Care Home: Edwardian Care Home

What the care home does well The home is situated close to the town centre. Even when full, but particularly currently because there are some vacancies, the home provides people with space to move around. The staff team are a consistent team and appear to be happy in their roles. On the whole the staff team are provided with training that gives them the basic skills to care for the people using the service. As well as being happy the staff team are polite when talking to residents and have a good relationship with them. The manager and the staff respond correctly to complaints and understand the importance of ensuring the residents are protected and kept safe at all times and in all ways. What has improved since the last inspection? Although the quality rating remains unchanged there have been some improvements since the last key inspection. For example, the care files are in better order and on the whole the information recorded is found where we would expect it to be found. This ensures that any staff, even if they do not know the resident well, can provide the care expected. Staff have a better understanding of how to keep residents safe and what to do if they expect an incident of abuse. The windows that open onto the street have been restricted, so that people could not enter or leave via them. What the care home could do better: There are a number of areas that the manager has yet to address and requirements and recommendations relating to these shortfalls have been made. They include: People using the service must be provided with current information about the service. This enables prospective residents to make informed decisions about the home. Plans of care must be written for all areas of care that staff provide. The plans must be written in a way the shows it is what the resident wants and that the resident has been involved. This ensures that there is guidance for each assessed need that staff can follow to ensure continuity of care is given, and that the care reflects the residents needs. Where fluid charts are used these should be totalled up daily so that is apparent if residents are receiving the correct amount of fluid over a 24 hour period. Staff should be able to demonstrate that the activities provided are suitable for, and in the best interest of, those in the home. The complaints procedure and log should be kept up-to-date and complete. All the items of furniture and equipment listed in NMS 24 should be in a person`s bedroom unless the reason for this is documented. This ensures people have a bedroom that meets their needs. Ongoing consideration should be given to the decor in the home to make it homely. Staff must be trained and competent to undertake the duties and responsibilities they have. This is so that people are cared for by a skilled and competent staff team. This relates particular to dementia care. Care should be taken that the staff ratios do not result in residents being unattended or having to wait for care. The Care Standards Act states that the home should have a registered manager. There must be methods to review and improve the quality of the service provided Staff should ensure that the necessary health and safety checks are carried out and that all residents have access to a call bell, unless the reason for the omission is documented. Key inspection report Care homes for older people Name: Address: Edwardian Care Home 168/170 Biscot Road Luton LU3 1AX     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: Sally Snelson     Date: 0 1 0 4 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Edwardian Care Home 168/170 Biscot Road Luton LU3 1AX 01582705100 01582705106 edwardian170@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Edwardian Care Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1 named person above the age of 60 years Date of last inspection Brief description of the care home The Edwardian is a purpose built care home that provides single room accommodation for 30 people over 65 years of age including those who have dementia and/or physical disabilities. The home is on a busy road, which is a short car or bus ride away from Luton Town Centre. Accommodation for people using the service is on the ground and first floor with a further third floor that accommodates administrative and staffing offices. Access to all floors is via staircases and a shaft lift. The home borders straight onto the pavement area of the street with a small Care Homes for Older People Page 4 of 30 Over 65 12 30 0 0 1 4 1 0 2 0 0 9 Brief description of the care home ornamental garden to one side that is not suitable for recreational purposes. A small patio area with summertime pagoda and garden furniture is situated to the rear of the building, as is car parking. The manager told us that fees were in the region of £446-£500 per week, depending on the assessed needs and the room occupied. Care Homes for Older People Page 5 of 30 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 inspection was carried out in accordance with the Care Quality Commission (CQC) policy and methodologies which require review of the key standards for the provision of a care home for older people that takes account of service users views and information received about the service since the last inspection. Evidence used and judgements made within the main body of the report include information from this visit and information received since the last inspection of the home. The home was rated as a one star service following the last Key Inspection in June 2009. A random inspection had taken place in October 2009 in order to met the new manager and ensure she was aware of her responsibility to support the staff team to meet the requirements made at the last key inspection. During this inspection we picked two residents to case track in detail. We spent time observing care practises and informally chatting with staff and residents, we also spoke to visitors to the home. We examined some documentation in staff files relating to Care Homes for Older People Page 6 of 30 recruitment, and staff training and supervision. Documentation relating to health and safety checking procedures, medication administration, complaints and accident and incident reporting were also inspected. The home manager was present to assist at the start of the inspection but had to leave for a period in the middle of the day. Feedback was given periodically throughout, and at the end of the inspection. The manager had been required to complete an AQAA by 01/03/10, this is document that provides us with information about the service, but this document had not been completed. A reminder letter has been sent and the document must be returned by 20/04/10. We would like to thank everyone involved for their assistance and support. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: There are a number of areas that the manager has yet to address and requirements and recommendations relating to these shortfalls have been made. They include: People using the service must be provided with current information about the service. This enables prospective residents to make informed decisions about the home. Plans of care must be written for all areas of care that staff provide. The plans must be written in a way the shows it is what the resident wants and that the resident has been involved. This ensures that there is guidance for each assessed need that staff can follow to ensure continuity of care is given, and that the care reflects the residents needs. Where fluid charts are used these should be totalled up daily so that is apparent if residents are receiving the correct amount of fluid over a 24 hour period. Staff should be able to demonstrate that the activities provided are suitable for, and in the best interest of, those in the home. The complaints procedure and log should be kept up-to-date and complete. All the items of furniture and equipment listed in NMS 24 should be in a persons Care Homes for Older People Page 8 of 30 bedroom unless the reason for this is documented. This ensures people have a bedroom that meets their needs. Ongoing consideration should be given to the decor in the home to make it homely. Staff must be trained and competent to undertake the duties and responsibilities they have. This is so that people are cared for by a skilled and competent staff team. This relates particular to dementia care. Care should be taken that the staff ratios do not result in residents being unattended or having to wait for care. The Care Standards Act states that the home should have a registered manager. There must be methods to review and improve the quality of the service provided Staff should ensure that the necessary health and safety checks are carried out and that all residents have access to a call bell, unless the reason for the omission is documented. 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 30 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 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information provided to potential users of the service was not up-to-date so could be misleading to people enquiring about this service. Prior to admission people using the service were correctly assessed to ensure the home could provide the necessary care. Evidence: At the last inspection we identified that the Statement of Purpose and the Service Users Guide needed to be updated, but that it was a task best left for the new manager, who had been appointed but was not then in post. The new manager had taken up her position in September 2009 but the Statement of Purpose and the Service Users Guide on display in the entrance of the home had not been up-dated to reflect the management changes. All of the pre-admission assessments completed since the last inspection were Care Homes for Older People Page 11 of 30 Evidence: completed by the manager and were of a high quality. The information gained was found to be accurate and used to inform the care plans. There were people living in the home who had a secondary a diagnosis of dementia but staff did not have a good understanding of the needs of people with this condition. This will be discussed more in the staffing section of this report. At the time of the inspection The Edwardian did not offer intermediate care. Care Homes for Older People Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written documentation did not always detail the care that a resident needed, so people using the service could receive inconsistent care. Evidence: We looked at the care provided to two residents; one being the most recent admission to the home. The documentation supporting the care for these two people was of different quality. Only one set of records gave staff all the information they needed to provide a consistent quality of care. Case tracking, that is looking at what was provided to the residents, confirmed that the correct care was being given to both, but for one the documentation to support the care was missing. We were told that the difference was because one of the admissions had initially been a respite admission and full care plans had not been written. We were unsure of the rationale behind respite admissions needing less detailed care plans. As this resident had been admitted more than three months previously detailed care plans should have been in place. For example comments such as needs assistance at all times when bathing did not indicate the level or type of assistance needed and would be interpreted by different staff in different ways. On the whole care plans had been reviewed monthly, Care Homes for Older People Page 13 of 30 Evidence: although they were a little over due for the month of the inspection. The plans of care and the associated risk assessments (for all but respite residents) were documented in books which reminded the staff to assess residents monthly for the risk of malnutrition, tissue viability and moving and handling. However from talking to the staff we were unaware of how they had addressed deviations. For example a resident with a recent history of weight loss had not been re assessed in advance of the next planned weigh-in. Records that had yet to be recorded in the care plans indicated that the weight loss had only been temporary but the manager had not been made aware of the loss or the subsequent improvement, so additional support had not been considered. Food and fluid intake and output charts were in place. They had been correctly filled in but not always totalled at the end of a shift or the day,so once again deviations and problems were not immediately recognisable. Care records were not produced in a person centred way and there was no evidence that residents were involved in the planning of their care. Daily notes were kept and much of the information needed was in these records but information had to be searched for. For example the daily notes recorded that staff noticed a resident had a swelling, and a body map showed where the swelling was, but we had to look in the record completed following the GP visit to confirm that this swelling had been investigated. People living at the home were supported to keep their own GPs or to register with one close to the home. Residents were also supported to have regular optical and dental check-ups. There was evidence that a resident who had developed a pressure ulcer had been successfully treated with the support of the community nursing team and the vigilance of the care staff in ensuring regular turns. Staff spoke