Care Home: Cherry Tree House

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What the care home does well People had their needs assessed prior to admission to the home. Care plans were usually completed and staff were provided with this information so that they were aware of the care people required. The home ensured that people were able to make choices about most aspects of their lives and provided flexible routines. Staff turnover in the home is low and there was a core group of staff that had worked at the home for several years and knew people well. Training for the staff was given on a regular basis and care staff had had a wide variety of training to help them do their job safely. Medication was well managed and all staff that administered it had received training. People were able to complain about services and were protected from abuse by staff who had knowledge of policies and procedures and had received regular adult protection training. The home was very clean and tidy and had recently been refurbished throughout. The home had a friendly and homely feel and there were lots of different areas for people to sit. The home had good procedures in place for recruiting new staff members and they kept clear recruitment records. What has improved since the last inspection? There was evidence that the care plans were checked to make sure that they were still relevant and they had been updated as necessary. However this process could be improved . (see below) People spoken with confirmed that the heating in their rooms now worked satisfactorily and stated they could choose the temperature to suit themselves. Staff had received training and there was improved forward planning to ensure that refresher training was provided as due. The quality monitoring processes had been reintroduced although these had not had the desired effect of improving quality in some areas, for example people were not happy with the quality of the food provided. What the care home could do better: Generally the care plans reflected peoples needs but specific areas relating to the care those who were at risk of pressure sores had not been developed. Evaluation of the care plans should take into account monitoring records to ensure that all the information about peoples health and wellbeing has been considered in assessing if the care plan is meeting peoples needs. The activities programme had not been maintained at the level seen at the last inspection. The activities programme should be extended and improved in consultation with people who live in the home. People were not happy about the quality of the meals provided. There should be discussion with people living in the home about the quality of the food and how this can be improved. Action should be taken to make the required improvements. People were able to complain about services and were protected from abuse. However some complaints were not dealt with by the company in a timely manner where senior management and financial input was required. People living in the home, staff and visitors felt there was not always sufficient staff on duty. There was no evidence in the home that staffing levels were determined using the recognised guidance. Staffing levels must be provided at sufficient levels to ensure peoples needs can be met. They must improve processes to remedy equipment faults noted at fire safety checks to protect the health and safety of the people living in the home in the event of a fire. They must ensure that issues with the hot water system are addressed to ensure peoples comfort. Key inspection report Care homes for older people Name: Address: Cherry Tree House Collum Avenue Ashby Scunthorpe North Lincolnshire DN16 1TF     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: Kate Emmerson     Date: 0 5 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Cherry Tree House Collum Avenue Ashby Scunthorpe North Lincolnshire DN16 1TF 01724867879 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Barton Medical Services Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP and Dementia - Code DE(E) Date of last inspection Brief description of the care home Cherry Tree House is situated in the Ashby area of Scunthorpe close to local shops and amenities. The home is registered to provide care and accommodation for up to thirty-four older people with a broad range of needs and people who may have needs associated with dementia. In addition they provide a day care service for up to five people per day. District nurses attend to those people who require day to day nursing support. Care Homes for Older People Page 4 of 29 0 5 1 1 2 0 0 8 0 0 Over 65 20 34 Brief description of the care home The home has two floors serviced by both stairs and a passenger lift. The home has four lounges, two quiet rooms and two dining rooms. All bedrooms are single occupancy although none have en-suite facilities. The home is divided into four units, each with two toilets and either a bathroom and/or a shower room. The garden has a secured lawned area with seating and a patio is accessible from one of the dining rooms. There is ample car parking facilities for visitors. According to information received from the home their weekly fees are £374.42 to £415.65. There is a top up of £29.80 for those funded by the Local Authority. Items not included in the fee are toiletries, hairdressing and chiropody. