Care Home: Devonshire Court

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What the care home does well Residents and relatives said that staff were friendly and attentive and welcomed visitors. Medication audits are in place to ensure residents health is protected. There are now more activities on offer to interest residents and so improve their quality of life. Most residents think that the food has been improved. Life history books that have been commenced and will be very useful in engaging residents in one to one reminiscence with staff and so give them stimulation and interest. The Organisation has a specialist in dementia care who is available for advice. Residents were satisfied with how their bedrooms were organised. Some bathrooms have been refurbished to improve the bathing experience for residents. The access and range of training available to staff has been improved to reflect the needs of people living at the home to ensure that the care people receive meets their needs. What has improved since the last inspection? Residents are swiftly referred to medical services if there is a potentially serious injury. There is a detailed and varied Activities Programme. Staffing levels have been increased. What the care home could do better: Residents welfare could be more effectively met by ensuring that: Assessments contain all aspects of individual needs to make sure staff can meet those needs from day one of a persons admission. All aspects of care e.g. proper toileting programmes, stated dates of health checks, a full record of daily living wishes etc are detailed in Care Plans to assist staff to meet all residents needs, that medication recording is always done after issuing it to residents and that relevant medications are kept at the correct temperature. An environmental audit is recommended to identify how to make facilities better signed for residents with dementia etc. Facilities issues need to be attended to quickly to provide an attractive home for residents by way of improved decor and flooring and that facilities for residents for disabilities mean that they have full access to these facilities. Staffing levels for busy times needs to be fully in place so that residents needs are swiftly attended to.Effective fire safety needs to be in place as quickly as possible by making sure identified action is installed to ensure fire safety to facilities. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Devonshire Court Howdon Road Oadby Leicestershire LE2 5WQ     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: Keith Charlton     Date: 2 6 0 6 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 29 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 29 Information about the care home Name of care home: Address: Devonshire Court Howdon Road Oadby Leicestershire LE2 5WQ 01162714171 01162717201 bbethell@rmbi.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Royal Masonic Benevolent Institution care home 67 Number of places (if applicable): Under 65 Over 65 67 67 67 67 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 0 The maximum number of service users who can be accommodated is 67. The registered provider may provide the following category of service only:- Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Physical Disability (over 65) - Code PD(E) Dementia (over 65) - Code DE(E) Mental Disorder (over 65) - Code MD(E) Date of last inspection Brief description of the care home The last key inspection was on 28/7/08. Devonshire Court is a large traditional care home built on a four and a half acre site. Care Homes for Older People Page 4 of 29 Brief description of the care home Built in 1966 and situated on the outskirts of the City of Leicester and in the residential area of Oadby, the home is close to the Leicester racecourse. It is within easy reach of the City by public transport or car. Wigston is also close by. The home is owned by the Royal Masonic Benevolent Institution (RMBI). It is a registered charity and offers accommodation to older Freemasons with nursing, residential or mental health needs. A separate unit accommodates older residents with mental heath needs. The registered provider also offers respite facilities. The home has sixty seven single en suite bedrooms. Internal communal facilities include one large lounge and several quiet lounges on each floor. There are also two conservatories giving access to the patio area. A communal dining area is on the ground floor. The home has mature gardens, which include a bowling green and patio areas. The registered provider has a minibus for outside trips. Residents may use the extensive facilities, which include a functions room, hairdressing room and chapel. The registered provider has installed voice messaging lifts, specialist signs and equipment to ensure that residents needs are addressed. The weekly fees range from #499 to #798 per week - the Registered Manager provided this information on the day of the inspection. There are additional costs for expenditure such as hairdressing, private chiropody, toiletries, newspapers, etc. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 quality rating for this service is Two Stars. This means the people who use this service experience good quality outcomes. We as it appears throughout the Inspection Report refers to The Care Quality Commission. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment, ( AQAA), which is selfassessment tool completed by a representative of the service and looking at the last key Inspection Report of 2008. We have sent surveys to people who use the service along with staff. We received twenty two of these surveys - a high proportion. Whilst Care Homes for Older People Page 6 of 29 the majority of comments made were positive there were also comments made which will be included in the Report which management need to consider, mainly regarding the food and staffing issues. The unannounced site visit commenced on the 26th 2009 and was carried out by Keith Charlton. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Devonshire Court. Four residents were selected. Discussions were held with nine residents, two visitors, the Manager and Deputy Manager, and four members of staff. What the care home does well: What has improved since the last inspection? What they could do better: Residents welfare could be more effectively met by ensuring that: Assessments contain all aspects of individual needs to make sure staff can meet those needs from day one of a persons admission. All aspects of care e.g. proper toileting programmes, stated dates of health checks, a full record of daily living wishes etc are detailed in Care Plans to assist staff to meet all residents needs, that medication recording is always done after issuing it to residents and that relevant medications are kept at the correct temperature. An environmental audit is recommended to identify how to make facilities better signed for residents with dementia etc. Facilities issues need to be attended to quickly to provide an attractive home for residents by way of improved decor and flooring and that facilities for residents for disabilities mean that they have full access to these facilities. Staffing levels for busy times needs to be fully in place so that residents needs are swiftly attended to. Care Homes for Older People Page 8 of 29 Effective fire safety needs to be in place as quickly as possible by making sure identified action is installed to ensure fire safety to facilities. 