Care Home: Fern Lea

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What the care home does well People who use this service have their needs fully assessed and have the opportunity to visit the home before they decide to move in. This means choice is promoted. Fern Lea continues to offer a very good level of care to people, ensuring that needs are looked at on an individual basis. The care plans describe needs in a person centre way, which means that the support offered is individual to that person. Risk is managed well and the management plans in place give clear direction or instruction to staff. The health, social and personal care needs of people are detailed in the person centred plans and within a risk management framework. Privacy and dignity is promoted and maintained. Staff have developed good relationships with people and showed respect at all times. There was a nice atmosphere within the home and people and their relatives could not praise the manager and staff enough. People are able to take part in appropriate activities, daily routines promote independence and people`s preferences are accommodated, choice is promoted and encouraged. The menu offered is varied and nutritious. People are informed about the complaints procedure and are able to express their concerns in an open culture, they are protected from abuse. The home is maintained to a good standard and the environment is clean, hygienic, comfortable and homely and it meets the general needs of people living there. The home recruits and trains staff in a safe way. People live in a home that is managed well, their views are sought and their health and safety is maintained. What has improved since the last inspection? The medication procedure has been improved and ensures that medication is handled in a way that prevents contamination from fluids, this ensures that people have their medication needs met. Activities are recorded and show an accurate account of what has been undertaken and also when people choose not to take part. The manager told us that the majority of staff have undertaken training in relation to safeguarding adults. She said, "the remainder of staff are booked on the course in July 09, they also have to read and sign that they have read the policy/procedure and that they understand it". What the care home could do better: The home should consult with a health care professional when considering using bed rails, this would ensure that the decision was made in conjunction with others and in the best interests of the person. Overall the medication procedure is safe, however a controlled drugs cabinet and clearer recording would ensure that medication is stored in accordance with legislation and handwritten MAR charts should be clearly recorded, this makes sure that the correct medication and dose is recorded so a person receives their medication as prescribed. Parts of the building is not accessible for some people, this means choice is restricted. The staffing levels are sufficient to meet basic need, however it is recommended that these be reviewed and should not include the manager`s hours. This is to ensure that there are sufficient staff to meet all of the needs of people living in the home. The quality assurance system currently seeks to the views of the people living in the home and their family, but does not extend to other professionals involved. This would ensure that all stakeholders views are sought and included in the quality monitoring process. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fern Lea 52 Pearson Park Hull East Yorkshire HU5 2TG     The quality rating for this care home is:   three star excellent 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: Angela Tew     Date: 1 9 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Fern Lea 52 Pearson Park Hull East Yorkshire HU5 2TG 01482441167 01482474719 danny@juvleys.karoo.co.uk 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) : Richard and Carol Sheehan and Stephen and Jane Brown care home 20 Number of places (if applicable): Under 65 Over 65 20 20 dementia old age, not falling within any other category Additional conditions: 0 0 To admit one named service user who is under the age of 65 (variation application 24923). Date of last inspection Brief description of the care home Fern Lea is a large Victorian house in Pearson Park approximately two miles from Hull City centre. It offers permanent and respite accommodation for up to 20 older people of either gender, who may also suffer from dementia. Staff provide a range of personal care and have the added knowledge of the Registered Manager, who is one of the Registered Providers and a qualified nurse. Nearby are local shops, public houses and churches. The home is near to major bus routes into Hull. Accommodation is on three floors. Two of these are split level with additional stairs, Care Homes for Older People Page 4 of 29 Brief description of the care home there is a chair lift from the ground to first floor only. There are currently seven single and six double bedrooms in use, but these are interchangeable, with many rooms reaching the requirement of 16 sqm to accommodate two people. Communal space consists of a lounge and dining room. There is a small, enclosed patio/garden area to the side of the home, with a new water feature. The front garden is mainly for car parking with some seating areas. The grounds are well maintained and the decor in the home is of a good standard. The accommodation fees are £359.50 per week. These figures were provided by the registered manager at the time of the visit. Additional charges are made for the hairdresser, chiropodist, newspapers and toiletries. 