Care Home: Cleggsworth Care Home Ltd

What the care home does well The staff were seen to be kind and patient with residents and residents spoken to were positive with regard to the skills of the staff.One resident spoken to said,"The staff are very nice and kind and they have a laugh and joke with us".We were also told by a relative that they were very happy with the care(there cared for resident) received at the home and that due to the care of the staff the resident had very quickly settled into the home and was very happy. The home carried out a pre admission assessment before a resident was admitted to the home to make sure that the home can meet the persons needs.The home had an open visiting policy and residents,relatives,friends and staff spoken to confirmed this.A relative said staff were very friendly and made them feel welcome when they visited. Systems were in place to support residents or visitors to make a complaint.Residents and the relatives spoken to confirmed this and the returned comment cards also indicated that people knew how to make a complaint. The acting manager made herself available to both residents and staff and during the inspection visit she stopped and spoke with any resident that she passed. The home looked after residents monies safely. The recruitment and selection process includes obtaining the views of residents about prospective employees. This detail and comments received is taken into account by the acting manager before taking on new staff. What has improved since the last inspection? There has been changes to the senior management at the home since our last visit in addition to changes to the care staff team. There were five requirements issued on the pharmacy inspection undertaken in June 2009 on this visit four of these requirements had been complied with. The acting manager had received some information about the Mental Capacity Act Deprivation of Liberty Safeguards and was awaiting information about when training about this was available so she could arrange for staff to attend. The acting manager has started collating information on life history during the pre admission assessment, to aid in establishing good relationships between staff and prospective residents, and for inclusion in the planning process of a person centred care plan. As part of the recruitment and selection procedure residents are asked their views and opinions on prospective new employees. The detail shared with the acting manager is written down in the notes made at recruitment and selection and is taken into account when selecting new staff. This is really good practice and demonstrates how the acting manager values the views of residents at Cleggsworth House.In relation to training,three senior staff have obtained NVQ2 qualifications and four senior staff are working towards obtaining NVQ3. Seven care assistants have already obtained NVQ2 and a further seven are working towards this qualification.This ensures staff receive the training they need to do their job properly. What the care home could do better: Three requirements were made on this visit to the home.These were in relation to pursuing the registration of a manager, ensuring that the reports of the monthly visits by the company`s representative are sent to the home for the manager to action and to be available for examination by the Care Quality Commission and the third requirement was in relation to the wedging open of fire doors (bedroom doors). There were a number of recommendations which need to be looked at by the home to develop the service. The acting manager needs to further develop the care plans so that they are more person centred so the care is specific to the individual and includes things like rising and retiring routines and when they want a bath or shower and other information that is personal to that resident. This will ensure that residents get what they need at a time and preference that they want. The acting manager needs also to further develop the care staff team to ensure they complete the daily and night reports in more detail and include how a resident has been during the day and night, the care and support they receive and any presenting difficulties. The acting manager needs to make sure these records do not contain staff judgments. The acting manager needs to make some adjustments to the risk assessment form so that it clearly identifies the risk to residents and also clearly identifies the action needed to minimize those risks. Additional work needs to be undertaken with residents and their relatives or friends to find out what activities they would like to take part in and these need to be provided routinely.When undertaking activities these do need to be recorded to demonstrate what is available to residents Residents need to be provided with opportunities to take part in activities and that these include what residents want to do either as a group or individual to the resident. Make sure that the activities include opportunities for residents to go out if they want to. To support residents to check what meals they are having,provide a menu on the table which would help them to know what they were having for there meals or act as a reminder what meals are being served. Review the provision of meals at the home ensuring that residents are having meals cooked to their liking and the choices available to them are different meals as opposed to a cut of meat being served or cooked in a different way. Also look at providing home cooked meals to further promote residents enjoyment of the meals. The acting manager needs to contact the local authority for herself and all staff to arrange for them to receive training in the Protection of Vulnerable Adults (POVA). This will ensure they have knowledge of how to identify signs or symptoms of abuse and know how to report it properly. To promote the privacy and dignity of residents and to promote the health and safety of residentsand staff.The practice of wedging open the majority of bedroom fire doors must be reviewed.The acting manager needs to speak with the Fire Authority regarding this routine and practice adopted by staff and ensure that they are in agreement with staff practice in relation to wedging fire doors open. An audit of all the bedrooms needs to be undertaken identifying what jobs need doing in each room and an action plan made with timescales of the work that needs to be done in relation to redecoration, repair or replacement of furniture and furnishings. Arrange for the deep clean or replacement of soiled and dirty lounge chairs. Review and amend the laundry service provided to residents ensuring that residents receive their clothes back in a timely manner. When this has been arranged carry out audits of the quality of the laundry service with residents and their relatives to evaluate whether the service has improved. Arrange for all staff who have the responsibility of preparing,serving or cooking meals to attend food hygiene training. Giving priority to those staff who carry out this role more than others. Ensure that there are sufficient numbers of staff on duty including domestic, cooking and care staff to meet the needs of residents and that staff practice and routine continues to be monitored by management to ensure best and safe practice, cleanliness and the right staff support to residents. In line with regulations and to ensure the home is being managed appropriately and residents are looked after properly.A representative from the company should in line with regulations visit the home once a month and undertake specific tasks to check that the home is being managed appropriately.This is in accordance