Care Home: Coombe House

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What the care home does well As a result of further training undertaken by the registered provider/manager, she undertook a review of how the home provided care. The ethos of the home has now been developed to support the principal of `Whole Person Care`. One of the aims of the home is stated as `In this atmosphere of care and support, our residents are both enabled and encouraged to live as full, interesting and independent life as possible, each valued as individuals, with rules and regulations being kept to a minimum`. This ethos was evident throughout the inspection. Each person has a needs assessment by the manager prior to admission to ensure that the home can meet the needs of that person. The home is very supportive or relatives at this time to promote a successful admission to the home. Each person at the home has a care plan. This plan outlines the preferences of the person. An agreed plan of care is in place to support both preferences and any specific care needs. These plans are detailed and person centered. Activities are provided and people have the choice if they wish to participate. People are supported through activity to maintain their well being and also establish and maintain contact with the community. The homes environment is comfortable, homely and maintained to an good standard. There is suitable communal space with a comfortable lounge and dining area and attractive, accessible outdoor space and gardens. Staffing levels at the home are adequate to meet the people`s needs. The home provides a consistent staff team with sufficient training and skills to meet the needs of people using the service. Health and Safety measures are in place to promote protection and policies and procedures are in place to ensure good practice. What has improved since the last inspection? At the previous inspection is was recommended that the registered provider should implement a daily social-recreational programme, in keeping with peoples interests and capabilities. The registered provider was required to ensure that the care records more clearly show the options available to service users and the choices made on a daily basis (e.g. enjoyed activity or declined to join in activity). This has been undertaken in a robust manner with records being maintained. The change in ethos and development of `Whole Person Care` is a benefit to all people using the service. What the care home could do better: The registered manager is recommended to review some medication practices and provide clear audit trails and ensure the safety of people using the service. It is also recommended that all wardrobes be risk assessed as a tip hazard and the appropriate action taken to ensure the safety of people using the service. The registered manager is required to address the areas identified as shortfalls within the homes recruitment practices. This is required to protect the people using the service from the risk of abuse. Key inspection report Care homes for older people Name: Address: Coombe House Coombe Lane Lamellion Liskeard Cornwall PL14 4JU     The quality rating for this care home is:   three star excellent 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: Gail Richardson     Date: 1 6 0 6 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 27 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 27 Information about the care home Name of care home: Address: Coombe House Coombe Lane Lamellion Liskeard Cornwall PL14 4JU 01579346819 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: anngray@clara.co.uk Ms Ann Elisabeth Gray care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service users to include up to 16 adults of old age (OP) Service users to include up to 9 adults aged over 65 with a mental illness (MD(E)) Service users to include up to 9 adults aged over 65 with dementia (DE(E)) Total number of service users not to exceed a maximum of 16 Date of last inspection Brief description of the care home Coombe House is situated in a quiet rural setting at the head of the Looe Valley. It is one mile from the centre of Liskeard, which provides a range of shops and community facilities. Coombe House provides accommodation and personal care for up to 16 older persons, some of whom may also have a mental disorder/dementia. Accommodation is Care Homes for Older People Page 4 of 27 Over 65 9 9 16 0 0 0 Brief description of the care home provided on two floors. A stair lift is available to assist people with access to the upper floor. The range of fees charged at this home is 357.00 pounds to 485.00 pounds ( Correct as of June 2009 ). This does not include toiletries, hairdresser, chiropody,newspapers and alcohol. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over 1 day ( 7 hours ) on the 16th June 2009 by Regulation Inspector Gail Richardson. As part of this inspection, the term we will be used when referring to the Care Quality Commission). The last key inspection was undertaken on 5th July 2009. An Annual service Review was completed on the 30th June 2008. No visits to the home have taken place in the interim period. At this inspection there were 14 people currently residing at the home receiving personal care. The home has one person receiving routine respite care. The home has provided the Care Quality Commission with a completed AQAA ( Annual Care Homes for Older People Page 6 of 27 Quality Assurance Audit ) which was completed by the Registered Provider/ Manager and gives details of all aspects of the home. A tour of the home took place and all of the bedrooms and communal areas were seen. We spent time observing the care being provided. We spoke to 6 people using the service, 1 visitor and 6 members of staff The Registered Manager was available throughout the inspection. As part of this inspection we surveyed the opinions of a random selection of people using the service and their representatives, GPs, District Nurses and Care Workers. No responses were received. Records relating to care including 3 care plans, 3 staff files, finances and health and safety records were examined The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The registered manager is recommended to review some medication practices and provide clear audit trails and ensure the safety of people using the service. It is also recommended that all wardrobes be risk assessed as a tip hazard and the Care Homes for Older People Page 8 of 27 appropriate action taken to ensure the safety of people using the service. The registered manager is required to address the areas identified as shortfalls within the homes recruitment practices. This is required to protect the people using the service from the risk of abuse. 