Care Home: East Riding

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What the care home does well The staff attended to residents in a pleasant and considerate manner. Residents told us that staff have always been nice to them when carrying out personal care tasks. The provider has been fully cooperative and committed to improving the home. Social opportunities for residents are good, there are two activities coordinators who job share the role. They attempt to provide both group and one-to-one activities for residents. What has improved since the last inspection? The actual care of residents has improved, residents told us that in the last few months they have received better care. Relatives also confirmed that this was the case. The carers are more knowledgeable about the care needs of people and had more time to carry out their role. Care records have improved. Food and fluid records are now properly kept up to date, these showed that people are receiving enough fluids throughout the day. Care plans have also improved and plans now contain enough information to enable staff to carry out care for residents. The care plans have been re-evaluated and are still undergoing some revision. Residents looked clean, they were wearing clean clothes and socks or stockings. Residents and their relatives have met with the provider and received a letter telling them of the recent problems within the home and the subsequent improvement plan. They were also encouraged to use the complaints procedure, this has resulted in a high number of complaints which have been addressed. There has been a lot of refurbishment and redecoration of the home. This has resulted in a very good improvement in the environment for residents. At the time of the inspection some work was still ongoing, there was a plan of works displayed for relatives and visitors to see. The levels of staffing have been increased. This has probably been the best area of improvement. Staff told us, and residents confirmed, that they can now spend more time with each resident. This has resulted in an improvement in some people`s challenging behaviour and overall the atmosphere is more relaxed. A senior care level has been created, this has enabled experienced carers to monitor and organise the work of other carers on their team. Staff recruitment was satisfactory, the most recent staff recruited have been properly screened before employment. Staff have received a lot of training in the last few months. Some of this has been mandatory refresher training, however they have also received training in subjects relating to care of the elderly. A new manager has been recruited for the home, at the time of the inspection he had been in post for one week. Staff, residents and relatives felt that the home had been better managed in the past few months. Those people who had met the new manager were confident that this would continue to improve. Record-keeping has improved, this includes records of complaints, health and safety, staff training, recruitment and auditing. What the care home could do better: The recent improvements in care planning needs to continue to ensure that all care records are of a high standard. The checking of medication is mostly carried out by the night staff, we have recommended that day staff are also involved in this. The new manager needs to seek registration with CQC. In one shower room and a sluice room staff had not emptied bins or tidied equipment away. This had created some odours and could lead to cross contamination or spread of infection. Staff had not received formal supervision on a regular basis. Staff should receive this at least six times per year to allow them to contribute to the development of service and address any educational or practice issues they may have. Key inspection report Care homes for older people Name: Address: East Riding Whoral Bank Ashington Road Morpeth Northumberland NE61 3AA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Thompson     Date: 2 7 0 1 2 0 1 0 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: East Riding Whoral Bank Ashington Road Morpeth Northumberland NE61 3AA 01670-505444 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: East.Riding@fshc.co.uk Four Seasons Health Care (England) Ltd care home 67 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 67 The registered person may provide the following category 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: Old age, not falling within any other category - Code OP, maximum number of places 35 Dementia Code DE, maximum number of places 67 Date of last inspection Brief description of the care home The home is a two-storey purpose built facility situated on the outskirts of Morpeth. There are no local shops nearby. The approach to the home is via a steep driveway, unsuitable for people with a physical disability. There is a good sized car park at the front of the building from which there is level access into the home. The home comprises two units. Millview Unit is situated on the ground floor and caters for older Care Homes for Older People Page 4 of 27 Over 65 0 35 67 0 Brief description of the care home persons with nursing care needs and residents who require social and personal care only. The Wansbeck Unit is situated on the first floor and has beds for people with dementia who require nursing care. Bedroom facilities are mainly single en-suite with a total of six double rooms throughout the home. Each unit has lounges and dining rooms and there are specialist bathrooms and shower rooms located on each floor. The kitchen and laundry are located on the ground floor. Stairs and a passenger lift provide access to the first floor. Information about the homes services and facilities are displayed in the entrance area. Fees for the home vary and information about fees is available at the home. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit we looked at information we received since the last visit to the home. This includes how the service dealt with any complaints, changes to how the home is run, the views of people who use the service and the managers views of how well they Care Homes for Older People Page 6 of 27 care for people. An unannounced visit was made on 27 January 2010 and the pharmacist inspector visited the home on 16 February 2010 to check compliance with medication requirements. The home was rated as 0 stars, this means that people using the service received poor quality care. CQC monitored the home using our enforcement pathways. This means that the home received a warning letter, followed by a random inspection and, in the case of medication, a statutory requirement notice. During this inspection we checked compliance with all of the enforcement requirements. During the visit we talked with people who use the service, some staff and the manager. We looked at information about people who use the service and other records which must be kept. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for and we looked around the building to make sure it was clean, safe and comfortable. Following the inspection feedback was given to the manager, area managers and operations manager who were all present throughout the inspection. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? The actual care of residents has improved, residents told us that in the last few months they have received better care. Relatives also confirmed that this was the case. The carers are more knowledgeable about the care needs of people and had more time to carry out their role. Care records have improved. Food and fluid records are now properly kept up to date, these showed that people are receiving enough fluids throughout the day. Care plans have also improved and plans now contain enough information to enable staff to carry out care for residents. The care plans have been re-evaluated and are still undergoing some revision. Residents looked clean, they were wearing clean clothes and socks or stockings. Residents and their relatives have met with the provider and received a letter telling them of the recent problems within the home and the subsequent improvement plan. They were also encouraged to use the complaints procedure, this has resulted in a high number of complaints which have been addressed. There has been a lot of refurbishment and redecoration of the home. This has resulted in a very good improvement in the environment for residents. At the time of the inspection some work was still ongoing, there was a plan of works displayed for relatives and visitors to see. The levels of staffing have been increased. This has probably been the best area of improvement. Staff told us, and residents confirmed, that they can now spend more time with each resident. This has resulted in an improvement in some peoples challenging behaviour and overall the atmosphere is more relaxed. A senior care level has been created, this has enabled experienced carers to monitor and organise the work of other carers on their team. Staff recruitment was satisfactory, the most recent staff recruited have been properly screened before employment. Staff have received a lot of training in the last few months. Some of this has been mandatory refresher training, however they have also received training in subjects relating to care of the elderly. A new manager has been recruited for the home, at the time of the inspection he had Care Homes for Older People Page 8 of 27 been in post for one week. Staff, residents and relatives felt that the home had been better managed in the past few months. Those people who had met the new manager were confident that this would continue to improve. Record-keeping has improved, this includes records of complaints, health and safety, staff training, recruitment and auditing. What they could do better: 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed, taking account of their needs and wishes, so that they can be assured this is a suitable home and receive an individual care service. Evidence: There have not been any admissions since the last inspection. The provider has decided not to admit new residents until the standards in the home have improved and that improvement has been maintained over a period of time. The admissions policies and procedures remain unchanged. There are suitable documents in place for staff to use to assess people before they are admitted. Some of these were examined for residents already in the home. They contained sufficient information to enable staff to prepare an initial plan of care for people entering the home. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care that is well planned and takes account of their diverse needs. Evidence: Four care plans were examined and two were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. Both case tracked care plans did reflect the actual care needed by the residents. Care plans have improved since the last inspection visit. Staff have worked hard to ensure that updated information is available for all residents. This has been a large task that has not been easy, therefore, there are still areas that could be better. For instance, one care plan contained very good information about the residents personal care needs however, this was written in the evaluation section and should have been written in the planning section. Another care plan contained good information that was written in the appropriate sections but the nutritional assessment was not up to date. Some work now needs to be done to ensure that all care plans are consistently written with good quality information. Care Homes for Older People Page 12 of 27 Evidence: The actual care people received appeared to have improved. We spoke to residents and relatives who told us that the care and attention they received was better. Residents said that staff now made sure that they received enough fluids throughout the day. Residents told us that staff treated them well and responded when they rang their call bells. We noted that everyone was well dressed and looked clean and cared for. We observed staff supporting residents and staff were able to demonstrate a good knowledge of the needs of those people in their care. Staff could tell us who required help with eating and drinking and were able to show us the care records that supported this. There have been several new nurses recently recruited, it will therefore take some time before the new improved care standards have a good impact on residents. Residents and relatives told us that they now felt able to voice complaints about the care, this should lead to long-term improvement. Although standards have recently improved, there needs to be a longer period of time to sustain the improvements and to demonstrate that good care can be provided. Medication records were examined by the pharmacy inspector. The records examined and practices observed during the visit, suggest that people living in the home can expect to receive their medication correctly, and as prescribed. Since