Care Home: Elizabeth Homes

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What the care home does well People have a full care needs assessment prior to their admission to the home and are only offered a place if it is considered their individual needs can be met. Care planning has improved and there are plans in place for further improvements to take place; a new care planning system has been ordered and staff training on how to use these has been booked. People tell us that their health care needs are met by the home. People tell us that they know who to speak to if they have any concerns about the service they receive, and that staff listen to them. Meal provision at the home is good but would be further improved if a true choice of meal was offered at lunch times. A new manager has been appointed since the last key inspection and there is a management structure in place that supports the manager and staff working at the home. This has resulted in a strong management team. People`s money is held securely and recorded accurately; this safeguards them from the risk of financial irregularity. There are quality assurance systems in place that give people an opportunity to express their views and to affect the way in which the home is operated. Health and safety systems in place protect people living and working at the home from significant risk of harm. What has improved since the last inspection? The arrangments in place for the storage and recording of medication, including controlled drugs, have improved and people are now protected from the risk of harm. Recruitment practices at the home are now robust. Locks have now been fitted to bedroom, bathroom and toilet doors to promote privacy and dignity for people living at the home. All staff have had training on safeguarding adults from abuse. This offers people living at the home some protection from the risk of harm. Staff have had the opportunity to undertake refresher training on fire safety, moving and handling and other topics to ensure that their practice is kept up to date. The home`s fire risk assessment has been updated. What the care home could do better: There are some risk assessments in place but these need to be expanded upon toinclude those for nutritional screening, emotional well-being and pressure care. The new care planning system is expected to include these risk assessments. There should be information available on advocacy services so that people can access this information without having to request it; this would promote independence and privacy. Any handwritten entries made on medication administration records should be signed by two staff to reduce the risk of errors being made. A receipt should be given to relatives who hand money to the home for safe keeping on behalf of people living at the home; this is to protect all parties concerned. There should be risk assessments in place for all health and safety topics to evidence that people are protected from the risk of harm. There should be a maintenance plan in place to evidence that there are plans for the ongoing upkeep and refurbishment of the premises. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elizabeth Homes 67 Hailgate Howden East Riding Of Yorks DN14 7ST     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: Diane Wilkinson     Date: 2 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Elizabeth Homes 67 Hailgate Howden East Riding Of Yorks DN14 7ST 01430431065 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) : Eaveshill Limited care home 30 Number of places (if applicable): Under 65 Over 65 30 30 dementia old age, not falling within any other category Additional conditions: 0 0 To admit one named service user under age 65 in category Physical Disability (PD). Date of last inspection Brief description of the care home Elizabeth Homes is a privately owned care home that is registered to provide care and accommodation for 30 older people, including those with dementia related conditions. The home is situated in the centre of Howden, a small rural town in the East Riding of Yorkshire. It is close shops, transport links and other local amenities. People have a choice of single or shared rooms, and most of these have en-suite facilities. The garden is private and well kept, and provides seating for residents and visitors. There is a small car park to the side of the home. The manager told us that the current weekly accommodation fee ranges from £362.04 to £405.00 per week. People who are interested in moving into the home are informed of this in the homes statement of purpose and service users guide. Care Homes for Older People Page 4 of 28 Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 4th July 2008, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 9.50 am and ended at 4.45 pm. On the day of the site visit the inspector spoke on a one to one basis with some residents and staff as well as the homes manager and two other managers from the organisation. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered persons submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the Care Homes for Older People Page 6 of 28 service. As part of the inspection process we sent survey forms to some of the people living at the home and staff; seven were returned by people living at the home and two were returned by staff. Responses in surveys and comments from discussions with residents and staff were mainly positive, for example, a homely welcome, clean and tidy, friendly staff and good food. Other anonymised comments are included throughout the report. The manager told us that the current fee for residential accommodation at the home is from £362.04 to £405.00 per week. At the end of this site visit, feedback was given to the managers present on our findings, including recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services 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. What the care home does well: What has improved since the last inspection? What they could do better: There are some risk assessments in place but these need to be expanded upon to Care Homes for Older People Page 8 of 28 include those for nutritional screening, emotional well-being and pressure care. The new care planning system is expected to include these risk assessments. There should be information available on advocacy services so that people can access this information without having to request it; this would promote independence and privacy. Any handwritten entries made on medication administration records should be signed by two staff to reduce the risk of errors being made. A receipt should be given to relatives who hand money to the home for safe keeping on behalf of people living at the home; this is to protect all parties concerned. There should be risk assessments in place for all health and safety topics to evidence that people are protected from the risk of harm. There should be a maintenance plan in place to evidence that there are plans for the ongoing upkeep and refurbishment of the premises. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are only admitted to the home following a full care needs assessment that evidences that their needs can be met by the home. Evidence: On the day of the site visit we saw that the homes statement of purpose is displayed in the entrance hall; on checking, we found that this document now includes information about the meals service provided by the home. We examined the care plans for three people living at the home; two of these people had been admitted to the home since the last key inspection. Information had been gathered about the person when they expressed an interest in admission and then a full care needs assessment had taken place. In one instance, comprehensive information had been obtained from the previous care home where the person had resided. A community care assessment and care plan is obtained from Social Services care managers when the service is commissioned by them. All of the information Care Homes for Older People Page 11 of 28 Evidence: gathered by the home is used to formulate an individual care plan for the person concerned. People are encouraged to look around the home prior to their admission. If they are not able to do so themselves, relatives are invited to do so. Seven people living at the home returned a survey to the Care Quality Commission in preparation for this inspection and they all told us that they received enough information about the home before they made a decision to move in. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans record the individual strengths and needs of people and are a clear record of how these are met by staff at the home, including health care needs and the administration of medication. Staff respect the privacy and dignity of individuals living at the home. Evidence: A new care planning system is being introduced by the home; the system has been ordered from the supplier and staff training has been booked on how to develop and use the care plans. Existing care plans were seen to be a thorough record of a persons capabilities and their need for assistance from staff and others. Care plans for everyone living at the home include a risk assessment on moving and handling, and there are more individual risk assessments in place for topics such as use of a bed rail and bumper. Risk assessments need to be expanded to cover such areas as nutrition, pressure care and emotional well-being. There is a monthly review of each care plan in place - these are quite detailed and record important events as well as details about general health and emotional well-being during the previous month. People are Care Homes for Older People Page 13 of 28 Evidence: involved in the development of their care plan whenever this is possible, but will have more involvement when the new care planning system is introduced. Formal reviews of the care plan are organised by Social Services when they commission the service; we recommend that the home holds in-house reviews for people who are funding their own placement. The manager has completed a brief version of each care plan - these are kept in individual bedrooms so that staff can consult them whilst in the process of assisting with personal care. This is good practice. When people living at the home were asked in a survey if they receive the care and support they need, six people responded always and one person responded usually. Individual health care requirements and provision is well recorded in care plans, both at the time of admission and then on an on-going basis. Weight charts are maintained as part of nutritional screening and any concerns about eating and drinking are referred to health care professionals. All contacts with GPs, district nurses and other health care professionals are recorded; this includes information about the reason for the contact and the outcome. Any hospital admissions are recorded as well as advice given to staff on discharge, and results of any medical tests are clearly recorded. We noted that hearing tests and sight tests are arranged, and that all of this information cross references to information recorded in care plans. All of the people living at the home who returned a survey told us that the home makes sure that they get the medical care they need. We examined the arrangements for the storage and recording of medication on the day of the site visit, and observed the administration of medication by the senior carer on duty. Medication is stored in a locked trolley that is stored in the medication room; staff take the trolley around the home on each occasion they administer medication. When medication is taken to a persons bedroom, the member of staff takes a glass of water with them so that the person can take their medication immediately, and also the medication administration record sheet, which they sign when they see that the person has taken their medication. We noted that each persons medication administration records are accompanied by a photograph to aid identification, and that there is a separate form in use to record the reason why people did not take a specific medication; this is good practice. We recommend that any handwritten entries that are made on medication administration records should be signed by two staff as an additional check on accuracy. Any medication returned to the pharmacy is recorded in a returns book and this is signed by the manager and the driver on collection. The medication room also includes a separate fridge for the storage of medication that needs to be stored at a low temperature. Fridge temperatures are taken twice daily and recorded. There are sample signatures in place for all staff that have completed medications training and are responsible for the administration of medication. A new medication cabinet has been purchased for the storage of controlled drugs; this is kept in a separate area of the home. We examined the controlled drugs book and noted that all entries were correct. Controlled drugs are also signed for on the persons Care Homes for Older People Page 14 of 28 Evidence: medication administration record sheet. On the day of the site visit we noted that staff respect the privacy and dignity of people living at the home. Most people are accommodated in single rooms and there are areas of the home where people can meet health care professionals and visitors in private. All bedrooms have had locks fitted so that people can have a key to their room if they choose to do so. We noted that staff use the term of address preferred by the person concerned and that the arrangements in place for laundering clothes is designed to ensure that peoples own clothes are returned to them. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to maintain their chosen lifestyle and to spend time within the local community. Meal provision at the home is good but people would benefit from being able to choose an alternative to the main meal on offer at lunchtime. Evidence: We examined the care plans for three people living at the home. We observed that these include information about a persons previous lifestyle, including thier hobbies and interests. Routines of daily living are flexible at the home; some people spend their day and take all of their meals in their room but most people spend their day in one of the communal lounges. There is a notice board that displays information about forthcoming events and photographs are displayed recording recent events. An exercise class is held every Saturday, a communion service is held every month and the hairdresser visits the home every Wednesday. The hairdresser was present on the day of this site visit and we noted that this was made into a social event. When asked in a survey if the home arranges activities for them to take part in, three people responded always, two usually and two sometimes. The manager explained the new activity rota to us; this system ensures that staff spend time with a different Care Homes for Older People Page 16 of 28 Evidence: person or group of people each day on individual or group acitvities of their choice. A member of staff told us, we have started one to one time in an afternoon, which is good for the residents. On the day of the site visit one person told us that they had been into the town to exchange their library books. The manager told us that several people enjoy attending music in the park events that are held in the town throughout the summer months. The day of the site visit was hot and we saw that some people were sitting outside; umbrellas had been provided to protect people from the sun. In the afternoon, people were offered an ice-cream to help to keep them cool. People told us that their visitors are always made welcome at the home. We observed that bedrooms are personalised to reflect a persons lifestyle, hobbies and interests. We did not see any information displayed about available advocacy services. This information should be displayed to enable people to access advocacy services without having to ask for assistance; this would promote independence and privacy. People told us that meal provision at the home is good. A relative that helped someone to complete a survey told us, good balanced diet, with care and consideration and another said, good food. There is a four week menu in operation and the daily menu is displayed; this evidences that there is a choice of meal at breakfast time and teatime but not at lunchtime. We were told that an alternative meal is provided if the person does not like the main meal on offer. However, a true choice of meal should be available so that people are able to choose what they would like for lunch. There are now two cooks employed at the home so there is a cook available every day. The manager recorded in the Annual Quality Assurance Assessment (AQAA) that special diets are catered for, such as meals for diabetics. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People tell us that they know who to speak to if they have any concerns and that they are encouraged to express concerns. All staff have undertaken training on safeguarding adults from abuse and this offers some protection to the people living at the home. Evidence: The complaints procedure is displayed in the entrance hall and the manager told us that a copy has been placed in each bedroom. Staff told us in returned surveys that they know what to do if someone has any concerns about the home and people living at the home told us that they know who to speak to if they have any concerns. Five people said that they also know how to make a formal complaint but two people said that they did not. We examined the complaints log and noted that this recorded the details of the complaint, the investigation and any action taken. In one instance a meeting was held with two people living at the home who had made a complaint to explain the outcome of the investigation that had been undertaken - the minutes of this meeting record that both residents were satisfied with the action that had been taken. Every month a member of staff speaks to each person individually to ask them if they have any complaints. Records of these discussions were seen and we noted that any comments made by people had been dealt with. For example, someone commented that the TV in the lounge was too small and a new larger TV was purchased. Care Homes for Older People Page 18 of 28 Evidence: Training records evidenced that all staff have undertaken training on safeguarding adults from abuse and the manager has attended training on Deprivation of Liberty. There have been no recorded allegations or incidents of abuse at the home since the last key inspection. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and is maintained in a clean and hygienic condition; laundry facilities are suitable for the needs of the people living at the home. Evidence: The home is suitable for its stated purpose and is presented in a comfortable and homely way. The grounds are kept tidy, safe and attractive - there is now a handyman/gardener employed at the home and it was evident when we toured the premises on the day of the site visit that the home is maintained in a safe condition. However, there is no maintenance plan in place to record a programme of routine maintenance of the premises. We saw that the laundry facilities provided by the home include appropriate equipment, including a sluicing facility within the washing machine. The room has wall coverings and flooring that can be kept clean and there are hand washing facilities for staff. We noted that staff follow good hygiene practices and that disinfecting hand wash is available. All areas of the home were free from unpleasant odours apart from one bedroom; this was discussed with the manager and it was agreed that there was a need for the flooring to be replaced. All of the people living at the home that returned a survey told us that the home is always fresh and clean. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 by well-trained staff who have been recruited safely; this ensures that only people who are considered suitable to work with vulnerable people are employed. Evidence: We examined the staff rota and, although staff appear to understand the content, we found it difficult to determine the role of each member of staff on duty and therefore difficult to establish the number of care staff and the number of ancillary staff working each day. We recommend that a clearer staff rota be developed. We noted that ancillary staff are employed in addition to care staff. However, one member of staff did tell us that they thought care staff should spend less time hoovering and sorting laundry and more time on caring. We examined the recruitment and training records for two new members of staff and the training records for another member of staff. These evidence that staff complete satisfactory application forms and that all safety checks are in place prior to staff commencing work at the home. Some staff have started to work following the receipt of a Protection of Vulnerable Adults (POVA) first check and we reminded the manager that these staff can only work under supervision until a satisfactory Criminal Records Bureau (CRB) check has been received. We noted that there is an induction programme in place and staff told us in surveys Care Homes for Older People Page 21 of 28 Evidence: that their induction covered everything they needed to know to do the job when they first started work. We recommend that the home obtain a copy of the Skills for Care induction standards so that they can check if their own induction programme meets these requirements. Staff told us that they receive training that is relevant to their role, helps them understand and meet the individual needs of people, keeps them up to date with new ways of working and informs them about health care and medication. The training and development plan evidences that most staff have recently had training on safeguarding adults from abuse, and refresher training on fire safety and moving and handling. Some staff have had training on the administration of medication and person centred planning. The manager told us in the AQAA that training is currently being arranged for continence care, dementia care, first aid, food hygiene, health and safety, catheter care and skin care. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and this includes the protection of any monies held on behalf of people living at the home, quality assurance systems and the promotion of safe working practices. Evidence: The organisation has a new management structure; this includes the appointment of two new managers who are experienced in the provision of residential care. There is also a new manager in place at the home - she has almost completed NVQ Level 4 in Care and will be working towards the registered managers award. There is evidence that the manager does training alongside the staff group as well as more specific training for managers, such as Deprivation of Liberty; this ensures that her practice is kept up to date. This new management structure has led to improvements in the arrangements for the administration of medication, care planning and recruitment practices. The quality assurance systems in place give people the opportunity to express their Care Homes for Older People Page 23 of 28 Evidence: views and to affect the way in which the home is operated. We saw evidence that regular staff and service user meetings are held at the home. Surveys have recently been distributed to people living at the home, visitors, family members and health and social care professionals. Eighteen responses have been received so far and the manager intends to collate the information received, take any required action and publish the outcome. They were reminded that the outcome of audits and surveys should be used to formulate a development plan for the following year. We examined the records and checked monies that are held on behalf of people living at the home. These were found to be accurate and we noted that two staff had recently checked the records and monies held. Receipts are obtained for any transactions made on behalf of people and we recommend that receipts should also be given to relatives or representatives when they hand money to the home for safe keeping, to protect all parties concerned from any misunderstandings. We examined health and safety documentation at the home and found that equipment and services had been maintained appropriately. The passenger lift was serviced in June 2009, an annual fire test took place in January 2009 and there is a gas safety certificate in place. In-house fire tests and drills take place regularly. Training records evidence that staff undertake training on health and safety topics, and that refresher training is also arranged. There should be evidence that risk assessments have been undertaken on all health and safety topics to ensure that safe working practices are maintained. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Risk assessments included in care plans should be expanded to cover such areas as nutrition, emotional wellbeing and pressure care. People who are funded by the local authority have in-house care plan reviews but these should be held in-house for those people who are self-funding. This is to give people the opportunity to check that their care plan still meets their individual needs. Any handwritten entries made on medication administration records should be signed by two people to ensure accuracy. Information about available advocacy services should be displayed in the home so that people can access this information without having to ask for it - this promotes independence and privacy. There should be a choice of meal every lunchtime to ensure that people living at the home can choose what they would like to eat. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented, with records kept. 2 7 3 4 9 14 5 15 6 19 Care Homes for Older People Page 26 of 28 7 26 New flooring should be provided for the bedroom where an unpleasant odour was identified to provide a pleasant environment for the person occupying the room. The manager should continue with plans to apply for registration with the Care Quality Commission and to complete appropriate training. Receipts should be given to relatives that hand money to the home for safe keeping to protect all parties concerned. There should be arrangements in place to maintain safe working practices, including risk assessments. This is needed to promote the health and safety of people living and working at the home. 8 31 9 10 35 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!