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: three star excellent 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: The quality rating for this service is 3*. This means that the people who use this service experience excellent quality outcomes. This site visit took place over one day and took a total of 9.30 hours. A regulation inspector visited the home as part of the process. Prior to the visit surveys were posted out to people living in the home and staff members, information was gained from these and has formed part of the evidence. The Annual Quality Assurance Assessment (AQAA) was returned to CSCI prior to the visit and this gave a detailed account of the what care and support was in place in order to meet the needs of the people living in the home. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The medication procedure has been improved and ensures that medication is handled in a way that prevents contamination from fluids, this ensures that people have their medication needs met. Activities are recorded and show an accurate account of what has been undertaken and also when people choose not to take part. The manager told us that the majority of staff have undertaken training in relation to safeguarding adults. She said, the remainder of staff are booked on the course in July 09, they also have to read and sign that they have read the policy/procedure and that they understand it. Care Homes for Older People Page 8 of 29 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 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 who use the service have their needs fully assessed and have the opportunity to visit the home before they decide to move in, this means choice is promoted. Evidence: Prior to the inspection visit taking place information was gained from the home and people living there confirming that people have their needs assessed prior to and following admission. Surveys were received from people who live in Fern Lea and one person commented, my sister was already living in the home so I knew it well and all seven surveys stated that they had received sufficient information about the home before they decided to move in. The home completed the Annual Quality Assurance Assessment (AQAA), which details how the home can meet peoples individual needs. During the site visit three care files were looked at confirming that an assessment of need is undertaken prior to admission and in addition the home further develops this Care Homes for Older People Page 11 of 29 Evidence: on a day to day basis. The manager said, I always try to visit people before they come to live here and undertake an assessment of need, to make sure that Fern Lea can meet their needs. Evidence was seen confirming that the daily living assessment contains information about all aspects of daily life including choice and inclusion. Training is offered to staff in relation to more diverse need such as dementia, loss and bereavement, mental health in older people, Parkinsons, age and ageism, mental capacity, values and attitudes. This shows that the home embraces diversity and encourages staff to undertake training that would give them a better understanding of difference. From speaking to some of the staff it was evident that they had enjoyed this training and felt that they had developed their skills in new areas. 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, social and personal care needs of people are detailed in the person centred plans and within a risk management framework. Privacy and dignity is promoted and maintained. However, the home should consult with a health care professional when considering using bedrails, this would ensure that the decision was made in conjunction with others and in the best interests of the person. Overall the medication procedure is safe, however a controlled drugs cabinet and clearer recording would ensure that medication is stored in accordance with legislation and handwritten MAR charts should be clearly recorded, this makes sure that the correct medication and dose is recorded so a person receives their medication as prescribed. Evidence: During the visit it was confirmed by speaking to people using the service, relatives and staff that care plans meet individual need and that these are developed in consultation with the person and their family or representative. People told us that the care offered Care Homes for Older People Page 13 of 29 Evidence: was of an excellent standard and some comments included, they are very nice, all of them, I am pleased with the care and support I receive, marvellous, I am very happy here and do not think I could be in a nicer home. One relative told us, the home is excellent, they work with me and we are involved with the care, I can recommend the home to anyone, its brilliant. Three care files were looked at confirming that the care plans and risk assessments are detailed and give clear information about what the needs are and what action is required, they give direction to staff. The care plans describe a persons needs in a holistic way and talk about their likes, dislikes, preferences and choices. Staff could describe what the needs of people were and throughout the day staff were observed interacting with people, this was undertaken in a very caring and professional way. The management of risk is done in consultation with the individual and their representative and covers a variety of areas such as falls, mobility, smoking and mental health issues. However, in relation to the use of bedrails although the person and family have been consulted and a risk assessment undertaken, a health care professional is not always involved in the decision making process. This would ensure that the decision has been made involving either involving