Care Home: Eastbourne Grange

What the care home does well The home provides personal care for older people in a pleasant, clean and well maintained home. All prospective residents receive thorough preadmission assessments followed by comprehensive care planning; thus ensuring a good standard of delivery of care. Residents said that there are sufficient leisure activities provided for their needs and one survey said that they had been on a trip to the local craft centre and cafe. The majority of residents enjoyed the meals provided by the home. Menus showed that the home provides a balanced diet of home cooked food which offers choices at each meal. The cook is aware of the resident`s particular likes and dislikes, and ensures that these are catered for. The home encourages staff training, with 50% of the staff having attained the National Vocational Qualification level 2 in care. Staff spoken with said that the home is always well staffed and rarely have to use agency staff. What has improved since the last inspection? The home has complied with the requirement made at the last inspection which was to ensure that risk assessments were in place for all areas of the home, and these have been reviewed on a regular basis. Hot water temperatures to resident`s outlets are now regularly monitored and recorded; therefore ensuring that residents are not put at risk of scald injury. What the care home could do better: Immediate requirements were made relating to the provision of a means of ensuring that a resident`s door closes on activation of the fire alarm, and providing a window restrictor for the window of another resident`s room. Subsequent to the inspection the manager gave assurances that these had been complied with. Two members of staff were employed prior to the receipt of written references a requirement has been made. It is recommended that the manager undertakes training in Deprivation of Liberty Safeguarding and the Mental Capacity Act. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eastbourne Grange 2 Grange Gardens Blackwater Road Eastbourne East Sussex BN20 7DE     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: Elizabeth Dudley     Date: 2 2 0 5 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 31 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 31 Information about the care home Name of care home: Address: Eastbourne Grange 2 Grange Gardens Blackwater Road Eastbourne East Sussex BN20 7DE 01323733466 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) : eastbournegrange@btinternet.com Mrs Patricia Pearce care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 25. The registered person may provide the following category/ies of service only: Care home only - (PC) 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 (OP). Date of last inspection Brief description of the care home Eastbourne Grange is a care home providing care for up to twenty-five (25) residents over the age of sixty-five (65). Nursing care is not provided at this establishment. There is a pleasant garden at the rear of the building. There is limited parking at the home, however there is free parking available in adjacent streets. Eastbourne Grange is a large semi-detached house in a quiet residential area of Eastbourne, close to the seafront, town centre and local amenities. There is access to public transport in the town. Rooms are located over three floors, with some mezzanine floors within the home. There is a passenger shaft lift available to assist residents to access all areas of the Care Homes for Older People Page 4 of 31 Brief description of the care home home. Fifteen rooms are for single occupancy and there are five double rooms. All rooms have en suite facilities. There are four communal toilets located throughout the home. There is one assisted bath and one assisted wheel in shower for residents to use. There are two lounges and a spacious dining area. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on the 22nd May 2009 over a period of five hours, and was facilitated by the registered manager, who is also the owner of the home. During the inspection a tour of the home took place, and records and documentation relating to care planning, medication, catering, health and safety records and personnel files, was examined. Whilst all residents were seen at the inspection, nine residents were spoken with in depth and discussions held with two visitors and four members of staff. Care Homes for Older People Page 6 of 31 Three residents were case tracked, which means their resident journey through the home was examined. This included their preadmission assessments, care plans and medication charts. These were examined, and discussion held with them to ensure that they received sufficient information before coming into the home, and that their time in the home was meeting both their needs and expectations. Prior to the inspection the home sent us their Annual Quality Assurance Assessment, (AQAA), which is a document required by regulation, and informs us of what has been achieved in the home in the past year, and what their plans are for the coming year. This was received within the timescale it was required. Surveys were sent out to residents and staff and six residents and five members of staff, returned these. Comments received were generally positive. Thanks are extended to those who took the trouble to respond as these are of great value in the inspection process. Comments received, both in surveys and during discussion with residents and staff included: I am satisfied with my care. Staff are always available and we often have activities. I am always aware of these, and it is my choice whether to attend. I think the meals are very good, we have a good choice, and I am never hungry. I know how to make a complaint and would speak with the manager. I am satisfied with everything and I am able to speak for myself. Love it here the staff are very good and its excellent food. I am so happy I chose this home, the food is good, the staff excellent, what more could I ask for? And they took us out to the local craft centre; it was lovely. I like working here very much. Thanks are extended to the residents, vistors, staff and management for their help, hospitality and courtesy during the inspection. Current fees as given to the commission on the 22nd May 2009 range between three hundred and ninety five and four hundred and thirty five pounds per week. Extra services such as hairdressing and chiropody are not included in the fees, and charges for these are available from the manager. The last key unannounced inspection took place on the 24th July 2007. What the care home does well: What has improved since the last inspection? 