with the Regulations. A report should be made of the visit which is sent to the home and made available to the Commission. In line with regulations and to ensure the acting manager has the skills and qualifications and is a fit person to be registered.The manager must make an application to be registered with the CQC To further promote the health and safety of Key inspection report Care homes for older people Name: Address: Cleggsworth Care Home Ltd 7/11 Little Clegg Road Smithybridge Littleborough Lancashire OL15 0EA     The quality rating for this care home is:   two star good 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: Kath Oldham     Date: 2 7 0 7 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 40 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 40 Information about the care home Name of care home: Address: Cleggsworth Care Home Ltd 7/11 Little Clegg Road Smithybridge Littleborough Lancashire OL15 0EA 01706379788 01706379788 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cleggsworth Care Home Ltd care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home is registered for a maximum of 38 service users to include: *up to 38 service users in the category of OP (old age not falling within any other category). Date of last inspection Brief description of the care home Cleggsworth House is registered to provide personal care and accommodation for 38 older people. It caters for both long term and respite stays. The home is located in Smithybridge village, which has a variety of shops and other amenities close by. It is near to public bus routes and the train station is in close proximity. The home consists of a two-storey building with purpose built extensions having more recently been added. With the exception of one double room, all rooms were single. En-suite facilities are provided in eight of the bedrooms. There is ramped access to the front entrance and a passenger lift is provided. Garden areas are provided to the rear of the building. The homes Service User Guide advised residents and their relatives that the most recent Commission for Social Care Inspection (CSCI) report was available in the entrance area. The fees were £370.64 to £459 per week. Additional charges were Care Homes for Older People Page 4 of 40 Over 65 38 0 Brief description of the care home made for hairdressing, trips, newspapers, telephone, alcohol, clothing and personal toiletries. Care Homes for Older People Page 5 of 40 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 visit was unannounced, which means that the manager, staff and residents were not told that we would be visiting, and took place on 24th July 2009 commencing at 9.15am. On 27th July 2009 the pharmacy inspector from the Care Quality Commission (CQC)undertook an unannounced visit to the home as part of this inspection to look at how well medicines were handled. This was to make sure that residents were being given their medicines properly. This was because at a previous inspection on 15th June 2009 there had been some concerns about how safely medicines were handled.On that visit we issued requirements in relation to medication which we wanted to check had been complied with. The acting manager made herself available on the visits and provided us with a lot of detail, information and support during the visit. The inspection of Cleggsworth House included a look at all available information Care Homes for Older People Page 6 of 40 received by the Care Quality Commission (CQC) about the service since the last inspection which was on 15th July 2008. We should have undertaken an Annual Service Review (ASR) this year instead of an inspection. This is when we do a review of good and excellent services that takes place between key inspections. Good services only have an inspection every two years and excellent services every three years. An inspection visit wasnt due as on our last visit the home was deemed an excellent service.We decided that as we had received a lot of information, comments,incidents and complaints and after the pharmacy visit in June 2009 we would bring forward our inspection.The registered manager had also left her employment at Cleggsworth House in August 2008 and an acting manager was appointed in September 2008. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide.Some weeks before our visit the acting manager was asked to fill in a questionnaire,called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. This helps us to determine if the management of the home see the service they provide the same way that we do.We considered the responses and information the acting manager provided and have referred to this in the report. Cleggsworth House was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to people staying at the home and some that residents could give to their relatives or friends and to staff working at the home, the views expressed in returned comment cards and those given directly to the inspectors are included in this report. We got our information at the visit by observing care practices and talking with residents and their visitors,the acting manager and staff.A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how the home was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to four residents were looked at in detail to help form an opinion of the quality of the care provided.We call this case tracking.This is a way of inspecting that helps us to look at services from the point of view of the people who receive a service. We track residents care to see whether the service meets their individual needs. The term preferred by people living at Cleggsworth House was residents. This term is, therefore, used throughout the report when referring to people living at the home. A brief explanation of the inspection process was provided to the acting manager at the beginning of the visit and time was spent at the end of the visit with the acting manager and operational director to provide verbal feedback of our findings. Care Homes for Older People Page 7 of 40 We have received complaints and comments about this service and have been made aware about safeguarding referrals. The local authority and or police took the lead in relation to these as they should do. References to we or us in this report represents the Care Quality Commission(CQC). Care Homes for Older People Page 8 of 40 What the care home does well: What has improved since the last inspection? There has been changes to the senior management at the home since our last visit in addition to changes to the care staff team. There were five requirements issued on the pharmacy inspection undertaken in June 2009 on this visit four of these requirements had been complied with. The acting manager had received some information about the Mental Capacity Act Deprivation of Liberty Safeguards and was awaiting information about when training about this was available so she could arrange for staff to attend. The acting manager has started collating information on life history during the pre admission assessment, to aid in establishing good relationships between staff and prospective residents, and for inclusion in the planning process of a person centred care plan. As part of the recruitment and selection procedure residents are asked their views and opinions on prospective new employees. The detail shared with the acting manager is written down in the notes made at recruitment and selection and is taken into account when selecting new staff. This is really good practice and demonstrates how the acting manager values the views of residents at Cleggsworth House. Care Homes for Older People Page 9 of 40 In relation