to us about the behaviours of one person living with dementia. There was no record to show if the reason for these behaviours had been explored so that work could be done with the person to remove the anxiety or stress that led to these behaviours. Staff did not appear to appreciate that these behaviours maybe able to be supported. The home had a variety of mechanical lifting hoists and other moving and handling equipment and staff were aware of how to use the equipment correctly. We looked at the way medication was handled. Staff had completed the Medication Administration Record (MAR) charts carefully using the correct omission codes when necessary and completing the reverse of the MAR sheet. We also noted that Care Homes for Older People Page 14 of 30 Evidence: medications were correctly recorded when they were received into the home and we were able to reconcile the medication of those people we were case tracking. Throughout the inspection we witnessed staff interacting well with the residents and addressing them in an appropriate manner. Care Homes for Older People Page 15 of 30 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. An unplanned approach to social activities meant that some people did not receive the support or motivation they need. Meals were varied and nutritious and enjoyed by the residents. Evidence: There was no one person employed to organise activities, but one member of staff was responsible for co-ordinating them and producing an activity plan. It was expected that all the staff would be able to run an activity. On the day of the inspection the hairdresser was in the home and most of the female residents went to have their hair washed and set. No other activity was taking place, although the published programme did suggest an activity. This was possibly because there were few residents on each floor and for much of the inspection, including lunchtime only one staff member on each floor. Care plans did not detail how people liked to spend their time and once again we had to rely on the daily notes to indicate that an activity had taken place, and if the person had participated in the activity. Care Homes for Older People Page 16 of 30 Evidence: There did not appear to be any activities organised to stimulate those people with dementia or those who chose to remain in their bedrooms. Visiting at the home was open and people could receive visitors at any time. We spoke to one visitor who said, It is very nice here, I can come and go as I want. Peoples care files had information regarding their nutritional needs and dietary preferences. The staff we spoke with were fully aware of these. We spoke to the cook and she showed an awareness of nutrition, health and safety and hygiene. Hot meals were served to the residents on the ground floor plated, and were taken to the dining room on the first floor in a hot trolley. People had made their main meal choices the day before. The manager told us that at times people had changed their mind by the time the meal was served. At the time of the inspection consideration had not been given to picture menus or visual choices being routinely offered on the day. As the cook knew the residents well and worked six days a week she was aware of peoples likes and dislikes and we witnessed her making an omelet for someone who had not wanted either of the meals offered at lunchtime. One of the people that we case tracked was used to eating a spicy diet from her country of origin, and the cook had learnt to sometimes cook some different foods and dishes to meet her needs. We looked at a four week menu that was offered to people living at the home. This showed us that people were offered a varied and nutritionally balanced diet. Care Homes for Older People Page 17 of 30 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 could be confident that their concerns would be listened to and dealt with properly and that, as far as possible, they would be protected in the home. Evidence: The complaints procedure was on display in the home and as part of the information provided to residents. We noted that the details about CQC had not been updated to reflect the closure of a local office. The manager reported that any concerns raised verbally were dealt with immediately before they could escalate. We saw evidence that these had been recorded in the complaint log but because it was a discussion the outcome was not recorded. There had been no written complaints to the home since the new manager had been in post. The manager was aware of the importance of recognising all complaints and using them as a positive tool to drive forward the quality of the service provision and to be able to identify patterns of complaints. Training records showed us that staff members employed to work at the home had attended Safeguarding Vulnerable Adults (SOVA) training and that the local SOVA policy and details of adult abuse were on display. The manager and staff spoken to were able to describe adult abuse and their actions if they had any concerns. The manager had a knowledge of safe recruitment practices Care Homes for Older People Page 18 of 30 Evidence: that would protect residents. Any incidents in the home were correctly reported to the appropriate agencies and the service had a good relationship with the local authority safeguarding team and would seek advice as necessary. Care Homes for Older People Page 19 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in clean and tidy surroundings that would benefit from some refurbishment. Evidence: At the time of the inspection their were 13 residents accommodated over the two floors. The home was registered for 30 residents so this reduced number made it look very bare. This was especially noticeable, as out of choice, often only two residents chose to sit in the downstairs lounge which was a large room with chairs placed against the wall. The home was clean and tidy but there were areas where the decor would benefit from renewal. There were no areas where an odour was noticeable. A recent fire service inspection (21/12/09) had identified some areas that needed to be improved to comply with the legislation and ensure residents safety. The manager told us that these deficiencies had been corrected immediately. We toured all the communal areas of the home and looked at the bedrooms of the two residents whose care we were case tracking and one other resident who invited us to view. Two of the bedrooms had all the expected furniture and it was apparent that people could personalise their rooms as they wanted. The third bedroom did not have Care Homes for Older People Page 20 of 30 Evidence: a call bell or a bed-side light. The manager was unsure of the reason why ,although she stated the residents behaviours as