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 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 Care Homes for Older People Page 8 of 31 7535. Care Homes for Older People Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive sufficient information about the home to enable them to determine whether the home can meet their needs, and to provide them with a quality of life that meets their expectations. All prospective residents have a preadmission assessment. Examples of these showed that they are comprehensive and include sufficient information to inform the care planning process. Evidence: Prospective residents receive a copy of the Service User Guide, Statement of Purpose and general information pack on enquiring about the home. Both the Service User Guide and Statement of Purpose are reviewed regularly and meet the regulations. Existing residents receive copies of these reviewed documents. Care Homes for Older People Page 11 of 31 Evidence: Once admitted, residents receive a contract and Statement of Terms and Conditions, this applies to both residents who are funded privately, or by the local authority. Contracts are in line with the National Minimum Standards and associated regulations. Prospective residents are encouraged to visit the home and may join the other residents for lunch or tea. Preadmission assessments, which are undertaken by the manager or her deputy, take place either when the prospective resident visits the home, or in the persons place of residence. These enable the manager and prospective resident to be confident that the home is able to meet the individuals needs and expectations. The prospective resident receives written confirmation of whether the home can meet their needs. Samples of three preadmission assessments were examined. These were comprehensive and included an assessment of the persons personal health and social care needs together with other relevant information. Information gained at the preadmission assessment is used to form the basis of the individuals care plan. The home accepts people for respite and permanent care but not for intermediate care. Care Homes for Older People Page 12 of 31 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. The standard of care planning ensures that the delivery of the care given to residents meets their assessed needs. The standard of medication generally safeguards the residents. Improvements to the storage and recording of administration of controlled drugs will ensure that residents are fully protected from medication errors. Evidence: During the inspection five (25 )of the care plans were examined. These belonged to the residents whose preadmission assessments had been seen, and a further two residents who had been in the home for a number of years. The standard of care planning was generally good, and whilst fully reflecting the personal, health and social care needs of the individual, showed that the residents preferences had been considered Care Homes for Older People Page 13 of 31 Evidence: Plans of care were in place for each individuals assessed need i.e. continence, nutrition mobility. Actions taken to address these needs were in place with, in most cases, clear directions for the care staff in delivery of the care. In some areas more direction was required; i.e. the cleansing and application of a hearing aid, or the size and type of continence aids required. Night care plans required more information regarding what care was required during the night for example how often checks are required and any specific times or reasons for waking during the night. Staff must ensure that care plans are signed on completion, and also formed and reviewed in consultation with the resident or their representative, and evidence shown of this. Although the home does not use the Malnutrition Universal Screening Tool (MUST)(a care tool for assessing the persons nutritional needs), all residents are weighed on a regular basis and actions taken to address any change. Daily records need to be consistent, although written up on a daily and nightly basis the amount of information was variable. Staff should be writing up any changes to care or any GP instructions in the care plan, and only detailing in the daily records which care plan they have followed or what care was given. There was evidence from both care plans and discussion with residents that GPs and other health and social care professionals are contacted promptly, and residents said that staff answered their bells quickly and were usually available as required. Residents said that they were well cared for and privacy and dignity respected: I am looked after very well here . Very good attention given. I havent been here long but its marvellous, I have got used to being looked after. Im an ex nurse and I must say that they really do look after me very well indeed; remarkably patient and kind to everyone. Two visitors spoken with were happy with the way that their relatives were cared for; one described the home as A very happy contented place. Another said Its a relief to me to know that my (relative) is well cared for as I live abroad. Medications are only