to training,three senior staff have obtained NVQ2 qualifications and four senior staff are working towards obtaining NVQ3. Seven care assistants have already obtained NVQ2 and a further seven are working towards this qualification.This ensures staff receive the training they need to do their job properly. What they could do better: Three requirements were made on this visit to the home.These were in relation to pursuing the registration of a manager, ensuring that the reports of the monthly visits by the companys representative are sent to the home for the manager to action and to be available for examination by the Care Quality Commission and the third requirement was in relation to the wedging open of fire doors (bedroom doors). There were a number of recommendations which need to be looked at by the home to develop the service. The acting manager needs to further develop the care plans so that they are more person centred so the care is specific to the individual and includes things like rising and retiring routines and when they want a bath or shower and other information that is personal to that resident. This will ensure that residents get what they need at a time and preference that they want. The acting manager needs also to further develop the care staff team to ensure they complete the daily and night reports in more detail and include how a resident has been during the day and night, the care and support they receive and any presenting difficulties. The acting manager needs to make sure these records do not contain staff judgments. The acting manager needs to make some adjustments to the risk assessment form so that it clearly identifies the risk to residents and also clearly identifies the action needed to minimize those risks. Additional work needs to be undertaken with residents and their relatives or friends to find out what activities they would like to take part in and these need to be provided routinely.When undertaking activities these do need to be recorded to demonstrate what is available to residents Residents need to be provided with opportunities to take part in activities and that these include what residents want to do either as a group or individual to the resident. Make sure that the activities include opportunities for residents to go out if they want to. To support residents to check what meals they are having,provide a menu on the table which would help them to know what they were having for there meals or act as a reminder what meals are being served. Review the provision of meals at the home ensuring that residents are having meals cooked to their liking and the choices available to them are different meals as opposed to a cut of meat being served or cooked in a different way. Also look at providing home cooked meals to further promote residents enjoyment of the meals. The acting manager needs to contact the local authority for herself and all staff to arrange for them to receive training in the Protection of Vulnerable Adults (POVA). This will ensure they have knowledge of how to identify signs or symptoms of abuse and Care Homes for Older People Page 10 of 40 know how to report it properly. To promote the privacy and dignity of residents and to promote the health and safety of residentsand staff.The practice of wedging open the majority of bedroom fire doors must be reviewed.The acting manager needs to speak with the Fire Authority regarding this routine and practice adopted by staff and ensure that they are in agreement with staff practice in relation to wedging fire doors open. An audit of all the bedrooms needs to be undertaken identifying what jobs need doing in each room and an action plan made with timescales of the work that needs to be done in relation to redecoration, repair or replacement of furniture and furnishings. Arrange for the deep clean or replacement of soiled and dirty lounge chairs. Review and amend the laundry service provided to residents ensuring that residents receive their clothes back in a timely manner. When this has been arranged carry out audits of the quality of the laundry service with residents and their relatives to evaluate whether the service has improved. Arrange for all staff who have the responsibility of preparing,serving or cooking meals to attend food hygiene training. Giving priority to those staff who carry out this role more than others. Ensure that there are sufficient numbers of staff on duty including domestic, cooking and care staff to meet the needs of residents and that staff practice and routine continues to be monitored by management to ensure best and safe practice, cleanliness and the right staff support to residents. In line with regulations and to ensure the home is being managed appropriately and residents are looked after properly.A representative from the company should in line with regulations visit the home once a month and undertake specific tasks to check that the home is being managed appropriately.This is in accordance with the Regulations. A report should be made of the visit which is sent to the home and made available to the Commission. In line with regulations and to ensure the acting manager has the skills and qualifications and is a fit person to be registered.The manager must make an application to be registered with the CQC To further promote the health and safety of residents the acting manager needs to undertake a monthly written accident analysis to see if there are any patterns to accidents, incidents or falls experienced by residents. This would assist in the deployment of staff and further support the homes efforts to minimise any risks to residents. 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. Care Homes for Older People Page 11 of 40 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 12 of 40 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 13 of 40 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. Prospective residents needs are fully assessed prior to them moving into the home. Evidence: The AQAA completed by the acting manager before the visit told us,Pre admission assessments are completed by a highly qualified member of staff to ensure all prospective Residents needs can be met.This can be done during the visit to our home,in hospital or at their own home,whichever is the most convenient.Full information regarding the facilities,fees and our contract of residence will be discussed at this assessment meeting.We can offer the facility of an overnight stay prior to admission to support people in making a more informed decision if they choose to do so.The support of an advocacy service is available if this is required.Prior to admission,arranged through social services,we will ensure that we receive a plan of care containing a summary of any assessments,care needs and ability that has been undertaken by social services care management. Care Homes for Older People Page 14 of 40 Evidence: Since the last inspection visit the service user guide and statement of purpose have been reviewed and updated to provide prospective residents with information about the home. Changes to the management had been written into the documents so prospective residents have up to date information. Care managers from the funding authority carried out assessments and copies of these assessments were available.The representative from the home then carried out further assessments.Information in the assessments was used to generate a working care plan. The acting manager told us that any prospective resident always received a pre admission assessment prior to moving in the home to ensure that the home could meet their individual assessed needs. The acting