the possible reason. There was nothing in the care plan to reflect how or why the decision to remove these items had been made and if it was in the residents best interest. The laundry facility was clean and tidy and a resident told us, it is wonderful, my clothes appear clean and ready to wear. Care Homes for Older People Page 21 of 30 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. People using the service could expect to be supported by staff who had a good level of basic training but who may need refresher training to ensure their skills were maintained. Recruitment practices ensured residents were protected from risk of harm Evidence: Staffing levels were maintained at three care staff during the day and two at night, plus the manager who was supernumerary, to attend the needs of 13 people in a home that was spread out over two floors. A cook and a cleaner were also employed and the home shared a maintenance person. During the inspection at some point during the day one of the three staff on duty went out with a resident and at another time a staff member went off duty for a period leaving two staff to cover the two floors. The manager was also away from the home during this period. However one resident told us, whenever I need help someone is always there. We spoke with staff who told us they had received training in areas including dementia, food handling, safeguarding vulnerable adults and moving and handling. The manager had produced a training matrix and this identified that some training, particularly in dementia awareness needed to be updated or delivered. Unfortunately the manager had had to cancel planned appraisals for the staff so did not have a record of individuals needs to fit into the training plan. The majority of the Care Homes for Older People Page 22 of 30 Evidence: staff team had completed the basic core training necessary for them to be able to care for people safely. The current manager had not recruited any staff since taking up the post. She was able to discuss safe recruitment practices and showed that she was aware of the need to regular check work permits and visas to check these remained valid. Care Homes for Older People Page 23 of 30 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 lived in a home that was run by a qualified manager; however the management needed to be more proactive and involved to ensure the health, safety and protection of the people living there. Evidence: There had not been a registered manager at the Edwardian for two years. In that time a manager had left before going through our registration process and the home was looked after for a period until the current manager came into post 14/09/09. She had a nursing qualification and had been registered with us for a home in another area in the past. Staff told us that the manager had a vision for the home and told them how and what needed to be done to improve and maintain the quality rating. We were therefore disappointed that she had failed to complete the AQAA. This is a quality document completed prior to a key inspection that outlines amongst other things what the home has achieved in the last year and what improvements they are aware need to be Care Homes for Older People Page 24 of 30 Evidence: made. The manager had not sent out any quality questionnaires to assess the care that the service was providing. She had planned a relatives meeting but this had been cancelled. Staff meetings were held regularly and at these meetings minutes were recorded and kept. Staff told us the manager supervised them. One member of staff told us that the last supervision session had been cancelled and she could not remember the one before that. These sessions should be meaningful times when staff can talk about problems and concerns and also highlight any personal development needs. As already mentioned a recent fire check had highlighted some shortfalls including emergency lighting not being tested monthly. Health and safety checks including water temperatures, fire call bells, freezer and food temperatures were now being recorded appropriately, and issues were addressed in a timely fashion. Care Homes for Older People Page 25 of 30 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 26 of 30 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 1 5 People using the service must be provided with current information about the service. This enables prospective residents to make informed decisions about the home. 01/05/2010 2 7 14 Plans of care must be 01/06/2010 written for all areas of care that staff provide and in a person centred way. This applies whether the resident is receiving long term or respite care. This ensures that there is guidance for staff for each assessed need and that the care reflects the residents needs. 3 24 23 All the items of furniture and 01/06/2010 equipment listed in NMS 24 should be in a persons bedroom unless the reason for this is documented. Care Homes for Older People Page 27 of 30 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 This ensures people have a bedroom that meets their needs. 4 30 18 Staff must be trained and competent to undertake the duties and responsibilities they have. This is so that people are cared for by a skilled and competent staff team. 5 31 10 This refers to the Care Standards Act. There should be a registered manager in the home. This ensures that the staff team are led with a consistent appproach 6 33 24 There must be methods to review and improve the quality of the service provided This ensures that the care provided is appropriate for the people living at the home. 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 01/06/2010 01/09/2010 01/06/2010 1 8 Where fluid charts are used these should be totalled up Page 28 of 30 Care Homes for Older People 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 daily so that is apparent if residents are receiving the correct amount of fluid over a 24 hour period. 2 12 Staff should be able to demonstrate that the activities provided are suitable and in the best interest of those living in the home. The complaints procedure should be kept up-to-date and all the information relating to a complaint investigation should be complete. Consideration should be given to the decoration in the home to make it homely and suitable for those with dementia. Care should be taken that the staff ratios do not result in residents being unattended or having to wait for care. Staff should ensure that the necesssary health and safety checks are carried out and that all residents have access to a call bell unless it is documented why. 3 16 4 19 5 6 27 38 Care Homes for Older People Page 29 of 30 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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