Care Home: Elms, The

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What the care home does well The feedback we received was very positive. Residents like the home and the care they receive from staff. Staff are described as having a kindly and respectful approach to their work. The home is very good at assisting residents to follow their religion. There are regular opportunities to attend activities which have a Christian focus. A range of other activities are available including opportunities to go on trips, use local facilities and classes are arranged including poetry, exercise and arts and crafts. Staff are well trained and supported. This assists them to provide high quality care. The building is homely and work is underway to improve the facilities. The gardens are attractive and enjoyed by residents. Residents we spoke to referred to the, "friendly atmosphere", and "good activities and nice food". We received positive comments about the way that care is provided. Staff were described as, "gentle and patient". What has improved since the last inspection? There have been improvements to the way that medication is managed in the home. Care planning has improved with the introduction of a new format for recording care plans. The home has taken action to ensure that water temperatures are safe for the residents. What the care home could do better: There was a matter about which the CQC should have been informed, we learned about it at our visit and we have made a requirement about this. We have made a requirement that the fire doors are reviewed to ensure they are safe, and that fire safety arrangements are not compromised. We have made a range of recommendations to improve medication practice and there is a requirement that staff follow the medicine procedure when medicines are received into the home. We have made a recommendation that all information taken into account when employing new staff is noted and included in the recruitment record. We have also recommended that the service user guide include all the information specified in the standards and regulations. Key inspection report Care homes for older people Name: Address: Elms, The 147, Barry Road London SE22 0JR     The quality rating for this care home is:   two star good 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: Alison Pritchard     Date: 0 7 1 2 2 0 0 9 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Elms, The 147, Barry Road London SE22 0JR 02086934622 02086939403 care.manager@virgin.net None South East London Baptist Homes care home 25 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 25) Dementia - Code DE (maximum number of places: 25) Date of last inspection Brief description of the care home The Elms is registered to provide care and accommodation for up to 25 older people. The home has been managed by South East London Baptist Homes since it first opened in 1953. The home is a large detached house with a single storey extension to the rear. Bedrooms are single occupancy. Communal space includes two lounges, a conservatory and a dining room. The home has a large, well-maintained garden to the rear and off street parking is available. Care Homes for Older People Page 4 of 29 Over 65 0 25 25 0 1 4 0 1 2 0 0 9 Brief description of the care home The home is located in a residential road in East Dulwich and is a short distance from local amenities such as a library, shops and several bus routes. The work of the home is based on Christian principles and it is stated in the homes Statement of Purpose that Christians from any denomination may apply. The aim of the home is stated as: To provide a secure, comfortable and caring home for residents, so they can spend the rest of their days in peace and security. We provide comfort and support in a Christian atmosphere where mutual help and friendship are encouraged. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place in December 2009 over two days. On the first day two inspectors visited the home. On the second day the pharmacy inspector visited and checked the medication and dispensing practices in the home. While we were visiting the home we toured the building; had discussions with residents, relatives and staff. We checked a range of records while we were at the home including care plans; staff records and building maintenance records. In advance of the inspection the Registered Manager completed a document called an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was completed and returned in time and was used as part of the inspection. We also looked at the things that the Registered Manager has told us have happened in the service, these are called Care Homes for Older People Page 6 of 29 notifications and are a legal requirement. We also saw the report of a contract monitoring officer from a placing authority. We found that the home offers a good care and support to the residents. The manager and staff were observed to be competent, caring and respectful. Care Homes for Older People Page 7 of 29 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 on page 4. Care Homes for Older People Page 8 of 29 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential residents and their families can visit the home and assess whether it will be the right place for them to live. Staff obtain and record information about care needs so that they can be sure that they can be met at The Elms Evidence: At the time of our visit The Elms had two vacancies. The home holds a waiting list for places at the home and arrangements were in place to fill the vacancies. On residents files we saw assessments of need that had been completed by senior staff at The Elms prior to their admission to the home, we also saw assessments of need made by social services departments. A resident that we spoke to said that her relatives had visited the home and made sure that it would be suitable for her needs. Some of the residents who move in permanently to the home have previously stayed there on a short term basis. All admissions are initially for a trial period of one month which can be extended if the potential residents needs longer to decide. Care Homes for Older People Page 11 of 29 Evidence: The document called Residents Guide was given to us, it was dated October 2009. As at the last inspection of January 2009 the document did not include some of the information that is required, such as a summary of the complaints procedure and the terms and conditions of occupancy. See recommendation. The Statement of purpose states that residents are provided with a copy of the complaints policy on admission. We spoke with eleven of the residents both in the main house and in the Friern Road annexe. Overwhelmingly, the feedback we received was very positive. Residents like the home and the care they receive from staff. One resident said that the home supported her to follow her religion. She told us that she organised religious meetings for the other residents. She also said that the staff, worked hard and were very nice people. Other residents we spoke to referred to the, friendly atmosphere, and good activities and nice food. We were able to ask some of the residents about the personal care provided and we received positive comments about this. Staff were described as, gentle and patient. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are cared for in a way that reflects their wishes and needs. Medication arrangements have improved since our last visit, we have made some recommendations to further improve the way that medicines are handled. Residents privacy and dignity are maintained. Evidence: Care plans are in place for each of the residents. We looked at a selection of four care plans. They addressed the issues raised in the initial assessment of need, were reviewed regularly and were clear. A new format has been introduced in the last year and this is an improvement. Staff have had training in care planning . Senior staff are responsible for monitoring the care plans. The care information and plans gave us a good idea of each persons daily routine, their needs and wishes. Residents said that they are satisfied with the way that they are cared for, and that they are treated with kindliness and patience. The notes on the care files showed that there are effective working relationships with health care professionals, including GPs, District Nurses and Community Psychiatric Care Homes for Older People Page 13 of 29 Evidence: services. This benefits the residents. Three requirements on medicines management were left at the last inspection. There is evidence that medicines handling has improved, two requirements have been met, and progress has been made on the third. Some good practice recommendations have been made to improve further the way medicines are handled. Over the counter medicines for minor ailments are no longer kept, all medicines are now prescribed. A separate cupboard for controlled drugs has now been installed and is in use. The home should ask the supplier of the cupboard to confirm that it meets the specifications of the Misuse of Drugs Safe Custody Act. Stocks of controlled drugs were checked, and tallied with records, showing that these are being used safely. Two medicines were missing from the index in the controlled drugs register, this should be completed fully, listing all controlled drugs stored. Although the policy has now been updated to include a section on receiving medicines into the home, receipts of medicines are still not being recorded in some cases. Good records are kept of medicines used and returned to the pharmacy, however an accurate record of medicines received into the home must be kept to show that the home can account for all medicines held for residents. The Manager is aware of the problem and the member of staff responsible is being retrained. This requirement is restated. A recommendation was made at the last inspection that staff countersign any handwritten entries on medication records, this will be restated as there were still some changes made where staff had not signed for the change so it wasnt clear who had made the change and why, for example, one dose was amended from 5ml to 7ml. Staff have recently had refresher medicines training, the medicines policy has been updated, and there is evidence that staff are following this, however it should contain more guidance to staff in some areas for example dealing with medication errors, handling of controlled drugs, and return of medicines. All medicines were available at the home, and there is evidence from records that residents are receiving their medicines regularly and as prescribed except in two cases. One resident is refusing medicines regularly, and the GP is aware of this. It would be useful for the home to have a care plan for this resident to show how the residents health conditions are being managed without medication. Another resident keeps a prescribed cream in her room, there was no record on the medication chart that this was being used. Care Homes for Older People Page 14 of 29 Evidence: There is evidence that the supplying pharmacist provides a good service to the home. There is also evidence that medicines are reviewed regularly by the GP and a psychiatrist for older people from the local hospital. Medicines were being stored in a trolley in an empty bedroom on the day of the inspection due to renovation at the home. This is only a temporary storage area, but as this room is not kept locked, it is recommended that the trolley is kept locked to a wall or removed to a lockable room when not in use. The medicines fridge is kept in an open office area, and is not kept locked. The fridge contained both a prescribed eyedrop for one resident and two unboxed and unlabeled medicines for staff as well as some food items. This is not safe, and must be reviewed, either a separate lockable fridge should be obtained for medicines, or staff medicines and food removed from this fridge. Our observation was that staff and residents have warm and respectful relationships. A resident described the staff as very kind and said that they were responsive to her needs. We heard that residents are able to spend time alone in their rooms if they so wish and they are granted privacy. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from the opportunities for spiritual and social care. There are spiritual services and regular classes for gentle exercise, a variety of games and creative activities. Mealtimes are enjoyed by residents and the food provided is suitable for their preferences and needs. Evidence: The home is run on Christian principles and aims to provide both physical and spiritual care for older people. There are regular Church services in the lounge which the majority of residents and staff attend and a Bible Group is held each week. Some people attend services at the Churches they attended before moving to The Elms. There are a range of other activities available, an activity takes place every day. A resident that told us that she ran a group and invited outside speakers to it. There is a satellite TV which when we visited was showing a Christian channel. There are lots of books, paintings and games available and this showed us that the home is well resourced with plenty of options for activities. Residents can choose to see a reflexologist, the therapist came to the home during our visit. Other people who visit to lead activities include teachers of poetry, exercise