manager has the responsibility for carrying out these assessments. We looked at four residents care files and all had an assessment carried out by the acting manager. The acting manager confirmed that the home did not offer an intermediate care service. Care Homes for Older People Page 15 of 40 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. Medicines are handled well and residents health is protected by safe handling and administration of medication. Evidence: The acting manager told us that,We feel we deliver a high standard of holistic,personal care from caring and competent staff.The care plans contain substantial in depth information of each residents needs and ability.A daily report is completed for each resident and care staff are encouraged to report any findings or issues that may adversely affect the residents health or well being. We asked residents what they felt the home did well. one resident said, Very pleasant atmosphere. A relative said, give care to X, with friendly attitude to all.Another person said, we are satisfied with the care and attention given by all the staff. A further resident said, generally, we are pleased with the standards of the home. One relative in response to the question,do staff listen to you and act on what you say, said,usually respond well. Care Homes for Older People Page 16 of 40 Evidence: We looked at the care files for four residents all had a care plan in place. Details of the care and support didnt always say what level of assistance was required. The lack of such detail could place the resident at risk of their needs not being fully met or their independence being compromised.The detail in the care plan could be further developed to record clearly the times for example residents like to get up and go to bed or when they liked to have a shower or a bath. Including this sort of information will ensure that residents get the care they need when they want it. The detail provided in the AQAA said in the next twelve months the home intends to provide training for senior members of staff in person centred care planning. We spoke with residents while we were on the visit and those spoken to did tell us that they went to bed when they wanted to and if they needed any help with this they would ring for care staff to help them. Residents did comment that staff didnt always respond to them as quickly as they would like on occasions,due to some staff not turning into work when they should or staff coming into work late for their shift. Residnets said staff did do a good job but the effect that staff not turning up for their shift meant that the staff on duty had to work doubly hard. Staff write in the daily and nightly reports how a resident has been during the day or night time. The acting manager told us that since the last inspection some work has been done with staff to improve their recordings. Some staff had completed the recordings with the right amount of information to give the reader an idea of the care and support residnets received. Other staff were writing things like, no problems, slept well or assisted with all hygiene care. This isnt enough information and doesnt indicate the care and support received. The acting manager said she was aware of the staff that needed additional guidance with this and was working with these staff to improve these recordings. This really does need to be done to demonstrate the care residents are receiving. This is identified as best practice as it keeps all staff informed about individual residents health needs and how they are being met on a day to day basis. Each resident has a separate written document to say when the doctor or other health professional has been in to see them . The recording in this document was informative. The daily reports did not always detail that the resident had the presenting problems that had resulted in the doctor being called. Staff looking at the daily reports if they hadnt been in work for a couple of days wouldnt know what the presenting problems had been for the resident. The care file with this information is not at the moment kept with the daily and night reports so staff would not know to ask unless the resident was able to say what had been wrong. This detail should be Care Homes for Older People Page 17 of 40 Evidence: included in the daily or night reports. There were risk assessments in the care files we looked at about things like falls, pressure areas and nutrition.The design of the form related to numbers and identified whether the residnets was at high,low or medium risk dependent on the score. The recording didnt have space to clearly identify the risk to the resident or the action that is needed to reduce or minimize those risks. We did make a recommendation on the last inspection to make some adjustments to the form so that it clearly identifies the risk to residents and also clearly identifies the action needed to minimize those risks. This recommendation is repeated on this inspection. When we looked at the care file for one resident it was evident from the recordings that the resident was loosing weight.A nutritional assessment had been undertaken before the resident went into hospital but one hadnt been done since they returned when it was identified that they had lost weight. It was identified that there was a need to complete a food and fluid intake chart so the food and drinks the resident was having could be clearly recorded. We asked to look at this document. It couldnt be found. The acting manager did speak to staff on duty and one could not recall completing this form for the resident. To ensure that residnets health is promoted this paperwork must be completed to ensure the resident doesnt become unwell and a system needs to be put in place to make sure that this paperwork is completed by all staff. This omission could seriously affect the residnets health and wellbeing. The pharmacist inspector looked at how well medicines were handled to make sure that residents were being given their medicines properly. This was because at the previous inspection there had been some concerns about how safely medicines were handled. We also checked to see if the requirements made at that inspection regarding medicines had been met. We found that the acting manager had addressed almost all the concerns highlighted at the previous inspection. The medication storage area had been tidied and only medication was stored in the room. The storage of creams had been looked at very carefully and various ways of storing creams safely had been looked into, to make sure residents had their creams applied properly and that their creams were stored safely. Other ways of storing creams were discussed during the inspection as the acting manager felt this area could still be improved. The records showed that checks, to decide if creams could be kept in residents rooms had been done, however the acting manager felt these risk assessments could be more detailed and would work to improve them. Care Homes for Older People Page 18 of 40 Evidence: The records about medicines had improved and additional information was included on the records to explain when errors had been made or the reason why medicines had not been given as prescribed. A new procedure had been introduced to make sure that residents were given their medicines as prescribed when they came home from hospital, especially when new medicines or new doses of old medicines had been prescribed. We looked at medicines and the records for one person who had recently come to the home from hospital and we found that all their medicines were given properly and checks had been done with their doctor to make