Care Home: County Homes Nursing Home

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What the care home does well There is a variety of training available to the staff in order to make sure that they can maintain and develop their skills. Records are kept of attendance on training in order to make sure that staff keep up to date. Staff told us that they receive regular supervision that helps them increase their skills. The environment has a variety of space that is suitable to meet the differing needs of individuals living in the home. This includes an enclosed garden area and a bar that is particularly enjoyed by people living in the home. There is a full time activities organiser who makes sure that there is a lot of different social activities available in the home to the people who live there. The people living in the home particularly like going to the bar for a pub lunch. There is a stable staff team in place who consider themselves supportive and encouraging of each other. Staff communicate individual needs well with each other and attend regular meetings in order for them to be aware of changes in the home. The manager and her staff team regular review the quality of the service provided and hold meetings with people living in the home to find out their views on how the home should be run. What has improved since the last inspection? The home has addressed the issues on the last report regarding the management of medications. This area has significantly improved and people in the home receive their medications when they should. Several areas of the building were being decorated as part of an on-going decoration programme. What the care home could do better: Records in the home need to improve in order to make sure that good instructions are available to staff at all times. This includes care plans, risk assessments, staff recruitment and some medications records. Information such as meals available and activities needs to be in formats that meet people living in the homes individual communicate needs. Meals available have deteriorated complaints regarding the quality of the food have been raised by relatives. People living in the home and staff did not find the meals maintained good quality at all times. The provision of special diets such as soft diets and vegetarian is not well planned and people who need special diets are not offered a choice or kept informed of the meals that are available to them. Staff were observed during the visit to not maintain good practice. This included leaving medications and hot tea unobserved both of which places people living in the home at risk. There has been thirty eight allegations of assault between people living in the home. The operations manager has put additional training in place. It would further benefit the people living in the home if individual risks were identified and staffing levels reviewed for the unit were most of the assaults occur. Inspecting for better lives Key inspection report Care homes for older people Name: Address: County Homes Nursing Home 40 New Hey Road Woodchurch Birkenhead Wirral CH49 5LE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Garrity     Date: 2 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: County Homes Nursing Home 40 New Hey Road Woodchurch Birkenhead Wirral CH49 5LE 01516040022 01516040066 countyhomes@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Modelfuture Limited care home 90 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 90 Date of last inspection Brief description of the care home County Homes is a purpose built two-storey building. The service is registered to provide support for ninety people with dementia care needs. There are three separate units, which are named after northern cities, Chester, York and Lancaster. Downstairs on York is for women only, upstairs on Lancaster is for women only, upstairs on Chester is for men only. The other areas have mixed occupancy of both male and female individuals. There is a central courtyard area which provides safe gardens area Care Homes for Older People Page 4 of 28 Over 65 0 90 Brief description of the care home for people who live in the home. The Service is situated on the Woodchurch estate close to all amenities such as shops and libraries. The M53 motorway is close to County Homes, which affords motorway access to Liverpool and the North Wales coast. There are six double bedrooms and eighty-four single bedrooms that have a shared en-suite toilet. There is a passenger lift on each unit to access the first floor and other aids to independence such as handrails. Fees for the service range from 450.87 pounds up to 650 pounds per week dependant on individual assessed needs. Items such as toiletries, hairdressing and newspapers are charged on an individual basis. Information about the home known as the statement of purpose (information about the services provided) and service users guide (information about how the home intends to provide support) is available in the main reception. Additional copies are available on request. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The visit was carried out over a period of 8 hours 50 minutes. We spoke with 7 people who live in the home, 3 visitors, 5 staff, and the operations manager. The manager was on holiday and was not available for this unannounced visit. We completed the inspection by a site visit to County Homes a review took place of many of the records available in the home and our offices. These included individuals care plans, assessments, accident records, staff rota, staff files, maintenance records, menus, staff rota, questionnaires, staff training and medications. Information was sent to the commission by the service and a self-audit (known as an AQAA) completed by the home. This site visit included discussions with people who live in the home, visitors, staff and management. Feedback was given to the operations manager during and at the end of the visit. Care Homes for Older People Page 6 of 28 The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs and preferences, promote independence and support people to make informed decisions in line with personal choices. What the care home does well: What has improved since the last inspection? What they could do better: Records in the home need to improve in order to make sure that good instructions are available to staff at all times. This includes care plans, risk assessments, staff recruitment and some medications records. Information such as meals available and activities needs to be in formats that meet people living in the homes individual communicate needs. Meals available have deteriorated complaints regarding the quality of the food have been raised by relatives. People living in the home and staff did not find the meals maintained good quality at all times. The provision of special diets such as soft diets and vegetarian is not well planned and people who need special diets are not offered a choice or kept informed of the meals that are available to them. Staff were observed during the visit to not maintain good practice. This included leaving medications and hot tea unobserved both of which places people living in the home at risk. There has been thirty eight allegations of assault between people living in the home. The operations manager has put additional training in place. It would further benefit the people living in the home if individual risks were identified and staffing levels Care Homes for Older People Page 8 of 28 reviewed for the unit were most of the assaults occur. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people wishing to move in the home have their needs looked at and are given information about the home. This makes sure that County Homes is the right place for the person to live and that their needs can be met there. Evidence: We looked at the assessments (how the service determines peoples needs) of recently admitted individuals and found that the service had made sure that they could meet their individual needs before they moved in. They did this by undertaking an assessment that looked at the persons needs. The assessments viewed were not always fully completed or signed by the person undertaking the assessment. The AQAA from the home told us, Prior to admitting a client we would carry out a pre admission assessment. From this assessment we will generate a pre admission draft care plan, which will highlight any immediate requirements or potential risks. A copy of information in the home known as the statement of purpose (which states Care Homes for Older People Page 11 of 28 Evidence: the services the home will provided) and the service users guide (information to the people who live in the home about the services they will receive) was shown to us. The statement of purpose was missing some information. We discussed this with the operations manager who told us that they intend to review statement of purpose and service users guide in the next few weeks.. The AQAA from the home told us that We encourage all prospective clients to visit the home. We provide comprehensive information to prospective residents, which includes a breakdown of fees. All clients have a 4 to 6 week settling in period. All our prospective clients are given a brochure, which contains our service user guide, statement of purpose, company newsletter, activity plan, and sample menu.. We looked at the different formats that the information is available in. The AQAA told us that this was available in audiotape and DVD. None were available in these formats at the visit. Given the needs of people living in the home different formats should be readily available to help them decide if the home can meet their needs. We received seven surveys from people who live in the home the majority thought that they had received enough information. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are given personal support in line with their individual preferences. Evidence: We spoke to people who live in the home who told us that, Always polite and helpful. Records showed that when people developed a medical need such as losing weight the relevant healthcare professionals were contacted for advice and support. We received seven surveys from people who live in the home five people told us that they always get medical attention as needed. We looked at how people were supported in getting their medications. This showed that the majority of people living in the home received their medications in a safe manner that maintained their health. There were some minor documentation areas that do not maintain good practice. This included a lack of clear instructions for some medications such as when needed and external medications such as creams. Other records were in need of development. These included risk assessments when a person undertook some of their medications themselves and best practice guidance for Care Homes for Older People Page 13 of 28 Evidence: covert (given without a persons permission) medications. These records were not clear enough to make sure that the service was following best practice and recently introduced legislation known as mental capacity. Good instructions need to be available at all times to make sure that staff can give medications as in a safe manner that meets the persons individual needs. A staff member was observed to not follow best practice such as leaving a medicine trolley unattended which is a substantial risk to health and safety. This was discussed with the person in charge and the operations manager who told us that they will deal would deal with this in a manner to reduce any further risks. The AQAA for the home told us The care plan is reviewed regularly with the involvement of the named nurse, key worker and family. The Service Users dignity and privacy are respected and promoted at all times. We looked at care plans and noticed that each person had their own plan of care. We looked at six care plans and noticed that instructions available in the care plans were not always specific as to how to meet the persons individual needs. Examples of this included no identification in care plans as to how an individual would prefer to bath. Staff told us that they did not always read the care plans but did get a verbal report each day. Not all the plans seen were up to date. In some cases needs were identified and no care plan was in place. An example of this include assessments indicating risks of falls and indications of a need for pain relief with no plan to instruct staff as to how meet those needs. When we spoke to staff they were able to provide information about the practice in place and how they meet the needs of individuals. Clear instructions that inform all staff on how to meet individual needs benefits the people living in the home. Good written instructions make sure that staff provide support in the same manner and verbal instructions which can be inaccurate are not the main source of guidance for staff. Staff observed during the visit demonstrated a genuine warmth and professional attitude to wards the people that they support. Staff discussed their enjoyment of the job that they do and their belief in looking after people. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The food available in the home does not meet individual needs choices or personal preferences. Evidence: The AQAA from the home told us that, We have a full time Activities Organiser, life history is incorporated into their social activities care plan. There is a range of varied activities to suit clients. We have our own mini bus. We have a large activities room with crafts available. We sent surveys to people living in the home and received seven in return two people always liked the activities, four thought that there was usually something they liked to do and one thought that sometimes things they wanted to do was available. We looked for records of personal preferences and choices. Some people living in the home had a record of this in their care records others did not. The activities organiser keeps records of activities that people do. A family member spoken with said that their relative did not get enough exercise and was always sitting around. There is an activities board that shows all the activities that are planned. This included trips out as an example. This