and arts and crafts, a hairdresser visits and manicure sessions are held. On a Care Homes for Older People Page 16 of 29 Evidence: Saturday activities around reminiscence are held. There is a series of functions held during the year such as plant sales, an open day and Christmas events to which friends and family of residents are invited. Residents have the opportunity to help towards the preparation of these, by, for example, folding serviettes, and making cards or craft items to sell. The Registered Manager and staff understand the value of making a contribution in whatever way is possible. During 2009 residents have enjoyed drama performances, one by students from the Brit School. The residents are assisted to use local facilities such as the Fair Trade cafe in Barry Road, they go to Dulwich Art Gallery and visit Dulwich Park. Some residents and staff go to meetings of the Parkinsons Disease Society. Residents told us that they enjoy the meals and said that if the meal for the day is not something that they like the cook will provide an alternative. On the homes survey of people involved with the home the majority described the food and meal time arrangements as very good, the others described them as quite good. We observed lunch being served both in the main house and the annexe. The building work going on has meant that dining space in the main house is temporarily reduced. Residents ate their lunch spread across the dining room, lounge and second lounge. Lunch looked appetising and inviting and was served well and carefully by staff. Staff also assisted residents to eat where needed. In the annexe there are six residents and lunch was served in the kitchen / diner. This was organised by the member of staff on duty in the annexe who arranged the table and served the meal. There was a pleasant, homely atmosphere. Two of the residents in the annexe ate their meal in their bedrooms. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints and safeguarding procedures assist in the protection of the residents. When required, information must be passed on to CQC and other authorities. Evidence: The complaints procedure was reviewed in 2008. It is included in the Statement of Purpose, but not the Service User Guide - see recommendation. The people that we spoke to were clear that they would feel confident in raising a concern with the Registered Manager or someone else they trusted. One person had done so and we were informed by the Registered Manager of the action she had taken in response. Although the action was appropriate the information should have been passed on to CQC and to the local safeguarding authority. This omission was corrected shortly after the inspection. No other complaints had been made over the last year. Staff have received training in safeguarding issues and knew what action to take in the event of a concern being raised with them. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and homely. Building work is underway to improve the facilities in the home, additional accommodation to the rear of the main building provides comfortable and safe facilities for six residents. Standards of hygiene and cleanliness are good. Evidence: A major building project began at The Elms during 2009. The aim of the work is to install a bigger passenger lift for access to the first floor where six new bedrooms with en-suite facilities will be created. In order to accommodate some residents while the work is underway The Elms have acquired a short term lease of a property to the rear of the home which is accessed through the garden. Six residents have moved to that property but are able to spend time in the main building if they so wish to do so. We inspected the premises with the homes maintenance person and we also visited a number of residents in their bedrooms. We also made observations throughout the inspection. The home is pleasant and welcoming with some attractive features such as bright aspects and mature gardens. Residents like the home and its character. However, there is a need to modernise and upgrade the facilities and indeed, work is in progress to do just this. Currently, building work is ongoing to provide new bedrooms and develop the home. Once this work is complete the home should provide very good and comfortable modern facilities. Care Homes for Older People Page 19 of 29 Evidence: Whilst the building work is happening an annexe is used to provide six additional places. The annexe is in a modern building to the rear of the home. Access is through the garden. The annexe provides good quality additional space. The homes fixtures and fittings have been well looked after so that, although they are not new, they are still serviceable. Residents have brought in their own possessions and made the bedrooms their own. The building was very clean and hygienic. In an infection control audit the home scored 93 and they are aiming to address the minor shortfalls to achieve 100 . Anti-bacterial gel is available at the entrance to the home for visitors and staff. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are well trained and the staff team is large enough to provide good care for residents, although during our visit staff numbers were slightly reduced because of sickness. Recruitment practice is safe and thorough. Evidence: In addition to the Registered Manager and the Deputy Manager there are seven senior care posts; ten care staff and three bank workers who fill shifts in the event of staff shortage. The usual staffing levels are for there to be one senior member of staff on duty throughout the day with four care staff during the morning and three in the afternoon. At night time three people are on waking night duty and a senior member of staff is on sleep in duty, available to be called if necessary. On the day that we visited there were three people on duty in addition to the Deputy Manager in the morning. This reduction from the usual level had been as a result of two members of care staff being unavailable for work through sickness, and we noticed from the rota that three people were on holiday. No bank staff had been booked for the day and the Deputy Manager assisted with care tasks. There is a team of ancillary staff including kitchen, domestic, laundry and administrative and maintenance posts. Several new people have joined the team over the last year although there remains a Care Homes for Older People Page 21 of 29 Evidence: core of staff who have worked at The Elms for several years and are very familiar to the longer standing residents and with their needs. All of the permanent care staff have achieved NVQ level 2 or above. Other training they have undertaken include a variety of health and safety courses (such