sure that their medicines were correct. Staff responsible for handling medicine had attended refresher training courses to update their knowledge so that medicines could be handled safely and residents health would not be at risk. The acting manager told us that one senior member of night staff had not attended the training and that she would ensure that until such a time that training had been completed the rotas would be changed to ensure that there was always a member of staff who had undertaken medication training on all shifts. Watching staff with residents during our visit showed that good relationships had been developed and that staff respected the privacy and dignity of individual residents. Staff were seen to be sensitive to the needs of residents and spoke to people with patience and respect. Care Homes for Older People Page 19 of 40 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. The lifestyle experienced in the home matched the expectations and preferences of the residents. Evidence: We were told by the acting manager that,Residents are offered a wide range of activities such as exercise sessions,craft afternoons,clothes parties,day trips out,bingo,board and card games,floor games and live entertainment.Provision is made for all residents to observe religious preferences. We asked residents what the home could do better. One resident said, more mobility exercises (armchair or otherwise). More mental stimulation. Another resident said,Need more short outings. One member of staff told us, In my opinion the home is very good with activities, give the service users choice of activities, we consult service users first before we start anything. A further member of staff, in response to the question,what does the home do well, said,encourages residents to participate in any activity and their choice. Keeps residents up to date of any changes. Keeps staff and family members informed of any changes the manager has made. Care Homes for Older People Page 20 of 40 Evidence: We looked at the records which are kept by staff to detail the activities at the home. They included such things as bingo, chair exercise, baking and a walk along the canal for one resident. Some residents spoken to commented that thy hadnt been out of the house for a while. One resident said they had only been out once since they came to stay at Cleggsworth two years before. A further resident said they had only been out twice and they had been at the home for a longer period of time. The acting manager said that she had enrolled some residents on the ring and ride service which she hoped would provide residents with an opportunity to go out and about more. One resident said if they could only go to the lake now and again this would be good. Residents were seen to go to listen to the organist that came into the home during our visit. One resident described there enjoyment of the organist from their previous visits but said that they had not been told the organist was at the home as they would have liked to have joined in the activity. The information in the AQAA completed by the acting manager before our visit told us. We provide varied nutritious meals and a choice is available at main meal times.Drinks are offered on a regular basis and any special dietary needs are highlighted in the residents care plan. There were mixed comments about the meals. One relative said the home could do with providing,Better meals ie not cold.When I have been in they didnt seem to do adequate meals just soup and half a sandwich. A couple of residents told us the home could improve the meals and have a better chef that can cook.Another resident felt the home could improve by providing,better meals. The acting manager told us that one of the cooks had problems cooking meat but they had received instruction and this had been dealt with. On the visit one resident told us that the meals were generally good but that they werent always home cooked. On the visit residents were having fish for lunch. The meal was a cod fish finger as opposed to a piece of fish. Residents said the soup they had at teatime was powdered soup and wasnt home made. One resident told us they enjoyed there breakfast most of all when they had cereal and a bacon sandwich. Cooked breakfasts are available and residents said they order what the want for breakfast the day before. Residents also told us that staff ask them what they would like to eat at each mealtime and a choice is available. When we looked at the four week menu the choice was limited at lunch time on some days. Lamb chops or shepherds pie is not really a choice when both meal choices are made of lamb. The acting manager said that she plans to look at and revise the Care Homes for Older People Page 21 of 40 Evidence: menus so residnets have a clear choice of meals. Consideration is also to be given by the acting manager to the suggestion that a menu on the table would be good so residents could check what the meals were for the day or could act as a reminder to what they were having for their meals. The dining room on the ground floor had plastic tablecloths on the tables. They looked more like a cafe as opposed to a home environment where adults are eating. This approach does not promote the dignity of residents.The acting manager told us that there had been linen cloths on all the tables but that there had been some problems with laundering them so plastic cloths were introduced. The appearance of the tables and the comfort of residents would be further enhanced by the provision of linen tablecloths. A record is kept of the food served to residents. The purpose of this record is that if any one is looking at the record they can judge if an individual resident is having the nutrition they need. Unfortunately the records are not always dated so it wasnt possible to check what residents had eaten over a specific time. This needs to be addressed by the acting manager. Care Homes for Older People Page 22 of 40 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. Policies and procedures were in place for staff to support residents to raise any issues of concern and to protect residents from neglect and abuse. Evidence: The manager said the home constantly monitor and update changes that are needed in the complaints procedure and she ensures all staff continue to report and record all complaints. We were told that all complaints no matter how small are documented. We saw that information about how to make a complaint was displayed in the home and was also available in the service user guide.Four compliants have been received in the last 12 months,three of which were dealt with by the homes complaints procedure within the 28 day timescale. Two were substantiated. We spoke to a number of residents and staff about the complaints procedure and all were clear about what to do should they have a complaint or a concern and staff were also aware that there was a whistle blowing policy and procedure available. A number of staff had received in house training in the Protection of Vulnerable Adults and, in most instances, were aware of the procedures to follow should an allegation of abuse be made. It would be good if training in adult protection (POVA) could be arranged to ensure that all staff have a clear understanding of what to do should an allegation be made.The home has in more recent months had six safeguarding Care Homes for Older People Page 23 of 40 Evidence: referrals made and four of these have been subject to safeguarding investigations by the local authnority.The local authority had carried out investigations supported by the management of the home in relation to alleged poor