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place over one day in November 2009. Throughout the day we spoke to people who lived in the home to gain a picture of what life was like at Cherry Tree House. We also had discussions with the manager and care staff . We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. We also examined records including those relating to medication, complaints , staff, how the home monitored the quality of the service it provided and how the home was managed overall. Prior to the visit to the home the inspector had sent out a selection of surveys to people living in the home and a selection of staff members. These were checked and Care Homes for Older People Page 6 of 29 comments are used throughout the report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Generally the care plans reflected peoples needs but specific areas relating to the care those who were at risk of pressure sores had not been developed. Evaluation of the care plans should take into account monitoring records to ensure that all the information about peoples health and wellbeing has been considered in assessing if the care plan is meeting peoples needs. Care Homes for Older People Page 8 of 29 The activities programme had not been maintained at the level seen at the last inspection. The activities programme should be extended and improved in consultation with people who live in the home. People were not happy about the quality of the meals provided. There should be discussion with people living in the home about the quality of the food and how this can be improved. Action should be taken to make the required improvements. People were able to complain about services and were protected from abuse. However some complaints were not dealt with by the company in a timely manner where senior management and financial input was required. People living in the home, staff and visitors felt there was not always sufficient staff on duty. There was no evidence in the home that staffing levels were determined using the recognised guidance. Staffing levels must be provided at sufficient levels to ensure peoples needs can be met. They must improve processes to remedy equipment faults noted at fire safety checks to protect the health and safety of the people living in the home in the event of a fire. They must ensure that issues with the hot water system are addressed to ensure peoples comfort. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were assessed and they were assured their needs could be met prior to admission. The home does not provide intermediate care. Evidence: Three care files were examined. Assessments had been completed and these detailed peoples needs and their preferred daily routines. Where people were funded by the Local Authority they had also obtained the authorities assessments and care plans. Surveys confirmed that staff were provided with information about peoples needs which enabled them to care for people appropriately. There was evidence that the home formally wrote to people who wished to live in the home or their representatives following assessment to inform them they were able to meet their needs and a contract stating the terms and conditions of admission was Care Homes for Older People Page 11 of 29 Evidence: provided on admission. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflected peoples health and personal care needs although these were not evaluated effectively to ensure that the care provided continued to meet needs. People living in the home did not feel that their needs were always met due to insufficient staffing levels. Medication was well managed. People felt that their privacy and dignity was protected. Evidence: Seven care files were examined during the inspection. All but one person had had a care plan developed by the home from the information gathered at assessment. The other person had been admitted for respite care and the staff were working from the information gathered at assessment and the care management care plan. It is recommended that the home develop their own care plans for all people admitted to the home to ensure a detailed record of care requirements is available for staff. The care plans were detailed in terms of the care people required and associated risks had been identified. Care Homes for Older People Page 13 of 29 Evidence: There was evidence from staff and diary records that care was being provided to minimise the risk of people developing pressure sores and the manger stated that no one had developed a pressure sore in their care. The care plans could be further improved by ensuring that where people were identified as at risk of pressure sores specific care plans to minimise risk are developed. This would ensure that this area was specifically monitored and the care regularly evaluated. There was evidence that a system to evaluate the care plans had been implemented and care plans had been updated as required. However there was only one written evaluation record in most files as the systems for creating the typed evaluation record were protracted. This meant that as the next evaluation was due, the staff would not have the previous months record to compare with to ensure that the care provided was being effective in meeting peoples needs. There was also some evidence that the process of evaluation was not as effective as it could in monitoring care and the quality of the care plans. It was noted that bowel monitoring charts had not been completed on a consistent basis and this had not been identified in any evaluation. This means that people may not have received treatment in a timely manner should it have been required. On our surveys people were asked if they received the care and support they needed. Of the twelve people who responded two answered always, six answered usually and four sometimes. There were written comments in the surveys from five people stating they would like to see more staff. One person said they could improve on answering the buzzer and it would appear that cigarette breaks take precedence over residents toilet needs when the manager is away. This means that there may not always be sufficient staff on duty to meet everybodys needs in a timely manner or the staff are not sufficiently well organised to ensure cover over staff breaks. (See standard 27) Medication records were examined. Records were well maintained. Information regarding medications were available for the staff and where changes had been made to peoples medication these had been recorded in detail. Regular medication audits were completed by the area manager. Staff responsible for medications had received refresher training in this area since the last inspection. Care records identified how people could maintain independence within their own limits and how privacy and dignity was to be maintained. People spoken with stated that their privacy and dignity was maintained by the staff when they were being assisted with personal care tasks. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home ensured that people were able to make choices about most aspects of their lives and provided flexible routines. People felt that the activity programme and food quality had deteriorated since the last inspection. Evidence: There was evidence that the homes activities programme not been as extensive as at the previous inspection. Comments from people living in the home included the entertainment could be better, organise some more activities and entertainment to relieve the boredom, take residents out and social activities could be better. The home employed a carer to organise activities but she also had other tasks within her role such as assessing potential residents and organising meetings. She thought that the activities could be improved and she had joined a group to get fresh ideas for extending the activity programme. Care plans included peoples likes and dislikes and social needs, they also acknowledged peoples need to maintain contact with friends and relatives. People spoken to confirmed that their relatives were able to visit at any time and were made welcome. There was evidence that the home supported people to maintain Care Homes for Older People Page 15 of 29 Evidence: relationships and the home arranged events to celebrate special occasions such as birthdays. People confirmed that their preferred routines were generally catered for. Comments included I can get up and go to bed when I want. Although this didnt seem to extend to having a bath. One person said I do not always get two baths a week and sometimes its more than seven days between. This may be attributed to the inconsistent provision of hot water in the home. The many comments received about this included there is something wrong with the hot water system, staff sometimes have to carry buckets to fill the bath. The menus were six-weekly rotating and offered variety and choice at each meal including a full English breakfast everyday. Comments about the food indicated that the quality of the food had deteriorated since the last inspection and included the fresh bread and tea cakes are hard and stale looking, need sharper knives to cut food, wider range of vegetables - greens - needed, mainly peas and carrots served or mixed frozen vegetables, the food is not of the best standard, food could be better, the food is not always nice, most meals are cold and they could provide better meals. Other more positive comments included plenty of choice, always offered an alternative and breakfast is the best. The manager stated that they had recently completed an audit on the meals and had received positive feedback. It was recommended that they revisit this and try to focus more on the quality of the meals provided. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to complain about services and were protected from abuse by staff knowledge of policies and procedures and adult protection training. Some complaints were not dealt with in a timely manner by the company where senior management and financial input was required. Evidence: The home had a complaints procedure and this was displayed in the home. Staff members were aware of the procedure and the documentation used to record complaints. Evidence from surveys and discussions with people living in the home indicated that people knew how to complain and would complain if necessary. One person said if there is a problem I go and see the senior or the manager and usually the problem is resolved. The three complaints that the home had received since the last inspection were recorded in detail, one had been upheld and two were ongoing. One of the outstanding complaints was being investigated by the local authorities safeguarding team and included issues regarding the lack of hot water, poor food standards, dirty toilet facilities and unacceptable bedroom facilities during the refurbishment. There was some evidence that, whilst day to day concerns were addressed satisfactorily by the care staff and manager, issues which required financial input and decision making from the Responsible Individual were not being addressed in a timely Care Homes for Older People Page 17 of 29 Evidence: manner. For example we received a number of comments in surveys from both people living in the home and the staff about the ongoing issues with the lack of hot water in the home. These issues had been the source of complaints recorded at the home prior to the last inspection and is currently part of a safeguarding investigation. One person, when answering a survey question, what does the home do well? said make excuses. (see standard 25) The home recorded comments on the care provided and held a number of letters and cards which praised the staff for their care. A suggestions box was provided in the home and there was evidence that any suggestions received were recorded and actioned where appropriate. All staff had received training in safeguarding vulnerable adults since the last inspection. The home had policies and procedures that linked to the multi agency policies and procedures and in discussions staff were aware of what to do if they suspected abuse had occurred. The manager was aware of referral and investigation procedures. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was an ongoing commitment to improve the environment for people but action to address issues with the hot water supply had not been taken in a timely manner. Evidence: The home had undergone major refurbishment since the last inspection and the home now provided a comfortable and homely environment for people. The home had been redecorated, new curtains, carpets and flooring had been fitted, fixtures and fittings had been replaced and new bathrooms and toilets fitted. The home was very clean and tidy throughout. Complaints records, surveys and discussions with people living in the home and staff indicated there there was still an ongoing problem with the supply of hot water. The manager confirmed that this was the case. At the last inspection in 2008 quotes to complete work to rectify the problem had been obtained between July and October 2008 and sent to the providers. At the time of the last inspection the manager was still waiting for a decision on the work to be completed. Following the last inspection the manager provided written confirmation that initial work had been completed and hot water was now available throughout the home. She stated further works were still required but due to the nature of this it would be completed during the summer months of 2009. This work had not been Care Homes for Older People Page 19 of 29 Evidence: completed at this time leading to further complaints which were being investigated by the safeguarding team. People had continued to be admitted into rooms were there was no hot water and where staff were having to carry buckets of hot water for people to get washed or have a bath. It was recommended to the manager that people should not be admitted to areas where there was no hot water. The commissioners who fund placements in the home were also advised of this recommendation. There was some evidence that work to address the hot water issue was underway. Workmen were in the building at the time of the inspection and three people living in the home confirmed that they now had hot water in their bedrooms where they hadnt previously. One said its lovely. During a tour of the building five bedrooms were without hot water and the water in two bathrooms was luke warm. People spoken with confirmed that the heating in their rooms worked satisfactorily and stated they could choose the temperature to suit themselves. However during the tour of the building two people complained of being cold, one person was in their bedroom and one seated in a communal area. In both areas the heating was on but was very low. Blankets were provided and the handy man was requested to turn the heating up. The manager was requested to monitor the temperatures of rooms daily and water temperatures weekly and provide a weekly report to the Commission until further notice. The gardens were very pleasant and well maintained and a sensory garden with wheelchair access had been developed. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by a well trained and appropriately recruited staff team. There may not always be enough staff on duty to meet peoples needs. Evidence: Staffing rotas were examined, these clearly showed who was on duty and any changes to the tota were clearly documented. Staff confirmed that there were four staff and a senior on duty in the morning and three care staff and a senior in the afternoon. There were two staff at night and one sleep-in staff member on call. The manager was supernumerary to the rota. The manager stated that staff at the head office used residential forum guidelines to determine the staffing numbers but there was no documentary evidence of this in the home. This system bases the staffing levels on the dependency of the the people living in the home and should be checked regularly to ensure that staffing levels are appropriate. There were some indications that staffing levels may not always be sufficient. People living in the home and visitors felt that sometimes there were not enough staff on duty. Comments from people living in the home included they could have more staff, I should like to see more staff, the staff work hard but everything is done in a rush, and need more carers. Relatives commented they need more staff, I feel the staff Care Homes for Older People Page 21 of 29 Evidence: are very stretched and could do with more help and have more staff. Of the nine staff that returned a completed survey to us, one answered that there was never enough staff on duty to meet peoples needs, four answered sometimes and three answered usually, one declined to comment. The layout of the building meant that staff had a lot of floor space to cover when supporting people and this should also be taken into account when planning staffing levels. Staff confirmed that staff morale was good and there was a low turnover of staff recorded in the homes Annual Quality Assurance Assessment (AQAA). This means that people are cared for by a consistent group of carers. Three staff files were examined and evidenced good recruitment processes. Files were organised and appropriate references and criminal record bureau checks were in place. A training log showed the training completed and when the renewal date was due. Training consisted of in-house training, distance learning and external facilitators. Service specific training had been accessed by some staff, for example pressure area care. All staff had completed training in safeguarding vulnerable adults and those administering medication had completed an accredited medication course. Mandatory training was up to date regarding fire, moving and handling and adult protection. The manager had received training in train the trainer for moving and handling since the last inspection. Staff confirmed that they received extensive training relevant to their role. The homes Annual Quality Assurance Assessment (AQAA) stated National Vocational Qualification (NVQ) training was progressing and the target of fifty per cent of care staff qualified had been exceeded. The document stated that twenty three of the twenty eight care staff had completed NVQ 2. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality monitoring processes had been improved but the inspection outcomes show that this may not be effective in maintaining the quality of the service. Peoples health and safety with regard to care provision was well managed. Processes to remedy equipment faults noted at fire safety checks were not sufficiently robust which could put the health and safety of the people living in the home at risk in the event of a fire. Evidence: The Registered Manager had completed her Registered Managers Award in May 2005. She had attended training relevant to her role since teh last inspection including train the trainer for moving and handling. This enabled her to ensure that all staff were up to date with training in this area and assisted her in ensuring good practice was maintained. Peoples views about the home had been obtained via the homes quality assurance processes. This consisted of audits completed by various staff members and Care Homes for Older People Page 23 of 29 Evidence: questionnaires sent out to people living in the home, relatives, professional visitors and staff. Action plans had been produced to address shortfalls and staff were informed of the results and the action required to put things right. The manager may need to review some areas following this inspection as it was clear from our surveys and discussions with people that people living in the home were not satisfied with the quality of the meals, the activities provided, the staffing levels and the issues regarding the hot water. The management of finances on behalf of people living in the home were assessed. Clear records were maintained and receipts were held for purchases. Regular audits were completed. Peoples health and safety with regard to care provision was well managed. Care plans included relevant risk assessments and staff had received training to care for people safely. There was evidence that equipment used to move people had been serviced. General environmental risk assessments had been completed and regularly reviewed. Staff fire training and regular fire drills had been completed and there was evidence that a fire risk assessment had been completed and reviewed since the last inspection. Checks of the fire alarm had been completed mostly weekly although on the day of inspection, records showed the weekly alarm test to be overdue, the last test to be recorded was 20 October 2009. Records showed that issues were noted during the fire checks. It was recorded that fire doors mainly closed and the emergency lighting was mostly working. There were no records of any action taken to address these issues and the manager confirmed there were no other records to support any work that had been carried out to address these faults. Faults should have been recorded in the maintenance book. The manager stated she was unaware of the faults and the issues had not been picked up in the Regulation 26 visits carried out by the area manager even though the records had been checked. This meant that the risks from fire in the home were not minimised as far as possible, there is poor communication between staff and management about issues with equipment and there is a lack of effective management monitoring. The manager stated she would review all these processes immediately and ensure that the equipment was tested and any faults attended to on the day of the inspection. Accident records were maintained and audited regularly by the manager and there was generally a low incidence of accidents in the home. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 16 23 Action to address the complaints relating to the lack of hot water in the home must be taken. To ensure that people have access to hot water at all times. 30/01/2010 2 25 23 Hot water close to but not 30/01/2010 exceeding 43 degrees centigrade must be available throughout the home. The providers must provide written details to the Commission that the work has been completed. To ensure the comfort of people living in the home. 3 25 23 To ensure that the 14/12/2009 temperature of the home and hot water is maintained at acceptable levels the manager must monitor the temperatures of rooms daily and water temperatures weekly and provide a weekly Page 26 of 29 Care Homes for Older People 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 report to the Commission. The ensure the comfort of people living in the home. 4 27 18 Staffing levels must be 31/01/2010 provided at sufficient levels to ensure peoples needs can be met. This is to ensure peoples needs are met in a timely manner. 5 38 23 Fire doors and emergency lighting must be maintained in working order. Records of checks and action taken to remedy any faults must be maintained. To ensure the risks in the event of a fire would be minimised in the event of a fire in the home. 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 31/12/2009 1 7 To ensure the care plan is up to date care plans should be evaluated monthly and a written record maintained. Evaluations should take into account monitoring records to ensure that all the information about peoples health and wellbeing has been considered in assessing if the care plan is meeting peoples needs. The home should develop their own care plans for all 2 7 Care Homes for Older People Page 27 of 29 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 people admitted to the home to ensure a detailed record of care requirements is available for staff. 3 8 Where a person is identified as being at risk of pressure sores a specific care plan should be developed to show how risks are to be minimised. The activities programme should be extended and improved in consultation with people who live in the home. There should be discussion with people living in the home about the quality of the food and how this can be improved. Action should be taken to make the required improvements. Evidence of how staffing levels have been determined should be provided to the manager and records kept in the home for inspection. 4 5 12 15 6 27 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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