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 27 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 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider/manager is thorough in ensuring that prospective people using the service will have their needs met at Coombe House. Considerable effort is made to ensure that the person and their family are supported to ensure a successful admission. Evidence: The registered provider / manager provides each person and their representative, with a copy of the homes Service User Guide. The home also provides an individual Statement of Terms and Conditions that specifies the fees to be paid and the room to be occupied. The manager undertakes a pre admission assessment and includes the involvement of appropriate health professionals. Prospective people and their relatives may visit to test run the service. The manager will only proceed with the admission if she is confident the person can be cared for at the home. Significant time and effort is spent Care Homes for Older People Page 11 of 27 Evidence: making admissions personal and well managed. Considerable effort is made to support both the people admitted to the home and their relatives. There is a facility for a relative to stay at the home for the initial few days to help the admission process, should they wish to. The involvement of families is supported and promoted to ensure that a full history is obtained to support the person centered care provided. Should family not be available appropriate advocacy assistance is sourced. The home provides respite care but does not provide intermediate care. Care Homes for Older People Page 12 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are person centered and detailed to ensure that each persons care is tailored to their needs and preferences. Medicines systems are mostly in place to ensure safe medicine management. People are treated with dignity and their right to privacy, support and independence is respected. Evidence: We looked at 3 care plans for people using the service. They highlighted all the peoples care needs and provided a clear plan for staff to follow to meet those needs. The care plans were very specific to each person. They highlighted what is important to each person and what staff could do to ensure that those choices and details were integral to each persons life. There were clear indicators to staff of body language and mannerisms to highlight when the person was happy. There are also clear details of the signs to act upon when the person was not happy. People have the choice of male or female staff to attend to their care needs and this is choice is recorded within their care plan. The care plans contained a record of visiting health professional to each person and Care Homes for Older People Page 13 of 27 Evidence: community nursing and mental health support staff visit the home to support people where there is an identified need. Staff told us that hand overs of information take place each days so that staff are aware of any changes in care needs. A person who visits the home regularly told us that, If I had to go anywhere it would be here - I would feel safe They do lovely things here with people. Lots of activities, I see staff treating people so well All staff who dispense medication have received the appropriate training. The systems in place were mostly robust. The manager is recommended to ensure that all medications no longer in use or accumulated stock must be returned to the pharmacy and must not be used as stock medication. The home uses the monitored dosage system to administer medication and recordings are clear and accurate. The manager must also ensure that any hand transcribed medication on the Medication Administration Record must be checked and signed by two staff to ensure that there is no risk of error in recording. We discussed that nutritional supplements and prescribed creams must also be signed when given to provide an accurate audit trail of medications supplied. Creams are recommended to be dated when opened to ensure the creams remain within their use by date. We observed people using the service, they appeared happy and content. Staff demonstrated a very good understanding of each person and this was seen to be reflected in how they responded to each person. The change in ethos by the home to Whole person care has meant that people using the service and staff spend more time together in a more integrated manner. This involves sitting together, eating together and ensuring that people feel part of the day to day running of the home. We observed people helping with household tasks and enjoying a joke with the staff. The manager has developed a care monitoring system to ensure that staff are aware of signs of well being and distress and develops care plans to address any issues highlighted. People using the service appeared to be very happy in the company of the staff and told us that staff were kind and caring. They told us that they felt safe. One person told us The staff are lovely - very ordinary. When we asked what they meant by this , they explained that were all the same, getting on with it together. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a lifestyle specific to each person which involves their personal choices and preferences of activity. People are supported to feel involved in aspects of day to day life at the home. The home offers freshly cooked meals and a balanced, attractive diet. Evidence: The home provides activities which are specific to each persons preferences. Some people are supported to paint, listen to music, walk in the garden. People are encouraged to chat and spend time with other people using the service and staff. One person has a shed in the garden to continue with their interests. One survey received at the home said that the thing they liked the best was The freedom of movement around the home and garden. The home has undertaken to make life history books for each person. They detail a time line of that persons life experiences. They also include what is important to them and why. These books provide the person and staff with chances to discuss and reminisce. The manager has also undertaken her own life history book and staff photos displayed in the hall are surrounded by photos of people and things which are important to them. The