practice. The manager had received some information about the Mental Capacity Act Deprivation of Liberty Safeguards and was awaiting information about when training about this was available so she could arrange for staff to attend. The manager and a couple of the staff have so far received this training.At the present time no one in the home was subject to an application made under these requirements. Care Homes for Older People Page 24 of 40 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 premises were homely and clean.This enabled residents to live in pleasant surroundings appropriate to their needs. Evidence: Cleggsworth Care Home is situated in Smithybridge Village,near to public transport and a train station.There are a variety of local shops a library,church and community hall within walking distance. Lounge and dining areas are situated on both floors to promote smaller group living.There is a small quiet lounge situated on the first floor where residents can receive their visitors in private in addition to the privacy of their bedroom. Some of the arms of the lounge chairs were dirty. They need either deep cleansing or replacement. This would further promote residents and relatives comfort whilst sitting in the lounges.Staff said in comment cards,We would benefit from new furniture (armchairs) carpet cleaner, vacuum cleaner. The home has 28 single rooms,eight of the bedrooms have en-suite toilets.Residents are encouraged to personalise their own bedrooms and take part in any changes in the redecoration of the home. Care Homes for Older People Page 25 of 40 Evidence: There is a flagged patio balcony on the first floor and a garden at the back of the home where residents able to sit outside during the warmer weather. There is a passenger lift to all floors to help residents who are less mobile and have difficulty using stairs.General aids and adaptations are provided within the home such as grab rails,multi-use hoists and individual slings. We had a look around the house and looked at some of the residents bedrooms. Residents have been supported to make their bedrooms homely by bringing in items of furniture or ornaments from home. One resident said she had everything in her bedroom that she needed and said she had brought with her some furniture and a bed. The majority of residnets bedroom doors were wedged open either by the placement of a door wedge or by pieces of furniture or ornaments. Some bedrooms doors were open when residents were poorly in bed or were asleep. This practice does not promote residnets privacy or dignity whilst sleeping. In addition in an emergency situation this practice compromises the health and safety of residents and staff as the doors which are fire doors will not act as a barrier to stop the spread of fire. We accept that some residents may want their bedroom doors open . However this must be risk managed to promote everyones safety and the procedures must reflect this. When we looked at the fire procedures it did not make any reference to the routine and practice of wedging open fire doors. The acting manager needs also to speak with the Fire Authority to make sure they are aware of this practice and routine. We didnt see anything in the homes fire risk assessment about this practice. The house generally is showing the signs of wear and tear and is in places looking tired and shabby in relation to the decoration. The acting manager said she was hoping to have some areas of the home repainted to brighten up the house as there were a lot of bangs and marks on walls in certain areas. We were not sure if the home had a lack of storage facilities as there were a lot of items that were stored in the lounges or in other areas of the home as opposed to them being put away. For example there were three vacuums in the downstairs lounge.The acting manager said she would sort things out and make sure staff returned items to there rightful place as opposed to leaving them about where they could potentially become a hazard. In the stairwell there were items stored there which could compromise the safety of residents and staff. These stored items need to be removed and staff given instruction that the stairwell shouldnt be used as a Care Homes for Older People Page 26 of 40 Evidence: storage area due to fire regulations. It would be a good opportunity for the acting manager to go to each of the bedrooms and check what each room needs. There was a couple of bedrooms where the carpets had buckled and could be a tripping hazard for residents whose mobility has deteriorated. In a vacant bedroom the sink base was not fixed which could compromise residents safety. Placed on the wall in one of the residents bedrooms was a note to staff about the light in the bedroom. Information about residnets wishes and preferences should be in the residents care plan and not on notices on the wall. The acting manager said this would be removed. In one of the bedrooms we looked at there was a mattress stood against the wall. We were offered some explanation by staff about the mattress however the practice described was not put into practice. The storage of the mattress in such a way could compromise the safety of the resident using this room. There is a designated hairdressing room which the visiting hairdresser uses to style residents hair. One resident told us that she looked forward to the hairdresser coming each week and she did her hair as she wanted. There were no unpleasant smells or odours throughout the house. One relative said that there are never any smells when she visits like there can be in some care homes. Hoists were available to staff to transfer residents safely. Individual hoist slings are available for those residents needing to be hoisted. We saw the service record of the hoists which were up to date. We were told that all the equipment in the laundry was working correctly. Residents and relatives commented to us that there appears to be problems with the laundry as residents dont always get there clothes returned and some items go missing never to be seen again. The laundry assistant explained that all residnets clothes have there room number in there clothes so they should be returned to their rightful owner. This system is not always working. To promote the respect of residents,the laundry service needs to be reviewed and changed to provide a reliable service. We were also told that sometimes the ironing of residents clothes was undertaken by staff in one of the residents bedrooms near to the laundry. This practice does not promote the privacy, dignity or respect of residents space and should be discontinued. Care Homes for Older People Page 27 of 40 Evidence: There were residents clothes hung on coat hangers in the hairdressing room as opposed to them being put away, this may be another reason why residents clothes go missing. The acting manager said that staff do put clothes in the hairdressing room for airing. Infection control procedures were in place and training provided to staff. Disposable gloves and aprons were provided for staff use. Care Homes for Older People Page 28 of 40 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. Residents living at Cleggsworth House receive care and support from a trained staff team who have gone through a thorough recruitment process to safeguard their interests but staff absentism may affect the ability of care staff to meet residents care needs fully. Evidence: The acting manager told us in the AQAA she completed before our visit that, We provide a high standard of care from well trained, caring and competent staff.We have a thorough recruitment procedure and ensure a full employment history