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Devonshire Court have had their needs properly assessed before moving into the home so that staff can meet their needs. Evidence: Residents said they had been provided with sufficient written information prior to admission to make up their minds about the home. I got some information about the home but I have known about it for years anyway so I knew what to expect, one resident said. We case tracked a person living in the home who had moved into Devonshire Court in the past. We checked that she had received information to help with the choice of home. We also checked that this person had her needs properly assessed prior to moving in, to ensure that the staff at the home could meet her needs and we found that the assessment system was detailed though past health checks had not been Care Homes for Older People Page 11 of 29 Evidence: included, which is useful so as to prompt these checks and improve the health and daily quality of life for people. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Devonshire Court receive good health and social care practice. Evidence: Residents and visitors said that staff provided friendly and sensitive personal care: Staff are really friendly and care about us, said one resident. In surveys there were seven comments that staff usually listen and act on what residents say. One comment stated, Some staff seem indifferent in their attitude towards residents. Another stated, the majority of agency staff do not seem as caring as permanent staff. Management need to consider how to progress this issue by way of supervision, training etc. Residents spoken with could recall having a care plan and said they could see it if they wanted, which makes sure the care supplied to them is right. Records showed that residents can be involved with their own care planning to make sure it is correct and meets their needs. Care Homes for Older People Page 13 of 29 Evidence: We checked the care plans of four people living at the home who were case tracked. Plans showed detail regarding the support required by staff to ensure the physical health of people living at the home, what personal care they needed, and there was information to inform staff of the residents personal history, but no information of preferred daily living routines of residents to ensure their social and emotional well being is fully supported. Some Plans showed that a referral to a specialist nurse has been done to work out the individual continence needs of residents, but there was no information showing the individual needs as to when people need to go. Staff said that there are set times for toileting, though residents can also alert staff and be taken between these times. A resident said that there were times in the morning when getting up and after breakfast where residents have to wait for up to an hour to have their needs met. There were gaps on health check recording insofar as appointments for sight and teeth had not been recorded so that residents could have waited unnecessarily long before having these appointments and been prone to falls, discomfort etc. Staff said they were asked by management to read Care Plans and that they had done this and they used the plans to refer to as needed, so that they can fully understand and act on residents needs. Accident records were checked and medical services were contacted when residents had potentially serious injuries. We checked the medication records, and found that there was good recording of the administration of the medicines in the home, with only one gap. A staff member had signed before issuing medication to residents, which could have meant that it was signed as taken when it had not been, which has possible implications for residents health. She acknowledged that this was a one off occasion and not the procedure she should have followed. Fridge temperatures for medication were found to exceed the maximum on occasion with no indication that action had been taken to lower this and so preserve the integrity of the medication. The Deputy Manager said that this would be followed up. There was good information on medication sheets regarding allergies, as needed medication etc so that residents health is protected. Staff and management said that only trained staff issued medication and that they had to pass in house and pharmacy training before they could do this. Controlled medicines storage was in a secured cabinet. The Deputy Manager said that an up to date storage cabinet is being ordered which conforms to the latest legal requirements. Care Homes for Older People Page 14 of 29 Evidence: We spent time watching staff interact with people living at Devonshire Court. We saw staff being friendly and caring to people throughout the day with residents confirming that staff respected their dignity and privacy by knocking on bedroom doors etc. There was one occasion where it appeared a resident was being lifted instead of being appropriately moved. The Manager said this would be followed up. Staff were seen to assist residents in various ways - giving choices for breakfast, encouraging residents in activities etc. There were a number of comments in surveys that residents should be offered more baths or showers. This needs to be considered. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are many opportunities for residents at Devonshire Court to have a relaxed lifestyle of their choosing. Evidence: Residents said that they were satisfied with the current activities. A resident said: There are activities most days so we can join in when we like. We spoke to the full time Activities Organiser and we saw that there is a current list of activities. We saw the Activities Organiser going around doing one to one activities with residents and there was a poetry session in the afternoon. The Manager said that she is also recruiting for a part time Organiser to supplement what is already going on. The Activities Organiser said she is to attend specialist training (however this does not specifically focus on activities for people with dementia - which would be useful as well). Residents said they had lots of games and quizzes, there were trips out, church services, they watched TV, we witnessed age appropriate music being played in a Care Homes for Older People Page 16 of 29 Evidence: lounge and residents said staff took them out to the garden in good weather etc. The Activities Organiser stated that there is a regular five times weekly activities - this was displayed on a noticeboard with pictures of the activities. We saw that the home produces a regular detailed and well set out newsletter to keep people up to date with relevant news about the home. A visitor said that her friend did not like to take part in activities and this wish is respected. Life history books have been given to residents in the dementia unit so as to gain information for staff to do one to one reminiscence with residents - at present residents have photos from their past that staff can use for this activity. The Deputy Manager said that Memory boxes had also been ordered so as to provide stimulation for residents with memory difficulties. The relations between staff and residents were observed to be relaxed. Residents said there were no rules. The home supports residents with dementia with staff training on this having taken place and the organisation has a dementia specialist that management can refer to for advice, and there was displayed information on dining tables for reference to what food is being served that day etc. The Deputy Manager said that the home can call upon specific advice from Head Office regarding dementia. Issues such as signing the environment and colour coding for decor and flooring are to be acted on in the short to medium term. Visitors are welcomed at Devonshire Court and we were informed by a visiting friend that she could come at any reasonable time and she was always greeted in a friendly way by staff. Residents largely said they enjoyed the food: The food is better now and we always get a choice, one resident said. Most residents said that the food was good. There were a small number of comments that the food was bland on occasion. There were comments in surveys - that staff need more training in the dining room, there should be rotation in serving meals, and the home should stop using cheap foods. These comments need to be considered by management. We tasted the lunch time food and whilst the vegetarian meal tasted bland, the fish and chips and a homemade dessert were tasty. The Deputy Manager said that food is kept under constant review as management also eat at the home. We recommended that the cook always take part in residents/relatives meetings to answer queries regarding the food. Lunch was a choice of two hot dinners followed by a choice of dessert. Two vegetables were served - this choice showed a commitment to healthy eating. Food records showed a good variety of traditional food served. Care Homes for Older People Page 17 of 29 Evidence: Residents were seen as being helped to eat food and there were a number of special diets available - soft, pureed etc and staff assisted residents to eat. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are listened to and protected from abuse. Evidence: Residents said if they had a complaint they were confident that the staff or Management, would sort it out. A resident said, I think that they would do something if I was unhappy about anything. A relative said that she felt comfortable voicing any concerns to management and that she was always welcomed to do so. We saw that there had been complaints since the last inspection in the complaints book, which were properly looked into and investigated by management. The Complaints procedure gives people the choice to go to the home or to the Lead Agency, the Social Services Department. We talked to staff to find out how much they knew about protecting people in the home from abuse. Records showed they had received training about safeguarding adults from abuse, and they knew the in house procedure, and Agencies to whistle blow to if the in house procedure failed. We looked at the staff recruitment records to see whether all the proper checks had Care Homes for Older People Page 19 of 29 Evidence: been made on staff at Devonshire Court and legal checks were in place to help management reach the judgement that people were safe to start employment. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Devonshire Court live in a homely environment, though this is showing signs of wear and tear and needs to be upgraded. Evidence: All residents spoken to said they liked their bedrooms: Domestic staff are very good and keep my bedroom clean and tidy, one resident said. There were some comments that the home was beginning to look run down. The Deputy Manager said that this had been identified by management and Head Office had given the approval for refurbishment. This had begun and so far two bathrooms had been refurbished. We saw that some carpets were heavily stained, e.g. in the conservatory and corridor in the dementia unit, and need replacement. The home carried out a survey in 2008 and residents commented that rooms are in need of upgrading (the Manager stated that twelve sets of curtains have been changed), bathrooms are scruffy and in need of updating, better lighting is needed in the dining room (the Deputy Manager stated that this was to be carried out), the homes decor needs to be upgraded, that areas are not always clean (the Deputy Manager stated that there is to be another twenty hours of domestic time to be available though the home was usually very clean). Care Homes for Older People Page 21 of 29 Evidence: There was one comment who said that the basins and soap dispensers in communal bathrooms were not positioned correctly so wheelchair users could not use them. There was another comment that the conservatory got very hot and needed blinds fitted to cool it down as it was a nice place to sit. The furnishings in communal areas are homely, and people said that they were encouraged to bring their personal possessions into their bedrooms. The Deputy Manager said the service is to review signs around the home to improve the environment to further help residents with dementia, e.g. colour coding toilet doors, pictures of residents favourite scenes on bedroom doors etc to make facilities clearer, and orientate residents to go to their own bedrooms etc. Records show that the home is well maintained, and good measures are in place to keep the home hygienic. There were no odours. There are radiator covers fitted throughout to ensure that residents are protected from burn risks. Residents said they loved sitting or walking in the large gardens and appreciated the garden. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by a competent staff group though staffing levels need to be reviewed and increased as needed to meet residents needs. Evidence: There were some comments from residents there were not enough staff to meet their needs: You have to wait such a long time to get staff to come and take me to the toilet in the morning sometimes, and After breakfast there are a lot of people that need to transfer from wheel chair to easy chair and they have to wait a long time - up to an hour sometimes, another resident said. We saw the rota staffing is one Nurse plus eight to nine care staff during the day/evening with four awake staff at night. Staffing in the dementia unit is three care staff during the day/evening with two awake staff at night. Domestic staff work to 1.00pm. As the staff have to deal with a large number of high dependency residents who need the help of two care staff and there were over fifty residents in the main home at the time of the inspection this means that care staffing at certain times does not seem to be sufficient to meet peoples needs. We spoke with the Deputy Manager about the staffing and asked her to ask the Manager to review this situation and act as needed. The home carried out a survey in 2008 and residents commented that there is not enough staff on duty (the Manager stated that there has been increased staffing Care Homes for Older People Page 23 of 29 Evidence: and it had increased twice in the past year - staff in the dementia unit confirmed this was the case for PM periods). Regarding domestic staff they are shown in the staff rota seven days a week though only until 1.00pm. This needs to be reviewed as it means that care staff have to deal with accidents/spillages in the afternoon/evening (the Deputy Manager stated that there is to be another twenty hours of domestic time to be available). A staff member said that she had been encouraged by management to do further training and was looking forward to doing a NVQ 3 course in the future and had already completed a number of training courses and a thorough induction. From information obtained from the Manager we saw that there are over 50 of staff with NVQ qualifications.The Deputy Manager stated that all staff have this encouragement and this has been extended to all other staff as well - domestic, catering and administration staff. We found that staff have been on a number of training events to help update their practice on areas such as Dementia, Palliative Care, Medication, Diversity, First Aid, Sova, COSHH, Health and Safety,Moving and Handling, Fire Safety, Infection Control etc though some issues regarding residents health conditions were missing from the Training Matrix we saw - e.g. Mental Health conditions (the Deputy Manager said that a qualified Nurse would be doing this training), Sight and Hearing Impairment, Stroke etc. We asked that these topics be added to the training programme. Staff records showed that proper checks had been carried out to protect residents from unsuitable staff. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are management systems in place to protect the health and safety of residents. Evidence: Beverley Bethnal is the Registered Manager of the home, who is a Registered Nurse and has completed the RMA Award in management skills. Bev said all the management team have achieved this award. Residents were positive about the management of the home.Everything seems to run smoothly in general and we can go to meetings to put forward our views if we choose, one resident said. We talked to the Deputy Manager regarding the need to make Deprivation of liberty referrals if for any reason residents are deprived of their liberty to ensure that this is given approval due to their best interests. Satisfaction questionnaires were sent around the home last year, and the results were seen to be generally very positive, though they did not contain an analysis of the Care Homes for Older People Page 25 of 29 Evidence: results to see if improvements in the service were needed, e.g. facilities, staffing etc so as to feed back to residents so they know they have a part and effect on the running of the home. Written records regarding finances for residents are properly in place, and monies were checked for two residents and totals were found to be correct. It was recommended there be a running total to prove the balance. Residents/relatives are supplied with monthly account details. There was evidence of residents and relatives meetings discussing relevant issues activities, food etc, which showed their involvement in the running of the home though they also did not contain an analysis of the results to see if improvements in the service were needed, e.g. facilities, staffing etc to feed back to residents so they know they have an effect on the running of the home. Safe working practices were observed as we went around the home - e.g. e.g. instruction for staff to wash hands to prevent infection, proper transfer of residents from wheelchair to easy chair, staff using bacterial liquid etc. Staff informed us that they were able to tell management of the problems they were facing and there were regular meetings and supervision to support them, which we saw as being detailed and well kept. There are proper Health and Safety systems in place in the home. We saw risk assessments for safe working practices and COSHH assessments to keep residents and staff safe. Proper fire records were in place with regular fire drills. Staff were asked about the fire drill procedure and they all knew what to do. Management have identified needed improvements to the fire system in the Fire Risk Assessment, which need to be actioned quickly. There was a Health and Safety folder with Risk Assessments completed in a systematic preventative way. We tested the hot water and found it met the National Standard so that residents are not scalded. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 contain residents preferred lving wishes, records of past health checks and individual details of assessed continence needs. Medication needs to be signed after it has been taken by residents and action recorded if fridge temperatures are not at the proper level. Management need to ensure that the refurbishment of the home takes place as soon as possible and that facilities need to be reviewed to ensure they are suitable for residents with disabilities. Management need to make Deprivation of Liberty referrals where needed. Improvements to the fire system must be carried out as soon as possible. 2 9 3 19 4 5 31 38 Care Homes for Older People Page 28 of 29 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. 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