Care Home: Farnham Common House

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• St Vincents
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• The Maypole Nursing Centre
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What the care home does well People using the service are thoroughly assessed prior to admission and have a range of useful information available to them to help make a decision about moving in. The health and personal care needs of people living at the home are generally well met, promoting health, well-being and taking into account their preferences and religious or cultural requirements. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting people`s preferences and religious or cultural requirements. Complaints and safeguarding are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. The service is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which is suitable for the range of disabilities that people have. The service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. The management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? Staffing levels have been increased in order that more carers are on duty to meet people`s care needs. A check of portable electrical appliances has been undertaken to make sure that these are in safe working order. En-suite bathrooms have been turned into wet rooms to provide better facilities for service users. What the care home could do better: Assessments of prospective service users` care needs need to be signed and dated in order that it is clear who undertook the assessment, and when. Some attention to the recording and disposal of medicines is needed to make sure that medicines are consistently handled safely. References need to be consistently obtained from managers, rather than peers, at current or previous places of employment, to make sure that people supplying information have full knowledge of people`s skills, competencies and workperformance. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Farnham Common House Beaconsfield Road Farnham Common Slough Bucks SL2 3HU     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: Chris Schwarz     Date: 2 4 0 4 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 29 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 29 Information about the care home Name of care home: Address: Farnham Common House Farnham Common Beaconsfield Road Slough Bucks SL2 3HU 01753669900 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.farnham@fremantletrust.org The Fremantle Trust The registered provider is responsible for running the service care home 50 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 0 dementia old age, not falling within any other category Additional conditions: 50 50 The maximum number of services users who can be accommodated is 50 The registered person may provide the following category/ies of service only: Care home only – PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Farnham Common House opened in May 2004. It is a care home providing personal care and accommodation for 50 older people. The development is the result of a partnership between The Fremantle Trust, London and Quadrant Housing Association and Buckinghamshire County Council. The service is run by The Fremantle Trust. The Care Homes for Older People Page 4 of 29 Brief description of the care home home is located in Farnham Common, Buckinghamshire, on the A355 road and is conveniently located for buses between Beaconsfield and Slough (hourly service) and about half a mile from shops and other amenities of Farnham Common. The home is divided into four houses - two of ten places and two of fifteen places. One house on the ground floor is dedicated to the care of people with dementia and a second house upstairs now provides care to people with dementia (25 beds overall). The home is purpose built and provides a good quality, well equipped and spacious environment for service users. All bedrooms are single and all have en-suite facilities. The home is set in compact and pleasant grounds. There is parking for staff and visitors cars. Fees for the service vary according to needs; contact the provider for details. 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 key inspection was conducted over the course of a day by Chris Schwarz and covered all of the key National Minimum Standards for older people. The last key inspection of the service took place on 5th June 2007. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion and comment cards were sent to a selection of people living at the service, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records, Care Homes for Older People Page 6 of 29 observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? What they could do better: Assessments of prospective service users care needs need to be signed and dated in order that it is clear who undertook the assessment, and when. Some attention to the recording and disposal of medicines is needed to make sure that medicines are consistently handled safely. References need to be consistently obtained from managers, rather than peers, at current or previous places of employment, to make sure that people supplying information have full knowledge of peoples skills, competencies and work Care Homes for Older People Page 8 of 29 performance. 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 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. People using the service are thoroughly assessed prior to admission and have a range of useful information available to them to help make a decision about moving in. Evidence: A statement of purpose and service users guide were displayed in the entrance hall and available to anyone visiting the service. Both had been produced to a good standard and contained information to assist people in making a decision to move in and giving them an idea of what to expect of life at the service. A senior member of staff went out during the morning to assess a prospective service user who was living in her own home. The assessment tool used covered a wide range of care needs such as mobility, communication, washing and bathing, continence, dressing and personal grooming, dietary needs and choices, getting up and going to bed, social skills, lifestyle and future plans, health care needs including history of falls, Care Homes for Older People Page 11 of 29 Evidence: dementia diagnosis and palliative care needs. Three completed assessments of people who had recently moved into the service were looked at. Each had been completed but they had not been consistently signed and dated. A recommendation is made to address this. People who completed surveys said they had received enough information about the service before they moved in so they could decide if it was the right place for them. Some people said they had received contracts, others said they had not. 