administered by staff who have the appropriate training. All medications have been signed for following administration. Medications are supplied in a prepacked blister cassette from the supplying pharmacist. A recommendation was made at the last inspection that a running total be kept of a Care Homes for Older People Page 14 of 31 Evidence: medication that is required by pharmaceutical regulations to be used as a controlled drug in care homes. There was no evidence that this had been done, although the manager said that in the other Medication charts this had been addressed. As the home has a resident who has recently commenced a controlled drug the home must keep a controlled drug register and a controlled drug cupboard, which meet the regulatory specifications. Subsequent to the inspection the manager informed us that the register is now in place and the cupboard ordered. Therefore no requirement has been made. Residents who self medicate have lockable storage for their medications and are regularly risk assessed. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The scope of the activities and standard of catering provided satisfy the expectations of the majority of the residents in the home. Evidence: Leisure activities provided within the home take place once or twice a week and are facilitated by the staff. There is an activities programme, and activities include quizzes, bingo, reminiscence, one to one shopping trips, and visiting entertainers. Outings to places of interest are provided once or twice a year, and a survey received from a resident said that they had recently been out to a local crafts mill. Surveys from residents stated that there were sufficient activities provided, although some said that they preferred not to participate. Every year the home includes a themed week in the activities programme, in which all members of staff and residents participate. In a previous year they decorated the lounge and dining room to resemble a cruise ship, and visited a different port every day. This year the theme is a trip to America; and plans are in place to accomplish Care Homes for Older People Page 16 of 31 Evidence: this. Whilst most residents are able to take themselves out and about the town, one resident said that they would like more outings. A monthly newsletter which goes by the name of EGG (Eastbourne Grange Gazette) is produced; this includes contributions from both residents and staff. Residents spoken with said that they can make choices around activities of daily living. Times of rising and retiring are flexible and according to the individuals choice, as is the serving of breakfast Residents said that they can have their friends or family to visit at any time and visitors can stay for meals if they wish. Two visitors were spoken with during the inspection and they said that they were always made welcome and that the home communicated well with them about their specific residents. A local religious group holds services once a month and a minister of religion visits at Easter and Christmas. Ministers of religion are accessed for residents as required, and residents are assisted to attend church if they wish to do so. The home provides a varied and nutritious menu with choices provided at each meal. There was plenty of fruit and vegetables in the home and these were incorporated into the menus. Generally residents were satisfied with the standard of catering: Excellent food far better than my friend had on a cruise she went on with a well known company. Its a varied menu, with a choice of food, and the chef is very good when you dont feel well, he tries to tempt you with something. Food very good, beautifully cooked, there is a good variety and they really change the food around. We always get a choice. Generally food is very good. Very, very occasionally, things are brought to table that are, to my mind, not fit to eat, so I tell the cook. I like the food I enjoy it all . I am thoroughly pleased with this place. However three residents expressed dissatisfaction with the supper menu. This was looked at and found to offer a full meal of soup, a cooked option, sandwiches and dessert. Residents are able to have the whole, or part, of this menu every evening. All Care Homes for Older People Page 17 of 31 Evidence: of the menu was home cooked, with convenience food, such as baked beans, only occurring around once every couple of weeks. The cook said he will always cook something different if a resident requests this. Two residents said that supper was too early. The manager says that she discusses the time of meals and the menu with residents at residents meetings and these have been reviewed in line with majority wishes. Documentation and records required by the Environmental Health Authority were in place, and catering staff have the required training and certificates. Care Homes for Older People Page 18 of 31 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 aware of how to make a complaint; and if this was required, would feel confident that it would be addressed in an open, transparent, and non judgemental manner. Staff receive annual training in adult safeguarding, and were aware of their responsibilities in safeguarding those in their care. Evidence: There have been no complaints or adult safeguarding issues received in the past twelve months, either by the home or by the commission. The home keeps records of any minor concerns and how they have been dealt with. Surveys received showed that residents were aware of how to make a formal complaint, but would generally bring any complaints to the manager in an informal manner. Discussions with residents identified that they would be comfortable with making a complaint, and confident that it would be dealt with in an open and transparent manner. The complaints procedure is available in the Service User Guide and displayed in areas around the home. Staff were aware of what constitutes adult