the GP or district nurse or someone who could give their view about whether this restriction is necessary for safety. Each file contains personal information and a photograph of the person and detail about specific need such as diet, mobility, continence, sleeping patterns, medication, mental health issues and a personal profile including likes, dislikes, choice and preference. The home operates a key worker system and staff have developed positive relationships with people living in the home. Evidence showed us that people have their needs reviewed on a six monthly basis. From looking at written evidence and speaking to relatives it was clear that the home meets the health care needs of people living in the home. Each file contained a health care check list and covered sight, hearing, dental check ups, other appointments were recorded with the psychiatrist, GP, CPN, District nurse. Nutritional screening is undertaken with people and there were records of fluid and food intake. Records also showed us that advice is sought when necessary from other professionals. The chiropodist attends the home on a regular basis and written evidence was seen to confirm this. A visiting district nurse told us, staff are always friendly and helpful and the manager is on the ball. Staff are co-operative and seek advice, I have no concerns. We looked at the homes medication system and this continues to be well managed. On the whole the storage of medication is safe. However, the controlled drugs cabinet Care Homes for Older People Page 14 of 29 Evidence: does not meet the required standard or comply with new legislation. The recording was of a good standard and although no gaps were present on the medication administration records MAR, there was confusion when using the code R for refused and it was difficult to ascertain what stock should remain. One bottle of ear drops had no opening date written on them. The manager told us that staff who administer medication undertake training before hand. Staff were osbserved giving out medication and this was done in a caring and safe way, ensuring that the person knew what was being given to them. We spent time observing staff practices at the home and it was clear that staff have developed good relationships with people, as they showed respect at all times and there was a nice atmosphere within the home. People and their relatives could not praise the manager and staff enough and comments included, the staff and manager are brilliant, very nice and they are approachable. No personal tasks are undertaken in public and people told us that their privacy and dignity are maintained at all times. The manager told us that staff are offered training in relation to death and dying, loss and bereavement and values and attitudes. Staff demonstrated a good understanding of peoples need and how they would offer support in difficult circumstances. Evidence was seen that the home seeks the wishes of the person in relation to palliative care and dying. 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. People are able to take part in appropriate activities, daily routines promote independence and peoples preferences are accommodated, choice is promoted and encouraged. The menu offered is varied and nutritious. Evidence: From looking at care plans and observing throughout the day it was evident that people are offered individual care. Written evidence detailed the likes, dislikes and preferences of people, therefore promoting choice and self-determination. From observation and speaking to people it was clear that they made everyday choices and decisions. For example, one married couple chose to share a room and said, our privacy is respected by all staff. Activities were observed taking place and these included hairdressing, singing and reading. The manager told us that one carer takes the lead role in organising activities, every Monday is a set activities afternoon and usually involves an outside entertainer/singer, we also have three trainees from College who help with activities. There is a fish pond in the garden and one person living in the home looks after this. That person was spoken to and said, I look after the fish, I really enjoy it Care Homes for Older People Page 16 of 29 Evidence: and sit out here a lot of the time. Surveys received from people indicated that the activities on offer where sufficient. People told us that they are able to receive visitors in private and when they chose to. Two relatives told us that they could see their family member in private and that the home consulted them with all aspects of care. People told us that the food offered is of an excellent standard and that they enjoy their meals very much. Some comments included, the food is very good, everything I get here I enjoy, I enjoy my food and feel well provided for, the home is good at providing specialised items. A score of B was achieved with the Environmental Health Department for cleanliness and hygiene in the kitchen. The cook told us that fresh produce is used and the menu is varied and healthy. She also said, we consult with people all the time about what they would like to eat. Evidence was seen confirming that choice is offered and the meals were well presented and of a good portion. 