is completed on staff application forms.All staff have POVA screening and references are requested and received prior to commencing employment.We ensure that staff are fully supported in their induction period.During induction period staff are required to complete mandatory training, timescales of the training are dependent on availability. Residents told us that the staff were good but that they were affected when staff fail to turn up for there shift or they arrive for work late. We asked residents what they thought about the staff and these were the comments we received. Staff pleasant, can have a laugh.Staff provide very good care at all times. Very helpful to relatives always welcoming. Employ staff that actually turn up for their shift. Three residnets said staff are always available when they needed them and five residnets said staff are usually available when they need them. When we asked what the home did Care Homes for Older People Page 29 of 40 Evidence: well,staff told us,Training of all staff members old and new. Team work ie manager, senior staff, care staff and cleaners.Staff also commented on what they thought could be improved.They told us, Improve discipline of staff who either are off sick a lot or do not turn up for there shift and do not phone in. Residents said that there are two care staff on each floor plus a senior and during the week the manager is also on duty. Residents told us the manager is on the rota at weekend or at night if there is a new member of weekend staff on duty or if there is a new night carer so she can show them how to do things right. We looked at a sample of newly appointed staff personal files and some that had been at the home for a couple of years. The staff files were well maintained and contained all the necessary checks including Criminal Record disclosures(CRB) and checks made against the protection of vulnerable adults (POVA)list. References were also on file as they should be and in the main,any gaps in employment were explained. The acting manager said that for one member of staff there were gaps in there employment which she was aware of but had not written down. The acting manager said that this would be written down and signed by the new employee and herself as confirmation of the details given to her at the recruitment stage. As part of the recruitment and selection procedure residents are asked their views and opinions on prospective new employees. The detail shared with the acting manager is written down in the notes made at recruitment and selection and is taken into account when selecting new staff. This is really good practice and demonstrates how the acting manager values the views of residents at Cleggsworth House. The acting manager is considering telephoning referees as confirmation of the written references received as another check to further improve on the recruitment and selection procedures. Domestic staff are employed between the hours of eight and three o clock for five days each week. The acting manager needs to review these hours to ensure if there are any cleaning tasks after this time care assistants are not taken away from their caring roles to carry out cleaning tasks. We described earlier in the report the comments we received about the cooking skills of some of the cooks employed at Cleggsworth. Some staff do hold the food hygiene certificate but it would be better if all staff who have the responsibility of cooking, serving or preparing meals had this training. In addition to cooking staff having additional qualifications in cooking. The detail in the AQAA identified the need to Care Homes for Older People Page 30 of 40 Evidence: ensure all staff complete a food hygiene course as soon as possible. In August 2008 the registered manager left her employment at Cleggsworth House. The acting manager was appointed in September 2009 undertaking administrative duties initially before looking at staffing and other management procedures. There have been a number of changes to the senior team at the home in addition to changes in the care staff team. We were told that the home had experienced a lot of staffing problems with sickness and absence which has been addressed by management and the acting manager said staffing had now improved. The acting manager told us that an application for consideration for registered manager had been made by her and she was awaiting instruction from The Care Quality Commission (CQC)on the next steps. The acting manager is currently studying to obtain her leadership and management qualification. In relation to training,three senior staff have obtained NVQ2 qualifications and four senior staff are working towards obtaining NVQ3. Seven care assistants have already obtained NVQ2 and a further seven are working towards this qualification. This ensures staff receive the training they need to do their job properly. A training record details that the majority of staff have received training in moving and handling, fire safety, health and safety, basic first aid, infection control and falls awareness. Additional sessions have been booked and further places are to be scheduled to ensure staff are up to date with this training. Care Homes for Older People Page 31 of 40 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. This service is run in the best interests of the residents,and the management ensure that the safety and welfare of residents and staff is promoted. Evidence: The AQAA indicated,We have a comprehensive range of policies and procedures to promote and protect residents and employees which are available at all times to staff and any residents or visitors upon request. A relative told us. since Amanda Richardson took over the management of Cleggsworth House, the atmosphere among staff and residnets is so much more relaxed and happy. The acting manager has been in post since September 2008 and has been nominated for consideration as the registered manager with the Care Quality Commission (CQC).This means that she has to attend a fit person interview with the registration team at CQC and has to satisfy them that she has the skills and qualifications to be Care Homes for Older People Page 32 of 40 Evidence: registered.The acting manager said she was currently studying for the Leadership and management qualification which is needed as part of her registration. We were told that the acting manager works closely with the Area Manager to ensure all legislation is complied with that head office provide a support network for the Acting Manager,her mentor is an experienced registered Manager. A representative from the company should in line with Regulations visit the home once a month and undertake specific tasks to check that the home is being managed appropriately. This is in accordance with the Regulations. A report should be made of the visit which is sent to the home and made available to the Commission. We asked to see these reports on our visit and were told that they were not available at the home. The Operational Director when asked said she would send these to us, at the time of writing this report these had not been received. A quality assurance system is in place that seeks and acts upon the opinions of residents in terms of their day to day experiences and improvements that could be made.The acting manager should compile a summary report of the findings of the recent questionnaire survey to residents and include the findings to accompany the homes statement of purpose to evidence this consultation process. The requesting of comments about the service should be extended to include other professional visitors to the home which could include social workers