abuse and were aware of their role in the Care Homes for Older People Page 19 of 31 Evidence: safeguarding of those in their care. They have had recent adult safeguarding training and this is renewed annually. The home does not have a copy of the recent Multi Agency Guidelines although it has copies of the reporting protocols. It was recommended that the manager obtains a copy of this and she gave assurances that she would do so.Subsequent to the inspection the manager informed the commission that she has applied to the local authority and they are in the process of sending her a copy. Care Homes for Older People Page 20 of 31 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 clean, comfortable and well maintained home, however there are some issues which could impact on the control of infection. Evidence: The home is pleasant and well decorated, and communal accommodation consists of a first floor lounge and another small seating area, a separate dining room is accessible by shaft lift. There is a garden to the rear of the home, which also gives entrance to a communal garden belonging to the properties in the road. The lift has a two-way access that enables residents to access parts of the building that have a mezzanine floor, and prevents them from having to negotiate the steps. Maintenance within the home is generally good, although some ongoing maintenance is required in some parts of the home, e.g. door handles not working and automatic door closures (not fire closures) not working. Residents said that since the fire lecture the day before the inspection staff are slamming the kitchen door and described this as really annoying . This was discussed with the manager. There is a programme of maintenance and redecoration, and a maintenance person is Care Homes for Older People Page 21 of 31 Evidence: employed by the home. Residents accommodation is over three floors, and consists of fifteen single and five double rooms, all with en suite facilities. The home currently uses the double rooms as large single rooms. Residents are encouraged to bring their own possessions into the rooms. Although all rooms had lockable doors and lockable drawers and cupboards, only one of the residents spoken with had a key to their room. Another resident said she would like one. The manager said that a few people had keys, but gave assurances that she would determine the amount of residents who wish to have one, and provide these within the auspices of risk assessment. Hot water temperatures in resident areas are now being monitored and recorded, and these fell within recommended parameters. The manager should ensure that these maintain within the higher reaches of the permitted parameters to ensure resident comfort. The home has two assisted bathrooms, both with bathing chairs, and rooms have en suite facilities consisting of WC and washbasin, with five rooms either having an en suite bath or assisted shower. During the tour of the home it was seen that staff are leaving toiletries in communal bathrooms which could put residents at risk by ingestion and also impacts on their choice. These must not be left in communal spaces. Residents have sufficient equipment, which includes hand rails, raised seats, and moving and handling equipment, to enable them to maximize their independence. The home has infection control policies, although these need updating, and the majority of the staff have attended infection control training. However, the top floor bathroom has a chipped toilet seat and the underside of the bath seat requires cleaning, and cloth towels are being used in the downstairs toilet. These factors could cause a spread of infection and should be addressed. Care Homes for Older People Page 22 of 31 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. Whilst there are sufficient numbers of staff employed with sufficient training to meet the needs of the residents in the home, some aspects of staff recruitment could put residents at risk. Evidence: The staffing rota, and discussions with staff, showed that there are currently sufficient staff on duty over a twenty four hour period. Staff said that: We have enough staff on all the time, and if anyone of the residents needs more care the manager brings in more staff. We are always willing to cover for each other so we dont often use agency. There are always sufficient staff. I cant recall ever being short. The manager is very much hands on in the house. Although residents said that Staff appear rushed and I think there should be more staff, this was not supported by observation on the day, staff discussion or by the duty rota. There is only one member of waking night staff. They are supported by a member of the managers family who sleeps in the flat on the top floor. The manager must keep this arrangement under continual review. Care Homes for Older People Page 23 of 31 Evidence: Four members of staff were spoken with and they said that there was sufficient training including mandatory training provided. One stated The manager encourages training outside the home, such as Dealing with Challenging Behaviour. Staffing records showed that staff attend regular mandatory training including fire safety, moving and handling and safeguarding of adults training. Some members of staff have attended other training which includes Dementia Care training and Infection control training. 