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 health and personal care needs of people living at the home are generally well met, promoting health, well-being and taking into account their preferences and religious or cultural requirements. Some attention to medication practice is needed to make sure that medicines are consistently handled safely. Evidence: Care plans were in place for each person living at the service and a sample from each house group was looked at. These followed a corporate format which listed essential information about people such as their name, date of birth, next of kin, religion, any equipment they needed to assist with daily living tasks and a pen picture. Their preferred daily routines were noted and a summary of needs had been completed. Care plans were arranged under various headings including mobility, continence, washing and bathing, personal grooming, getting up and going to bed, food and drink, general physical health, mental health needs, family and spiritual beliefs. It was noted that care plans had been promptly organised and put in place after people had been admitted to the home. All care plans that were viewed were up to date with evidence Care Homes for Older People Page 13 of 29 Evidence: of being reviewed. Risk assessments were in place for moving and handling, personal emergency evacuation of the premises and for risk of developing pressure damage. Nutritional assessments were also in place and records of weight were seen. Some possible issues were fedback to the manager: the organisational expectation of pressure risk assessments being reviewed each month was not consistently evident in all files, one persons file showed that they had only been weighed once in 2008 and her nutritional assessment indicated that she needed to be weighed each month. Also, one persons weight records reflected a 2 kg loss recently yet the nutritional risk assessment reviewed after this date stated no changes under the section covering weight. The manager said the service user had been affected by a recent diarrhoea and vomiting infection and the weight loss would have been as a result of that. It would be advisable to include this information on the assessment form to explain the weight loss. The service has increased its dementia care provision and now has two houses (25 beds) providing care to people with these increased care needs. Dementia care mapping was undertaken by one of the external senior managers in February this year and another is due to take place in June. Records of visits by and to health care professionals were noted in peoples care plan files. A general practitioner who completed a survey said that the service always seeks advice and acts upon it to manage or improve health care needs. They said peoples health care needs were always met and that the service usually respected privacy and dignity. Regarding medication, the doctor said that the service usually managed it correctly where people were not able to administer their own medication and added sometimes there is a delay in obtaining medicines, especially antibiotics. The system for processing prescriptions seems slow and cumbersome. The doctor considered staff sometimes had the right skills and experience to meet social and health care needs and that they usually responded to different needs. The doctor said overall package is very good, especially meals and social events and added there have been marked improvements over the last two years. Quality of staff and training has improved immensely. People using the service said in surveys that they receive the care and support they need, including medical support. One person said I am very happy here, everyone is so kind to me and my wife. We are treated like a big family. A couple of people raised the issue of other service users coming into their rooms, especially at night. Medication practice was looked at. Medicines were securely stored and keys kept safely. A monitored dose system of medication administration was being used. Care Homes for Older People Page 14 of 29 Evidence: Photographs of service users were contained within the folder for administration records. Some gaps to records were noted, in most cases the medication had been taken from the blister packs but not signed for. A requirement is made to improve practice in order that accurate records are maintained. Controlled medications were checked. Safe storage arrangements were in place although the room housing these and other medicines was very warm and could exceed the recommended maximum storage temperature of 25 degrees Celsius in summer. The manager is advised to monitor this. All controlled drugs at the home were checked against the register and quantities tallied with records. A discrepancy was noted where some tablets that were no longer needed were concerned. They had been signed out of the controlled drugs register on 9th April this year by two staff as returned to the pharmacy but were still in the cupboard. This related to 82 whole tablets and 2 half tablets. The manager was advised to ensure that any medicines in the controlled drugs cabinet are included in the register until they are actually returned to the pharmacy, and not signed out in advance of this. She was also advised to ensure prompt disposal of unwanted medication. A requirement and recommendation are made to address this. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences and religious or cultural requirements. Evidence: People said in surveys that there are activities arranged by the service that they can take part in. There is a large, comfortably arranged room on the ground floor which is used for communal activities, as well as those which take place in the individual houses. Books, a massage chair, television and a dart board were available in the activity room and it had its own bar area for refreshments. The room leads out into the gardens. Two part time activity co-ordinators, covering 20 hours per week, are employed at the service. One has achieved National Vocational Qualification in activity provision. One of the co-ordinators was met during the inspection. A log was being kept of activities arranged at the service such as discussions, coffee mornings, bingo, keep fit, crafts, Care Homes for Older People Page 16 of 29 Evidence: music, Scrabble, manicures and sing-alongs. Times for activities were being displayed throughout the building. One service user has been helping to keep the garden looking neat and tidy and tending raised flower beds, which have been added since the last inspection. There were chairs outside for people to make use of and safe, enclosed gardens for people to wander around. Two church services are held at the home each month. There is a hairdressing salon on the ground floor and a visiting hairdresser is available. Themed days had been started, a St Georges Day event taking place the day before the inspection and an Indian day earlier in the year. Meals on these days were linked to the theme, such as chicken curry, onion bhajis, samosas, naan bread and Indian sweets and treats on the Indian day. Further themed days for other parts of the world were being planned. The co-ordinator said she had attended a therapeutic movements course and was aiming to start individual sessions for service users. She said there was a budget for purchase of any craft and other items that were needed. An interactive games package and wide screen television on which to use it were being purchased for the home. Visitors were seen to be made welcome by staff and well behaved dogs were also welcomed. People who completed surveys said they liked the meals; one person adding the food is excellent. The service has a competent chef manager who has achieved level 3 in supervisory food management. A four week rotating menu was being used; the lunch time meal was fish or beef burger and chips with baked beans. Staff had lists of choices previously made by service users and referred to these as they served food up from heated trolleys. The chef manager advised that there was usually enough of each choice to go round if people subsequently changed their minds. Dining tables had the menu for the day displayed and tables had been attractively set. Service users were observed being asked if they wanted to come to the table for lunch or if they wanted to stay where they were. Tea, coffee and cold drinks were served to people throughout the day; food and fluid intake charts were being maintained where necessary. 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. Complaints and safeguarding are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. Evidence: In the pre-inspection self-assessment, the manager said there had been seven complaints since the last inspection and one safeguarding referral. No use of restraint was indicated. A complaints log was being maintained at the service, which had significantly more compliments than complaints in it. Procedures for making complaints were included in the operations manual for the service as well as in the service users guide and statement of purpose. All staff who completed surveys said they knew what to do if a service user, relative, advocate or friend had concerns about the home. People using the service said they knew how to make a complaint if necessary and most knew who to speak with if they were unhappy. The manager notified the Commission last year about some money that was reported missing by a service user. This was reported to the police and Social Services Department at the time. Procedures for safeguarding vulnerable adults were in place, as well as a copy of the local authority procedures. The manager is involved in a safeguarding good practice group run by the local authority and is aiming to make advocacy services available at the home. Care Homes for Older People Page 18 of 29 Evidence: No other complaints or safeguarding matters have been brought to the Commissions attention. Care Homes for Older People Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which is suitable for the range of disabilities that people have. Evidence: The service is located on the A355, Beaconsfield to Slough road. The building is a large, purpose built property which is five years old and divided into four house groups. It has parking for staff and visitors cars. The entrance hall is welcoming and contains useful information, such as the statement of purpose, service users guide, philosophy of care, external support organisations and the General Social Care Council code of practice. There are two houses on each floor with a house for people with dementia on each floor. There is a passenger lift for access between floors. Each house has its own lounge with dining room and kitchen area. All bedrooms meet modern care home standards and have sufficient space for manoeuvrability. Each bedroom has its own en-suite bathroom and all of these have been converted to wet rooms since the last inspection. This was in response to poorly installed showers which caused leakage throughout the building. Bedrooms had been personalised to different tastes. Adapted bathrooms and toilets were close by to bedrooms. Sluice rooms were kept locked when not in use and contained infection Care Homes for Older People Page 20 of 29 Evidence: control products such as gloves, alginate laundry bags and yellow bags for clinical waste. There is a large activities room downstairs and a hairdressing salon. A quiet room is available for people to use upstairs. Corridors are wide and equipment has been provided to assist people with daily living tasks. People using the service said in surveys that the premises are kept fresh and clean. All parts of the building that were seen were clean and in good decorative order. Bath panels were waiting to be fitted back on by the manufactures due to some design fault. The kitchen and laundry were in good order and kept clean and tidy. There were problems with the heating system in the winter which was remedied. Portable heaters are available for such occurrences. The need for discreet storage space in bedrooms for incontinence products was raised with the manager, to better promote peoples dignity. Care Homes for Older People Page 21 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 service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. Evidence: A senior member of staff is on duty at all times to co-ordinate shifts. The duty office is located on the ground floor and has the necessary records and policies and procedures available to staff to refer to. One of the group care co-ordinator positions (focusing on dementia care) was vacant at the time of this inspection. Minimal use of agency staff was being used to cover gaps for carers on the rota. Staff who completed surveys said they are given up to date information about the people they care for. One carer pointed out that information is sometimes slow to come in for service users on respite care. They considered they had