is located on entry into the home and is not in an area accessed by the people who live in the home. Each unit in County Homes has a Care Homes for Older People Page 15 of 28 Evidence: handwritten activities and menu board completed daily. The activities listed for the day of the visit was hairdressing. There was no other activities organised and none were observed during the day. We looked into three lounges in the afternoon and the majority of people were watching television. The activities organiser told us that there are activities boxes available for staff to use that include a variety of different things to do. These were not seen to be used on the day of the visit. The activities organiser was utilised for most of the day taking people to and from the hairdresser. We discussed this with the operations manager who agreed this was not the best use of her skills. The service has a room decorated as though it were a pub, each day up to eight people go out to lunch in this area. There is also a large activities room. We discussed with staff how they undertake social activities when the activities organiser is not available. They told us that they did not have the time. A range of activities are available and the activities organiser has a well developed programme. Not everyone living in the home are involved in activities that meet their needs, preferences or choices. There are menus available to tell people who live in the home about the food available. A daily menu board is filled out as to what meals are available that day. The men boards seen on the day of our visit did not detail the evening meal or what special diets were available. There was no choice available for people who need a softer diet. People living in the home told us that dont know what we are having for lunch, they do come around with a list but I never remember what it is. People spoken with had varying opinions of the food including its okay, it seems fine and I like the food. There have been two complaints in the last three months regarding the quality of the food. We spoke to staff who told us that the food was not of the same quality as it had been. The operations manager told us that the system (known as nutmeg) that they used to create the menus had changed in the last few months. Records in the home showed that two people had lost weight in this period of time. This had been recognised by the staff and a dietician had been contacted. to review their needs. We observed meal times and noticed that staff did support people to eat in a dignified manner. Some areas of practice that need to be improved were also observed. An example of this include a staff member pouring out several drinks of tea and then leaving the room for 15 minutes. During that time people living in the home were walking around the room and the hot tea presented a risk to their health and safety. Surveys returned from people living in the home told us that two people always liked the food and five people usually liked the food. There are concerns expressed by families, staff, management and people living in the home about the quality of the food. There is no evidence that shows that the menu available is taken from individual needs, choices and preference. Information available does not support people to make a choice about the food they would like. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home believe that their concerns will be properly dealt with. Evidence: Surveys from people living in the home showed that not everyone knew how to raise concerns. We spoke with people living in the home who told us, theres not a lot of point in moaning does not help, staff fix anything, my family would sort. The AQAA from the home told us The complaints procedure is displayed in the reception, All complaints are dealt with swiftly and effectively. The manager records any complaints raised, in the care records of people who live in the home and in a complaints file. We viewed the investigation records from several concerns that were dealt with by the manager. All the records seen showed that the concerns had been looked at and a response sent to the person complaining.. All staff have received training in protection of adults from abuse. This is part of their induction and also a separate training course. Staff spoken with had an understanding of this process and the ways in which an allegation of this nature would be dealt with. County homes have reported thirty eight allegations of abuse to Social Services. The majority of incidents reported were concerned with assaults between people who lived in the home. We spoke to the operations manager about these concerns and what action the service was taking to protect people living in the home. In some cases the persons needs have been reviewed by social services to see what additional support is needed. The operations manager told us that he is arranging training for all staff in Care Homes for Older People Page 17 of 28 Evidence: monitoring people who live in the home behaviour and developing skills in reducing any risks. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a variety of araes in the home that support people living there to choose where they would like to spend their time. Evidence: A tour of the home was undertaken and a sample of peoples bedrooms seen. On each of the three units the small corridor opposite the lounge / dining areas has been themed with different aspects. The people living in the home spoken with said, its a nice place to live and its always very clean. The AQAA from the home told us that Service Users are encourages to bring personal items from home including furniture and pictures. Bedrooms seen contained items that were personal to the individual living there and created a familiar environment for them. The Kitchen is located on the ground floor. A full cleaning schedule was available for the staff and the kitchen was clean and well maintained at the visit. The freezers and fridge were checked, the chef detailed that there was sufficient equipment available in the kitchen and any breakdowns are dealt with very quickly. County homes is a purpose built care home containing a number of bedrooms, a lounges and dining areas. Additional facilities include activities room, quiet lounges, relaxation rooms and bar arae. Most of these were well used by the people living in the home on the day of the visit. The bedrooms and corridors are decorated in a very Care Homes for Older People Page 19 of 28 Evidence: similar style and whilst in keeping with the decoration that would be in individuals own home, does not make it easy for people with short term memory issues to identify their bedrooms or bathrooms. There are gardens in a central courtyard arae that the people living in the home enjoy spending time in, particularly in the summer. Several of the staff have received training in preventing the spread of infection. When we observed staff during the day we noticed that they used protective equipment such as gloves and plastic aprons. In our tour of County homes we found that hand washing facilities were available to people living in the home, staff and visitors that would help prevent the spread of any infection. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment records are not sufficient to make sure that all staff are properly recruited and monitored. Evidence: The AQAA for the home told us that, Robust recruitment policies and procedures are followed for all new staff, interview, 2 references, POVA CRB Checks, Work Permits etc. We looked at 4 staff files and found that all of were incomplete. The home has all of their police checks done through their head office and this information is put on a computer system. This means that the manager does not see the police checks, unique numbers and the date that they were requested is not recorded in the computer . There was little evidence that POVA (protection of vulnerable adults checks)were available. Nursing staff are required to have an up to date registration with the Nursing and Midwifery council (PIN) that demonstrates that they are able to work as a nurse. All nursing staff had up to date PINs that showed that they were still registered to work as a nurse. The policy for recruiting staff is designed to protect the people living in the home. Records in the home were not clear enough to demonstrate that all staff were properly recruited. Some staff had been recruited before a police check was completed. There was no assessment of this risk or records to show that the person had worked supervised until the check was received by the manager. We sent surveys to staff and received five in reply staff told us that had concerns Care Homes for Older People Page 21 of 28 Evidence: about the amount of staff available. We spoke to the operations manager who told us that staff had recently been reduced as there was less people living in the home. He also identified some concerns with staff levels particular over weekends and will be addressing this in the future. People living in the home told us that staff are very professional. Staff spoken with told us that they had training available and were given initial training when they start in the home known as an induction. Training records were well organised and showed clearly what training staff had received. In most cases staff had up to date training, in some cases staff training needed to be updated. The manager monitors the practices in the home to make sure that staff are competent in their job roles. Training such as moving and handling and fire safety for some staff members needs to be updated as this can place both people living in the home and staff at risk. We were contacted after the site visit by the operations manager who evidence to us that further specialised training was being put into place for staff. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home makes sure that the service can support the staff to undertake their job roles. Evidence: An AQAA was sent to us before the visit which explained some areas that the service which to improve but did not included the level of plans that the manager has for the next 12 months. It is always worth including plans for development of quality and assists at the visit to make sure the we can be aware how the home plans to increase its quality. People who live in the home, relatives and staff were very complimentary about the manager. They said that they found her, supportive, always willing to listen and to make sure that care was good. As part of their own quality development the manager undertakes a variety of audits on a number of areas including care plans and medications. Further work is needed in both these areas in particular care plans. There are regular meetings help with both staff and people living in the home in order to determine their views. Staff surveys Care Homes for Older People Page 23 of 28 Evidence: told us that they all received supervision designed to look at their skills, competency and support them to develop a quality service. The service does hold some personal allowances for people who live in the home. This is funds left with them by relatives to buy items for individuals. There are clear records available that record what money was received and what is spent by the individual. Individuals can access their funds when the senior staff or the administrator is available and as such their access to their own funds is limited by the availability of certain staff. We looked at the arrangements for managing heath and safety in the home. There are risk assessments available for individual activities of the people who live in the home. Some of these had not been reviewed and in one case a risk assessment for an individual self-medicating was not available. All activities that present a risk need a plan in place to reduce the risk. In some cases risks were identified and assessed but there was no clear management plan. This was particularly noticeable regarding the level of assaults between people living in the home. Records regarding the maintenance of equipment such as gas and electricity were seen and all were up to date. This action helps maintain the safety of people living in the home. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 14 16 The menus in the home 22/05/2009 need to be reviewed in order to provide people with a tasty, nutritious diet that meets their individual choices and needs. People living in the home are at risk of not getting a diet that they enjoy or meets their needs. 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 care plans need to be reviewed. Clear instructions that cover all assessed needs need to be in place to support staff to always provide the correct support. The management of medications needs to be reviewed in order to make sure that all staff meet the homes own policy and best practice. Review the level of assaults amongst people living in the home and take action to reduce, prevent and monitor these incidents. 2 9 3 18 Care Homes for Older People Page 26 of 28 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 22 The communal areas would benefit from being redecorated in a manner more in keeping with the needs of the people living in the home. All staff files need reviewing. Missing items or lack of information needs to be made available in order that the manager can be confident that staff are suitable to support the people living in the home. Were staff start before a police check is available all recruitment, induction, references and PoVA checks need to be done first. Staff can not work unsupervised until the policy check is received. It is best practice to record how the person was supervised during this period in order to reduce any potential risks to people living in the home. Review arrangements for people to access the funds available to them that are managed by the home. Information needs to be available to people living in the home regarding interests rates, were the money is kept and how rapidly it is distributed to them once received by the service. Check risk assessments and management plans are availiable for all at risk activities and that these are kept under review. 5 28 6 34 7 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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