monitoring of activity is recorded. Activities are now recorded Care Homes for Older People Page 15 of 27 Evidence: as meaningful occupations with a record chart that staff tick to ensure that contact is made with all people regularly. Records of activity include 1 to 1 time, collecting dishes, washing up, folding laundry, walking. The manager told us People are fully included in everything in the home Surveys received by the home said The atmosphere is pleasant and relaxed. We see staff sitting and talking and doing activities with residents. People have access to local churches and clergy also visit the home. All people are registered to vote should they wish to. The home has a person to cook each day and food is locally sourced and homemade. One survey received by the home said The quality and freshness of the food being prepared when I visit has always been very good. The menu is amended seasonally and is agreed by both staff and people using the service. Within the change of ethos in the home, staff now sit and eat with the people using the service, this makes eating a more social event. One survey received by the home said Eating with the residents, a tiny thing that reflects so much of the ethos. The dining room is light and airy with a record player and choices of music. Wine is served with meals. A record of food provided, including whether a resident eats well or not, is kept. Alternative meals are available, and the residents are asked on a daily basis if the alternative would be preferred. People are supported to eat in the dining room but can eat in their rooms should they choose. We observed lunch to be a pleasant time with people choosing what they wished to eat and staff showing insight into how people chose to dine. People interacted socially and the meal appeared to be enjoyed. Care Homes for Older People Page 16 of 27 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. The Complaints Procedure and Adult Protection Procedures are in place protect people using the service. Evidence: There have not been any complaints received by the Care Quality Commission since the last inspection. A complaints procedure is in place, and is included in the Service User Guide, this details the timescale for initial responses people would be expected to have. The home undertakes a regular review of quality in the form of questionnaires and any issues arising from that are dealt with promptly. Staff have a good understanding of the complaints and whistle blowing procedures and have undertaken adult protection training. The home has a copy of the safeguarding Adults in Cornwall local policy and demonstrated a good understanding of the protocol. Care Homes for Older People Page 17 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in safe, comfortable, clean homely environment. The environment is being decorated to support the abilities, choices and interests of people using the service. Evidence: Coombe House is in a rural, peaceful setting that requires access across a railway line (this involves telephoning the nearby train station and opening and closing two gates). New visitors to the home would be advised to ring for directions once in the local area. The house is in keeping with its country surroundings and provides a personal environment. All rooms are single occupancy with one exception. Each room is individual with the personal belonging of people being evident . Rooms contained lots of family pictures and evidence of hobbies and interests. Rooms without en suite facilities have a toilet/bathroom nearby. Equipment is supplied where there is an assessed need and hoists and wheelchairs are accessible in all areas. It was noted that the wardrobes were not risk assessed and secured as needed. The manager confirmed that this would be undertaken by the homes Health and Safety representative. Communal areas were seen to be decorated with items for people to pick up and look at. These included games, ornaments, books, hats , stuffed animals, newspapers. Corridors had seating areas to encourage purposeful walking and all areas of the home are accessible to people using the service. The bedrooms do not have locks on the Care Homes for Older People Page 18 of 27 Evidence: doors, the manager feels this would create a higher risk as people may not be able to manage the locks. As part of the change of ethos the manager has reallocated the cleaner to be part of the care staff and cleaning tasks are part of everyday activities. The premises were noted to be very clean. The lavatories and bathrooms were seen to have some communal toiletries with collections of items such as soap and personal items. The manager explained that people move things around and staff put things back later. Some bathrooms appear to be worn in places. The manager confirmed that the budget plan for the home this coming year is to refurbish the bathrooms. The systems in place for the risk of cross infection are suitable for people using the service, however the manager is recommended to ensure that hand wash and paper towels are available in all bathrooms used by staff to prevent the risk of cross infection. The gardens are well maintained and attractive with patio and seating areas which were seen to be in use. One person at the home smokes and has had a garden door fitted to enable them to smoke near their room. The laundry area is small but functional with a washing machine and separate dryer provided. Fouled items are currently hand washed in the sluice sink. The washing machine will be replaced when it is no longer functioning. The manager plans to replace this with a machine with a sluice facility. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are staff in sufficient numbers with appropriate training to meet the needs of people using the service. There is an evident commitment to staff training and resident welfare. Recruitment procedures must be followed to ensure the safety of people using the service. Evidence: There are 4 staff on duty each morning, 3 each afternoon and one waking staff overnight. There is always a further person on call overnight. If those two staff are not senior staff a third more experienced staff member is also on call. The registered manager works each day at the home and is on call 24 hours a day. Should she not be available a further sleeping staff is in place with an experienced staff member on call. The staff team is stable with two staff recently returning to the home from other employment. No agency staff are used. Staff told us that they felt there were sufficient numbers of staff each shift to meet the needs of people using the service. Staff spoken with at inspection have all been employed at the home for several years and told us that they were happy working at the home. Staff have a clear understanding of person centered care and work with the management of the home to develop the service to move forward with improving care practices. People using the service who spoke with us were all very complimentary about the Care Homes for Older People Page 20 of 27 Evidence: kindness of the staff. Quality Audits in the home contained several comments about the staff which included I think the staff go out of their way to do everything possible for the residents and their visiting family and friends. Further surveys said Staff are prepared to adapt, change and try new things. Adaptable- forward thinking and well motivated care team Staff training is ongoing. Staff training records were not up to date but staff told us that they received training in all mandatory areas. Further training in specific areas relevant to the people using the service was also provided. The home has designated trainers for moving and handling and health and safety including fire training. Staff are encouraged to undertake NVQ training. Staff receive regular supervisions and appraisals to promote good practice and provide an opportunity to identify and develop skills. Recruitment procedures have been developed to include people using the service as part of the interview process. The manager told us that this had been valuable within the interview for all parties involved. We looked at three recruitment files of people employed at the service. The procedures in place were not consistently followed to ensure safe practice. Whilst all staff have a Protection of Vulnerable Adults Check (POVA) and a Criminal Record Bureau Check (CRB), one person started work one month prior to the checks being received. The person was supervised at all times, however, all staff must have the correct recruitment checks in place prior to commencing employment to ensure the safety of people using the service. The employment histories for all three files were not fully completed and so did not give the dates of when people changed employment. This detail is recommended to provide a clear record of where people have been employed and any gaps should be explored and documented. The same file contained only one reference, when two should be received. The manager stated that this had been received but was not available at this time. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes leadership, management and development of ethos provide a positive experience for people using the service and staff. The management of recruitment by the registered manager must be robust to protect people using the service. Evidence: The Registered Manager Provider is Ann Gray. She has managed the home for many years and has a Deputy Manager to support her role. She has recently completed the Alzheimers Leadership Course in Dementia Care. Ann is involved on a day to day basis in the home and has demonstrated a clear vision of how she wants the home to be run. The management style appears to be open, positive and inclusive. Staff at the home support the development and change in ethos and the manager and staff appear to work as a team to support people using the service. Several staff told us The manager is very approachable, you can talk to her .Somebody who visits the home told us The manager is very professional. The management of recruitment (See outcome group 6 ) is not robust and may place Care Homes for Older People Page 22 of 27 Evidence: people using the service at risk. The registered manager must ensure that the management of this area shows a consistent improvement to support and protect people using the service. Annual quality assurance questionnaires are undertaken and the responses are used to monitor the quality of care provided and change practice where needed. Review of the recent audit showed very positive responses from both relative and visiting health professionals. The registered provider does not handle any resident money, any transactions being invoiced to the resident or their representative retrospectively. People are supported in maintaining their personal finances and affairs through relatives and Power of Attorney processes. All records are stored securely in line with the Data Protection Act. The homes policies and procedures are comprehensive, regularly reviewed, and as issues arise for discussion the relevant policy is brought to the attention of staff during supervision sessions. Accidents are recorded appropriately, audits are not required due to the lack of frequency. Sensors are used in some rooms to alert staff in the night or afternoon if people are moving in their rooms to promote accident prevention. The homes maintenance records folder showed that the fabric of the building and the equipment within it are regularly and properly maintained for the safety of all. Care Homes for Older People Page 23 of 27 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 24 of 27 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 29 19 The registered manager 24/07/2009 must ensure that all staffT have the correct recruitment checks in place prior to commencing employment This is required to ensure the safety of people using the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Nutritional supplements and prescribed creams must be signed when given to provide an accurate audit trail of medications supplied. The manager is recommended to ensure that any hand transcribed medication on the Medication Administration Record must be checked and signed by two staff to ensure that there is no risk of error in recording. The manager is recommended to ensure that all medications no longer in use or accumulated stock of Paracetamol must be returned to the pharmacy and must not be used as general stock medication. 2 9 3 9 Care Homes for Older People Page 25 of 27 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 4 5 6 9 24 29 Creams are recommended to be dated when opened to ensure the creams remain within their use by date. The registered manager is recommended to ensure that all wardrobes are risk assessed and secured as needed. The registered manager is recommended to provide a clear record of where people have been employed and any gaps should be explored and documented. Care Homes for Older People Page 26 of 27 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!