been recruited thoroughly and their induction covered the areas they needed to know about very well. They said training was being given which is relevant to their role, helped them to understand and meet the needs of individual service users and which kept them up to date with new ways of working. They described regular opportunities to meet with their manager for support and to discuss how they are working. They said the ways information is passed worked well and that there were usually enough staff to meet Care Homes for Older People Page 22 of 29 Evidence: individual care needs. Staffing had been increased at the service since the last inspection to provide ten carers on duty during the day. Most staff indicated that they felt they had the right support, experience and knowledge to meet a wide range of needs, including those arising from equality and diversity. Some of the things they considered the service does well were menus and meal provision, activities, training opportunities, promoting choices of service users, promoting equality amongst staff and service users, person centred care and dementia care. Some felt that communication and support could be improved plus more staff on duty. People using the service said in surveys that staff listen and act on what they say and that there were usually staff available when they needed them. One person said there needed to be more carers and cleaners. Observed interactions between staff and service users were gentle and conveyed respect. Choices were offered to people where relevant. Twenty one staff had achieved National Vocational Qualification level 2 or above at the time the pre-inspection self-assessment was completed. Training records showed that most staff were up to date with mandatory courses although some certificates were needed to verify entries on spreadsheets. Specialist courses undertaken included dementia care, health care and older people, infection control, care of skin and pressure areas, arthritis and Parkinsons Disease, conflict resolution, cultural awareness and diabetes and stroke. Recruitment files for six staff who started since the last inspection were looked at. All contained satisfactory Protection of Vulnerable Adults and Criminal Records Bureau clearances. Application forms has been completed and health clearance obtained. Proofs of identification and rights to work in the country (where applicable) had been obtained. Two written references were in place for each person. In two files, the references had been obtained from referees who were at peer level to the applicant, such as sales assistants and a registered nurse. The manager was advised to make sure that references are addressed to managers of current or previous places of work to ensure that references are always obtained from people who are in a position to comment more impartially than peers. A recommendation is made to this effect. Care Homes for Older People Page 23 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 management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. Evidence: The service has a registered manager who is experienced in the care of older people. She has achieved the Registered Managers Award. No issues were identified from surveys about the way in which the service is managed. The deputy manager has National Vocational Qualification level 3. The manager has contacted the Commission since the last inspection to advise of notifiable incidents. There is regular monitoring of the service by the provider and reports of monthly visits were available in the duty office. Two quality audits had taken place since the last inspection, the report of one from April 2008 was read and reported favourably on care standards, the other was not yet available. Care Homes for Older People Page 24 of 29 Evidence: Service users money is managed within a residents savings scheme. The services administrator maintains manual and electronic records of expenditure and credits and receipts are kept. Access to the system is restricted to authorised persons only. Health and safety was being well managed. A requirement was made at the last inspection for a safety check to be undertaken of portable electrical appliances, to ensure electrical safety. This had been attended to. Checking of the electrical hardwiring of the premises was due this year. A current gas safety certificate could not be located; the manager will need to make sure that this is obtained and available at the service. The fire log was being maintained with regular checks of the means of escape, call points and emergency lighting. A fire based risk assessment was in place. The most recent inspection by the fire officer took place in November 2008 when measures in place were satisfactory. Extinguishers had been serviced in November 2008. Legionella testing took place in August 2008 with satisfactory results although some action was recommended to reduce risks. Hot water temperature testing was last done on 20th April this year. Records of fridge and freezer temperatures, core food temperatures and cleaning schedules were being maintained in the kitchen. Washing machines had appropriate sluicing programmes and alginate bags were in use for soiled items to reduce risk of contamination. A falls register was being maintained. Staff training covered health and safety related topics such as moving and handling, first aid, fire safety and food handling. A member of staff was seen placing a yellow hazard bollard onto a kitchen floor she mopped in one of the lounges after lunch and made sure that service users were aware that the floor was wet. Care Homes for Older People Page 25 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 26 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 Accurate records of medication administered to service users are to be maintained. This is to make sure that clear audit trails are in place. 30/05/2009 2 9 13 Controlled drugs are to be included in the register until the point at which they are returned to the pharmacy. This is to make sure that an accurate log of all controlled medicines on the premises is maintained. 30/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Assessments of prospective service users care needs are to be signed and dated in order that it is clear who undertook the assessment, and when. Care Homes for Older People Page 27 of 29 2 9 Unwanted medicines are to be disposed of promptly to make sure that safe medication practice is followed. Care Homes for Older People Page 28 of 29 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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