as manual handling and first aid) and training on issues to do with the specific needs of residents such as stroke; dementia care; Parkinsons disease and visual and hearing impairments. Six staff (including the Registered Manager) have recently completed a nine month course in dementia care at Croydon College. This is a comprehensive course with a focus on person centred care and leads to a certificate from the National Council for Education. Staff told us that they are well supported in their work; there are formal systems to provide support through supervision and staff meetings. We spoke with a range of staff including the manager, deputy manager, care staff, catering and maintenance staff. We observed staff working well together and communicating efficiently. One care worker described the good aspects of work at the home as being, good communication skills, good atmosphere and the fact we collaborate well. The staff said that they enjoy their work, and demonstrated respect for residents in the manner in which they talked to and of the residents, for instance one person said I like talking to the residents,they have a wealth of experience. A Human Resources consultant is employed by the home to assist with staffing issues. We checked a selection of recruitment records of staff appointed over the last year. We found that the records were in good order. They showed that all of the required checks and references had been obtained prior to their employment at the home. In some cases the Registered Manager had been in touch with previous employers to query references. We recommend that notes of this contact are kept on file to ensure that the record contains all of the information taken into account when making a decision about employment. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the management systems take into account the views of residents and other people with an interest in the service. Health and safety is generally managed well but the practice of holding open fire doors must be reviewed. Evidence: The Registered Manager has worked at the home for twenty five years and has been the Registered Manager for several years, having previously been the Deputy Manager. She is appropriately experienced and qualified for the role and continues to take up training opportunities. She has recently completed a certificate in dementia care at Croydon College. The Registered Manager is assisted by a Deputy Manager who is also well qualified and experienced. They have an open approach to management and we observed that they are familiar to and with all of the residents, staff and relatives. Quality assurance systems include visits to the home by members of the Board of Trustees Board as required by regulation 26 of the Care Homes Regulations. We Care Homes for Older People Page 23 of 29 Evidence: learned from the AQAA that it is intended that the policies and procedures of the home will be reviewed over the next year, and annually thereafter. Residents and visitors to the home are asked to complete questionnaires which contribute to an annual review of the quality of the service provided at The Elms. In addition feedback is gathered from residents at their regular meetings. The service has had a recent detailed fire risk assessment which has required them to change fabrics, upgrade signage and check door safety. We were shown evidence that this work had taken place. However, we noted that some of the bedroom doors were not fully self-closing. These will need to be checked so that they can provide an effective means of fire safety. In addition, some bedrooms were being held open by door wedges and in one case, a chair. This practice should be reviewed in line with the homes fire risk assessment. Evidence was provided of regular testing of the fire alarm system as well as emergency lighting and regular fire drills. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All staff must follow the 22/02/2010 medication procedure about the action they should take when medicines are received into the home. This will help staff to account for all medicines and will protect residents. 2 16 37 The Registered person shall give notice without delay of occurrences detailed in regulation 37 of the Care Homes Regulations 2001. To be sure that the appropriate action has been taken in response to events and meet regulatory requirements. 23/02/2010 3 38 23 The doors must be checked 10/03/2010 to ensure they work effectively and the practice of holding open fire doors with wedges and other items must be reviewed in line Care Homes for Older People Page 26 of 29 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 with the homes fire risk assessment. To ensure that residents, staff and visitors are kept safe from the risk of fire. 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 4 The Service User Guide should include all of the information listed in regulation 5 and standard 1.2 of the national minimum standards for older people. A risk assessment should be completed before medicines including creams are stored in residents bedrooms, and there should be a record of all creams applied. Medicines requiring refrigerated storage should be kept separate from food and staff medicines to avoid contamination. The index of the controlled drug register should include all controlled drugs stored at the home. It is recommended that all areas where medicines are stored are monitored to ensure medicines are being kept at the right temperature to prevent contamination. If a resident refuses medicines regularly, a care plan should be written to show how the residents health conditions will be managed without medicines. A competency assessment should be carried out to ensure that staff understand the homes medication procedure and are competent to administer medicines. The assessment should be repeated at regular intervals. Handwritten entries on medication charts should be checked and countersigned by a second member of staff. This will reduce the risk of errors. The medicines trolley should be stored in a locked room or Page 27 of 29 2 9 3 9 4 5 9 9 6 9 7 9 8 9 9 9 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 locked to the wall when not being used, for the safety of residents. 10 9 The supplier of the controlled drugs cupboard should provide confirmation that it meets the requirements of the Misuse of Drugs Safe Custody Regulations. We recommend that notes of contact with referees are kept on file to ensure that the record contains all of the information taken into account when making a decision about employment. 11 29 Care Homes for Older People Page 28 of 29 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. 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