or care managers.All residents and their relatives spoken to during this visit expressed satisfaction on how the home was run and the quality of services in the home. There is an established supervision process in place. Where staff meet with their manager to discuss their career development and their work and any training they feel is needed.The residents benefit from a staff team who are supported by the acting manager. Accident records were available and monitoring or an analysis of accidents could be undertaken by the acting manager to see if there are any patterns to accidents, incidents or occurrences experienced by residents. To protect the privacy of residents the collation of these records is in keeping with data protection regulations. One of the relatives spoken to during this visit said that she had found the manager very responsive to any problems and that the manager was approachable and quick to respond to any concerns. Staff who were spoken to showed confidence in the manager, saying that they found her approachable and that they could talk to her about any concerns. Care Homes for Older People Page 33 of 40 Evidence: There was a written record of staff and residents meetings. The meetings were used as an opportunity to exchange views, and to seek the views of residents about how the service could be developed. Information in the AQAA provided evidence that good standards were maintained for the maintenance of equipment for health and safety including fire prevention equipment. The home had a policy and procedure for supporting residents with their personal finances. Financial transactions were recorded and the resident and staff member sign the record. Receipts for purchases are maintained on file. All incidents affecting the health and wellbeing of residents should be routinely reported to the Commission.To ensure the Commission is aware of these events the acting manager arranges for this information to be sent to us routinely.This is being undertaken as required by the regulations. Care Homes for Older People Page 34 of 40 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made 17/06/2009 to ensure that a suitably qualified member of staff is on duty at all times. To make sure that medicines can be given safely. Care Homes for Older People Page 35 of 40 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 19 23 The practice of wedging open the majority of bedroom fire doors must be reviewed.The acting manager needs to speak with the Fire Authority regarding this practice and ensure that they are in agreement with staff practice in relation to wedging fire doors open. To promote the privacy and dignity of residnets and to promote the health and safety of residnets and staff 28/07/2009 2 31 8 The manager must make an application to be registered with the CQC In line with regulations and to ensure the acting manager has the skills and qualifications and is a fit person to be registered. 29/07/2009 3 31 26 A representative from the company should in line with 29/07/2009 Care Homes for Older People Page 36 of 40 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 Regulations visit the home once a month and undertake specific tasks to check that the home is being managed appropriately.This is in accordance with the Regulations. A report should be made of the visit which is sent to the home and made available to the Commission. In line with regulations and to ensure the home is being managed appropriately and residents are looked after properly. 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 7 The acting manager needs to make some adjustments to the risk assessment form so that it clearly identifies the risk to residnets and also clearly identifies the action needed to minimize those risks. Develop the care plans to be more person centred so the care is specific to the individual and includes things like rising and retiring routines and when they want a bath or shower and other information that is personal to that resident. This will ensure that residnets get what they need at a time and preference that they want. The acting manager needs also to further develop the care staff team to ensure they complete the daily and night reports in more detail and include how a resident has been during the day and night, the care and support they receive and any presenting difficulties.The acting manager needs also to make sure these records do not contain staff judgments. Page 37 of 40 2 7 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 8 Ensure that when it is identified that residnets are loosing weight that a nutritional assessment is undertaken and the record of food and fluid intake is completed and this information is kept safe and available. Liaise with residnets and their relatives or friends to find out what activities they would like to take part in and provide these routinely.Ensure that activities undertaken are recorded to demonstrate what is available to residnets. Provide residnets with opportunities to take part in activities and that these include what residnets want to do either as a group or individual to the residnets. Make sure that the activities include opportunities for residents to go out. To support residnets to check what meals they are having,provide a menu on the table which would support them to know what they were having for there meals or act as a reminder what meals are being served. Review the provision of meals at the home ensuring that residnets are having meals cooked to their liking and the choices available to them are different meals as opposed to a cut of meat being served or cooked in a different way. Also look at providing home cooked meals such as soups to further promote residents enjoyment of the meals. 4 12 5 15 6 18 The acting manager and all staff need to receive appropriate training in the Protection of Vulnerable Adults (POVA). This will ensure they have knowledge of how to identify signs or symptoms of abuse and know how to report it properly. Review and amend the laundry service provided to residents ensuring that residents receive their clothes back in a timely manner. When this has been arranged carry out audits of the quality of the laundry service with residents and their relatives to evaluate whether the service has improved. Undertake an audit of all the bedrooms identifying what jobs need doing in each room and compile an action plan with timescales of the work that needs to be done in relation to redecoration, repair or replacement of furniture and furnishings. Arrange for the deep clean or replacement of soiled and 7 19 8 19 Care Homes for Older People Page 38 of 40 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 dirty lounge chairs. 9 28 Ensure that there are sufficient numbers of staff on duty including domestic, cooking and care staff to meet the needs of residents and that staff practice and routine continues to be monitored by management to ensure best and safe practice, cleanliness and the right staff support to residents. Arrange for all staff who have the responsibility of preparing,serving or cooking meals to attend food hygiene training. Giving priority to those staff who carry out this role more than others. To further promote the health and safety of residents the acting manager needs to undertake a written monthly accident analysis to see if there are any patterns to accidents, incidents or falls experienced by residents. This would assist in the deployment of staff and further minimise any risks to residents. 10 30 11 38 Care Homes for Older People Page 39 of 40 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. 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