the last inspection visit daily checks on all of the medication administration records (Mars) have been introduced and medication is counted and checked against records. Any discrepancies are recorded on the audit sheet and investigated, we noted that this ensured prompt action to resolve any medication issues. We examined current Mars on both floors. There were no gaps in the administration records, and where codes were used to record non-administration an explanation was given on the reverse side of the Mars. Handwritten entries on Mars were fully completed and had been signed by a second person to confirm the accuracy of the entry. Where medication had been carried forward from the previous month the quantity was recorded on the Mars. This means that the home keeps a full record of all medication and is able to check medication records against the quantity of medication remaining. There were no significant discrepancies between the quantities of medicine supplied, the number of doses administered and the quantities of medicines remaining. We saw no evidence that medication could not be administered because no supply was available and the stock control of medication was well managed. Separate Mars have recently been introduced to record the application of prescribed creams and ointments. These Mars were well maintained and contained clear guidance for carers on when and where to apply medication. The carer signs the Mars after Care Homes for Older People Page 13 of 27 Evidence: applying the medication and the Mars are closely monitored by the nurse in charge. Where medication was prescribed to be given as required there was usually written guidance with the Mars to help the nurse decide when it was appropriate to offer treatment. Checking of medication is carried out by the nurses on night duty, we advised that nurses on day duty should also be involved in this. Structural improvements have recently been made to divide the treatment room and provide separate nurses office. The new treatment room is well equipped and all medication was stored safely and securely. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead a healthy and fulfilling personal lifestyle. This takes account of their wishes and diverse abilities. Evidence: There are two staff members in charge of activities. They share the role and try to provide a mix of one-to-one attention and group activities. They support residents to use a range of services within the local community. Residents are encouraged to be in control of their own lives as far as possible. There is a broad plan of activities supported by good personal records. The records included information about residents and their abilities, which activities were undertaken, the extent of the resident involvement and how much they had enjoyed it. On the day of the inspection the activities coordinator was carrying out one-to-one sessions, one resident was painting in her bedroom supported by care staff. The residents told us that they regularly meet with the activities people to talk about what they would like to do and where they would like to go. External activities are limited due to the need for transport and extra staff support but they do happen as often as possible. Residents told us they could choose exactly how to spend their day. They said they had choices about whether they join in activities, where they ate their food and what Care Homes for Older People Page 15 of 27 Evidence: time they went to bed or got up in the morning. Residents also said they liked the food, though one resident said she would prefer a wider range of food such as Currys and European dishes. One relative thought that the evening meal was not appropriate for old people, with particular reference to dishes such as chicken nuggets and other convenience type foods. We ate the food at the home. It was well presented. The food was hot enough and tasty. The lunchtime meal was beef stew with dumplings, mashed potatoes, cabbage and carrots. The meat was tender enough for older people to eat. There was rhubarb crumble and custard to follow which was also tasty. Although residents themselves did not raise complaints about the food, they did not seem to be regularly consulted about menus. 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. People who use the service are protected from harm through thorough policies, procedures and staff training. Evidence: Staff follow the homes policies and procedures relating to the management of complaints and allegations of abuse. Staff have received training in adult protection. Residents are told how to complain through the complaints procedure. This was clearly visible within the home. Residents and relatives told us that a meeting had been held by the provider at which they were given the complaints procedure and encouraged to use it. A letter was also sent to all relatives informing them of what action had been taken to improve standards in the home, this letter also contained the complaints procedure. As a result of this, higher numbers of complaints had been received. These were well documented and the records showed that good efforts had been made to satisfy the complainants concerns and improve standards within the home. A number of safeguarding referrals have been made, some of these are still ongoing but the home is now working with the Local Authority to resolve these . 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 a safe comfortable home that is generally pleasant and clean. Evidence: A lot of refurbishment and redecoration of the home has taken place. On the day of inspection there were electricians and decorators working in the home. There is a planned schedule of works which is ongoing, this was taped to the front door to inform relatives and visitors about the upgrade of the home. The home was a lot cleaner than at the previous inspection visit. There were still some slight odours in the entrance way and one bedroom, these were on the plans to be addressed by replacement of carpets. We walked around the home and noticed it was generally tidier and better cared for, however, one of the shower rooms was untidy. The linen trolley in this room was untidy and overflowing onto the floor, the bin was full and was also overflowing onto the floor. There were cartons and bags stored in a corner. A resident told us that there was sometimes a smell coming from the sluice room opposite her, when we looked at this room we noted that it did smell, the smell was caused by a bin and separate full bin bag containing clinical waste. These were both full to the brim and should have been removed to limit spread of infections and prevent odours. The visitors toilet contained a cloth towel, these should not be used and should be replaced with paper Care Homes for Older People Page 18 of 27 Evidence: towels. Residents bedrooms did look clean and comfortable, they were well personalised and individual. Some of the bedlinen is starting to look faded and some of the towels are frayed. Most of these issues should have been addressed by the time this report is issued. They have all been identified on the action plan to improve the premises. However, there remains a need to remind staff to work in a tidy way to improve the living area for residents. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and protected through staff numbers, skill and ability. Evidence: On the day of the inspection there were enough nurses and staff on duty. Some of the nurses have left and others have been suspended, this has left a shortfall of nurses in the home. The nurse shifts have been covered by bank and agency nurses. Nurse recruitment is ongoing and it is expected that new nurses will be in place in the next few weeks. A deputy manager has been appointed, she has worked at the home for some time and is familiar with residents and staff. There were three nurses on duty and eight care assistants. We noted that staff were relaxed and friendly when caring for residents, staff told us that they had noticed an improvement in the behaviour of one resident with dementia. They believe that improvement has come about because they have more time to spend with him and can take their time when carrying out personal care tasks. Staff told us that they have done a lot of training in the past few months. Records confirmed that staff have received training in moving and handling, infection control and health and safety. They are about to do training in wound care and dementia care. More than 50 of staff have achieved NVQ level II or above. Care Homes for Older People Page 20 of 27 Evidence: We examined the recruitment records for three staff, these included one nurse and one care assistant who was on duty. Recruitment files showed that all staff had been properly screened before employment, there was evidence that the identity of staff was checked, staff were interviewed, suitable references were sought and a criminal records check was carried out. The registration of nurses check had also been made using the nurses personal identification number. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are protected through reflective management which needs some improvement to take account of the diverse needs of the service. Evidence: The home has a new manager, at the time of the inspection he had only worked at the home for a week. The new manager has been supported by a peripatetic manager who has been managing the home since the previous inspection. The new manager is experienced in management and is in the process of applying to CQC for registration. The management systems have improved since the last inspection. There were always good tools and systems of review, however these were not being used properly, this has been addressed and audits are now carried out effectively. The use of the effective audits has highlighted a number of issues that have either been addressed or are ongoing. Residents and relatives told us that communication has improved in the home but is Care Homes for Older People Page 22 of 27 Evidence: not yet as good as it could be and they were not yet confident that good communication would be sustained. Relatives told us that they appreciated the opportunity to meet with the provider recently, however they remain angry that some of the issues in the home have been long-standing and should have been addressed before now. Staff do not receive formal supervision on a regular basis. This would give them an opportunity to contribute to the running of the home and identify any training needs they might have. Servicing and maintenance agreements are in place for facilities and equipment. Risks in the environment and tasks, including safe working practices are assessed and reviewed. All fire safety checks, tests and instructions to staff are conducted at the required frequency and recorded. There were no obvious trip hazards in the home. Fire exits were clear of obstruction and all hazardous fluids locked away. There were one or two doors that did not close fully on their rebates, these are checked regularly by the handyman, but his records did not include details of whether the closing mechanisms were properly working. It is important that the doors close properly in the event of a fire. The handyman also checks emergency lighting in the home, records showed that these were checked regularly, however, when checked by an external contractor there were a number of issues identified. This could indicate that the regular checks are not being carried out properly. The management of residents monies has not changed since the last inspection. Monies are held centrally with electronic accounts. Auditing of the accounts takes place regularly. 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 26 13 Ensure all clinical waste is removed as soon as the waste bag is full. Ensure all washing areas are kept free of extra equipment and tidy at all times. Remove cloth handtowels and replace with disposable ones. Regulation 13(3) requires the registered person to make suitable arrangements to prevent the spread of infection in the home. 01/03/2010 2 36 18 Ensure staff are formally 01/06/2010 supervised at least six times per year. Regulation 18(2) requires the registered person to ensure that staff working in the home are appropriately supervised. 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 1 7 Review the consistency of care planning to ensure that the care required by all residents is clearly identified and documented. The responsibility for medication checks should be shared between nurses on night and day duty. Review menus with residents on a regular basis. The manager should seek registration with CQC. Continue to improve and review the methods of communication with residents and relatives. Review the internal checks to ensure they fully reflect all of the areas needed. 2 3 4 5 6 9 15 31 33 38 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. 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