50 of the staff have attained the National Vocational Level 2 Qualification in Care and another member of staff has commenced training for this. Whilst the manager is using the recognised Skills for Care induction training for staff, this does not commence until they have been in employment three months, with staff using the in house induction course during this time. One recently employed member of staff said that she had not had any induction training. The manager must ensure that all staff have some form of induction training, preferably the recognised course, at the commencement of their employment. Three personnel files were examined. However, whilst all documentation was in place, it was noted that two members of staff had commenced prior to a second written reference having being received. This puts residents at risk and a requirement has been made. All staff receive the General Social Care Code of Conduct on commencing at the home. The manager gave assurances that members of her family who provide the sleep in duty now have the Criminal Records Bureau check. However her son does not currently have this, and this must be applied for if he is to continue to spend time at the home. The manager must also ensure that he has reached the permitted age before he is allowed to assist in any care ,matters. Care Homes for Older People Page 24 of 31 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. Whilst management systems in the home generally support the residents and staff some areas within the home may put residents at risk Evidence: The registered manager, who is also the registered provider, is a first level registered nurse and has the Registered Managers Award. Residents, visitors, and staff spoke of the relaxed atmosphere in the home. Residents said that The staff are very good. Very helpful, always cheerful and polite, and very caring. Visitors said that both the staff and management communicated well with them and always informed them if there were any concerns with their relative or friend (resident). The Annual Quality Assurance Assessment (AQAA), required by regulation, which informs the commission of what has taken place in the home in the past twelve Care Homes for Older People Page 25 of 31 Evidence: months, and of plans for the next twelve months, was received when we asked for it: and gave accurate information about the home. The home runs its own Quality Monitoring Process, and this includes the monitoring of the services offered by the home and the assessment of risk. It reviews services offered and amends them if required, in accordance with residents views. Residents views are gained by questionnaires and residents meetings, which are held six monthly. Staff meetings are also held at regular intervals. The home does not hold any monies for residents, or act as appointee for any resident. Staff receive regular supervision at intervals as directed by the National Minimum Standards, and supervision records were seen. Neither the manager nor the staff have received training in the Mental Capacity Act or Deprivation of Liberty Safeguarding although the manager is aware of the implications of these acts. It is recommended that this training takes place in the near future. Some of the policies and procedures which direct the staff are in need of review to include current practice and research. Amongst those needing review are infection control and safeguarding. The manager is aware of the policies which require review and gave assurances that this would be done. Certificates of service for equipment and utilities were in place and in date. Risk assessments are in place throughout the home including personal risk assessments for residents. The manager is recommended to seek advice on the Fire risk assessment from the local fire authority. Staff have received mandatory training in the past year. Some staff did not attend the last fire training and the manager must ensure that they attend this, and are aware of their responsibilities to the home, themselves and the residents. During the tour of the home it was noted that one resident had the door to their room wedged open, and in another room a window restrictor was not in place. An immediate requirement was made on both these issues and subsequent to the inspection the manager informed the commission that they have been addressed. Care Homes for Older People Page 26 of 31 Evidence: It is good practice to monitor the patency of window restrictors on a regular basis Care Homes for Older People Page 27 of 31 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 28 of 31 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 1 38 13 To ensure that any doors to 28/05/2009 service user rooms that the service user wishes to be left open are protected by a device which responds to the fire alarm. To safeguard the service user 2 38 13 That a window restrictor to 28/05/2009 be put in place in the room identified on the day of inspection. A risk assessment to be commenced until this can be undertaken To safeguard the service users 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 7 15 That care plans are formed 01/07/2009 and reviewed in consultation with the service user or their representative unless it is impossible to carry out such consultation To ensure service users are aware of the care they are to receive 2 26 13 That communal toiletries are 11/06/2009 removed to ensure the Care Homes for Older People Page 29 of 31 safety of service users, and that cleanliness to all areas of the bath seats are maintained. That the toilet seat is replaced and cloth towels replaced with paper towels to minimise the spread of infection. To minimise the spread of infection and ensure the safety of service users. 3 38 13 That action to be taken to ensure that all staff attend the mandatory fire training arranged by the manager. To maintain the safety of staff and service users 26/06/2009 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 25 That the temperature of the hot water to service user outlets is maintained at the high end of the permitted parameters to ensure service user comfort That the manager and senior staff attend training on the Mental Capacity Act and Deprivation of Liberty Safeguarding. That the manager consults the local fire authority regarding their opinion on the fire risk assessment. 2 31 3 38 Care Homes for Older People Page 30 of 31 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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