the above need before this report was completed. Staff also demonstrated awareness of the importance of ensuring that information about residents is kept confidential. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with meaningful activities and are encouraged to mantain contact with families and friends. Nutritious diet is provided at the home. Evidence: On the day of the visit several residents were having their hair done, residents clearly appeared to enjoy this activity and found it reassuring and calming. Music was being played in the lounge during the afternoon. One resident commented that she enjoyed her knitting, and she also likes to sit in the lounge to chat with her friend. The visitors book showed that the relatives and representatives regularly visit the residents. Residents spoken with confirmed that they had regular visitors. One resident spoken with said that the relatives visit every weekend. Another resident told us that her daughter and granddaughter also comes to see her. The AQAA states that residents are encouraged to make choices on how they spend their day and what time to get up and retire. Residents are given opportunities to participate in activities organised by the home and Care Homes for Older People Page 15 of 28 Evidence: attend community-based groups.The activities programme was examined and activities noted included games of Bingo, Keep fit, manicures, board games and armchair exercises and arts and craft. There is also monthly planned external entertainment, and weekly church service and monthly Holy Communion service. One resident told us that those who prefer not to participate in any of the activities organised at the home are seen on a one to one basis by staff. Evidence from the activities record shows that care staff are currently providing activities for the residents and at a discussion staff stated that this arrangement sometimes leaves them with limited time to spend with the residents in terms of presonal care. The manager stated that the home is actively looking to recruit an activities coordinator to organise more activities for the residents and to relieve care staff from the responsibility in order to spend more quality time with the residents. This will be the focus of our next inspection. During the inspection, a cooked lunch was prepared for residents. Most residents were assisted to sit at tables in the dining area, and seem to enjoy the social event. The residents had a choice of either Cottage Pie or Bubble and Squeak served with potatoes, carrots and broccoli followed by a bread and butter pudding with custard. The meal was well presented and looked appealing. Some residents were assisted with their food; this was done sensitively by the staff and showed respect for residents dignity. Some residents were assisted to eat in their bedrooms by individual staff as they preferred. The kitchen was found clean; there was a cleaning schedule in place. The pantry was full of dry foods, and very well stocked with good brand names and a good selection of fresh food available. The fridge and freezers temperatures were recorded daily in a log record. Food in the fridge was covered and dated to reduce risk of serving out of date food to residents. The home was recently inspected by the North Somerset Council Environmental Services and was given a five star rating on food safety. There was a kitchen risk assessment in place. All staff working in the Kitchen have attended Basic Food Hygiene updates. Their certificates were displayed in the kitchen area. Care Homes for Older People Page 16 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. Residents have access to a complaint process and steps have been taken to protect them by training most staff in protection of vulnerable adults from abuse. Evidence: The home has appropriate procedures in place for the management of any complaint at the home. There was no recorded complaint and no complaint had been received at the Commission for Social Care inspection. Residents we spoke with told us that they have no complaint. One comment we received from a resident before the visit was I hardly have a cause to complain but if I do it is always dealt with. Another comment was To date I have not needed to complain about anything, as I am looked after very well indeed. There is evidence that staff have attended Protection of Vulnerable Adults from abuse training and has Protection of Vulnerable Adults policy; there was evidence of the North Somerset Council document on how to report incidents of suspected abuse. The manager demonstrated knowledge of the procedure for reporting incidents of abuse if they occur. Staff are aware of the Whistle Blowing Policy and are able to report incidents of abuse. without fear of reprisal. Two staff members stated that they would report any bad practice or suspected abuse even if it was their very close friend. Care Homes for Older People Page 17 of 28 Evidence: Evidence from the most recently employed staff files showed that an appropriate recruitment procedure was followed to ensure that residents are adequately protected. Care Homes for Older People Page 18 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 residents enjoy a clean, hygiene and pleasant home; however, the home fails to provide them with safe and well-maintained environment. Evidence: Cherry Orchard is a care home offering residential, respite and day care to older people in the Clevedon area. It is well sited in the community for local amenities and is also well known by local residents.The home offers single bedrooms over two floors. The upper floor is accessed via a passenger lift. There are a number of communal spaces including a large dining area and lounge with additional smaller lounges situated throughout the building. The home remains suitable for the stated purpose of the provision of care for the individuals living there. Generally the environment was found to be homely, warm, well lit and free from offensive odours. People who use the service were noted to be relaxed and were enjoying the company of each other and staff members. We sent out questionnaires to the people who live at the home to tell us how the feel about the services that they receive regarding the environment. These are some of the comments that they made: Hygiene in the home Care Homes for Older People Page 19 of 28 Evidence: is excellent and my room is well maintained and I have my personal possessions with me which I keep clean and tidy. Whilst the general environment was found clean we also noted that the walls on the corridors and doors were looking tired with some minor sharp edges due to scratches created by residents wheelchairs and in need of redecoration to provide the residents with a more comfortable environment. This was also confirmed in the AQAA sent ot us by the home. We have issued a requirement in relation to the above observation to enable the Commission to monitor the homes action plan. One ressident met in the bedroom told us that the hot water tap in the persons bedroom was lukewarm and the person has to wait for a long period before washing and dressing. This was comfirmed when we tested the hot water tap in the persons and another residents bedroom. The manager stated at a discussion the maintenance person would check those taps in order to remedy the situation. The home told us in the Annual Quality Assurance Assessment (AQAA) that negotiations have commenced between Shaw Healthcare and the local Authority (North Somerset) regarding a possible refurbishment of Cherry Orchard. We noted however while touring the building that six bedrooms on the ground floor have been redecorated. The laundry area was found clean and tidy. Staff interviewed were aware of infection control and where and when to access the policy when necessary. The homes infection control policy and procedure was satisfactory. The home has recently installed a mechanical bedpan washer for a better hygienic environment and infection control. Staff are also aware of how to seek assistance in event of spillages and chemical emergencies. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents enjoy a good, warm relationship with competent staff. The homes recruitment procedures offer protection to residents. There are adequate numbers of staff to meet the needs of the residents. Evidence: Staffing levels were found to be satisfactory on the day of inspection. For example on the day of inspection there was three support workers 7.30am to 3pm and one Team Leader 7.30am to 3pm. There were also three care assistants from 2.30pm to 10 pm and one Team Leader from 2.30am to 10pm. Three support worker from 9pm to 9.45 pm to 07.45 am on the rota. The home also employs an Administrative assistant 20 hours a week to support the manager. There is one cook 7am - 2pm and a kitchen assistant from 730 to 8pm. There is also a handyman who ensures ongoing refurbishment in the home. Residents spoken with on the day stated that they were satisfied with the numbers of staff on each shift, feel safe and that the services provided by staff are good. However some staff members told us increasing the staffing levels would enable them to spend more time with the residents whilst providing personal care and at other times when required by the residents. Care Homes for Older People Page 21 of 28 Evidence: Staff spoken with confirmed that they have received supervision and that they benefited from the exercise. It afforded them the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to residents care. Discussion with the manager and evidence from the records viewed showed that staff have received supervision. Staff were noted knocking at the doors and waiting before assisting residents with personal care. House keeping staff were also noted working together as a team. There is good team building at the home; this had contributed to continuity of care for the residents and less staff turnover. One staff spoken with states that Every one generally work together we make a good team. Evidence showed that the home is committed to ensuring that staff are appropriately trained to provide good standards of care for the residents. Staff spoken with stated that they attended various training courses to include abuse training food hygiene, manual handling and fire safety. Evidence from staff record and discussion with manager show that three staff have been booked to attend infection control and health and safety updates on 8/12/08. The staff training records that we rerviewed showed that fourteen care staff have achieved National Vocational Qualification (NVQ) at level 2 and all Team Leaders have NVQ level 3. The manager has NVQ level 4 and Registered Managers Award. The home a robust recruitment procedure to ensure that suitable staff are recruited to meet residents needs and to ensure that residents are adequately protected.The records of two recently recruited staff members contained required information to include personal details, previous employment details, two satisfactory references, Criminal Record Bureau (CRB) disclosures and relevant qualifications. The manager stated that new staff members are assigned a mentor on commencement of employment and are supernumeray initially shadowing an experienced staff member. Inductions are held regularly and staff attend the first one available after commencement. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care. Health and safety issues are monitored in the home are always addressed in a timely way for the protection and safety of residents. Evidence: The manager is well qualified and gives clear leadership; guidance and direction to staff to ensure residents receive consistent care. Residents feel she is approachable and seeks to ensure all their needs are met. One resident said she cant do enough, Sara is very good she is really easy to talk to. Ms Sara Jane House has managed Cherry Orchard Care Home for many years. Ms House has a Certificate of Management Studies (CMS) and also a National vocational Qualification (NVQ) Level 4 in Care Management. We looked at residents monies held by the home for resident. Two records were Care Homes for Older People Page 23 of 28 Evidence: inspected and both tallied. The manager stated that some residents look after their own money and that she is an appointee to five residents because the individuals have no relatives to perform that role. All entries are supported by one signature for any transactions. All monies in the safe are checked on a weekly basis and the key to the safe is handed over to the Team Leader on each shift. The manager told us that the home has a formal quality assurance system which include the manager carrying out regular audits in the home for the safety of residents. Such audits includes medication, infection control, environmental and catering audits. Other tools used include an annual survey of residents and their relatives to provide opportunity for them to have their say and contribute to the running of the home. eve Relatives and advocates are invited to social events in order to foster relationships and trust. The home also uses care planning reviewing processes, residents meetings, staff meetings, policies and procedure reviews, staff supervision as a form of monitoring the satisfaction of its services. The homes records are stored securely and used in accordance with the Data Protection Act 1998. Records are accurately maintained and up to date to enhance the effective and efficient running of the home. Records were available to show that regular safety and fire checks are carried out. Certificates of safety checks, servicing of equipment and other required safety inspections were seen. Some of the certificates include emergency call equipment; portable electrical equipment, heating system and gas appliances were all in date to ensure that residents are not put at risk. We noted that generic risk assessments were undertaken in different areas of the home, however it was agreed that the risk assessments should include the dining and bedrooms to ensure potential hazards are eliminated to minimise/prevent accidents to residents. For example a recent fall where a resident knocked the nose on their shelf in the bedroom. The fire logbook was viewed and is well maintained. Staff have attended fire lectures also regular fire drills to ensure that staff are aware of action to be taken in the event of actual fire emergency. Care Homes for Older People Page 24 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 25 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 1 7 15 Ensure care plans are in place for identified individuals To ensure that needs are met 30/12/2008 2 8 13 Ensure risk assessment is in place and revieviewd after falls To protect the residents from injuries. 30/12/2008 3 9 13 Ensure all hand written entries on MARS are signed and dated. To protect the residents from medication errors 30/12/2008 4 19 23 Refurbish identified areas at the home To provide a comfortable environment 18/03/2009 5 38 13 Ensure generic risk assessment includes the bedrooms. 30/12/2008 Care Homes for Older People Page 26 of 28 To minimise/prevent falls to residents Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) 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. 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