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. People who live in the home are aware of the complaints procedure and are able to express concerns in an open culture and are protected from harm or abuse. Evidence: The home has a complaints procedure and it was clear from speaking to people living there and relatives that complaints are listened to. Surveys received from people living in the home also stated that they knew how to complain. The manage told us that there had been one complaint since the previous visit and it was recorded that these had been investigated. People told us that, I always know who is in charge and to go to them if I have any concerns, yes I do know who to go to. A relative told us that she has never had any complaints, but any minor issues have been dealt with quickly and efficiently by the manager. The home has a multi-agency policy and procedure for the prevention of abuse and the manager told us that the majority of staff have undertaken training in relation to safeguarding adults. She said, the remainder of staff are booked on the course in July 09, they also have to read and sign that they have read the policy/procedure and that they understand it. Since the last inspection visit there has been one safeguarding referrals made to the local authority safeguarding team. From speaking to two staff members it was clear that they had a good understanding of the needs of people and how they would need protecting from harm or abuse. Care Homes for Older People Page 18 of 29 Evidence: The manager told us that there are policies and procedures for dealing with peoples money and finances. Records for maintaining personal finances were looked at confirming that people had access to their money when they needed to and these were up to date and accurate. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well maintained and the enviroment is clean, hygienic, comfortable and homely and meets the general needs of people living there. However, parts of the building is not accessible for some people, this means choice is restricted. Evidence: A tour of the building was undertaken and the standard of accommodation and cleanliness was of a good standard. The health and safety of people living at Fern Lea is maintained and promoted. Since the last inspection the recommendation made in relation to restricted access has not been met and the one in relation to the laundry has been partially met. The communal areas were nicely decorated in a homely in style and individual bedrooms were personalised with photographs, pictures and furniture. People told us that they could bring in personal items to the home. The majority of bedrooms were decorated and maintained to a very good standard, however, bedroom nine had carpet tiles and these were poorly fitted in part and worn. Seven surveys received from people living in the home confirmed that the environment is homely, clean and hygienic. Some comments included, the home is very clean, it is lovely, the toilets are always clean. People spoken to during the Care Homes for Older People Page 20 of 29 Evidence: visit commented, it is always very clean. The home was clean, hygienic and fresh smelling. Staff receive training in relation to infection control and there are clear guidelines set down for staff to follow if there are infectious diseases. Although since the last inspection visit the laundry floor has been painted with a waterproof covering, it has begun to peel in part and may cause cross contamination. The issue of restricted access to the communal areas remains outstanding. There are three bedrooms situated on the ground floor located to the rear of the property. Due to internal steps the people in those rooms who have limited mobility have to go outside in order to access the lounge and dining room. The manager explained that this had been looked into, but would prove to costly to rectify. The home should address the need for access to communal areas of the home without having to use an external door. This would ensure that people are supported to access all areas of their home and that their daily choice is not restricted. One person spoke about wanting to have a shower or bath, but due to their physical needs was not currently able to. The home does not have a downstairs assisted or disabled access shower room/bathroom. The provision of an assisted bath/shower room would promote choice and enable all people to bath/shower when they wished to. 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 home recruits and trains staff in a safe way. The staffing levels are sufficient to meet basic need, however it is recommended that these be reviewed and should not include the managers hours. This is to ensure that there are sufficient staff to meet all of the needs of people living in the home. Evidence: People told us that the staffing levels in the home were adequate and during the visit the staff rotas were looked at, currently the home provides 371 care hours per week. However, the minimum recommended amount is 410 hours for the amount of people and the level of their need. The registered manager told us that she currently undertakes 24 care hours and that these hours are included in the 371. Surveys received from people living in the home indicated that the staff were usually available when needed. Some comments included, they try and do everything they can to help. If staff are busy with someone else they make me aware of this and ask me to wait until they are available, if they are not immediately available they will call in to make sure I am ok with the delay. During the visit it was observed that several people required constant monitoring and interaction from staff. This was carried out in a sensitive and caring way and although the overall feedback was very positive about staff and management, it is apparent that people sometimes have to wait for staff to attend their needs. Therefore it is recommended that the staffing levels be reviewed Care Homes for Older People Page 22 of 29 Evidence: and the managers hours are not included in the actual care hours, to ensure that people receive support when they need it. The manager told us that 88 of the staff have achieved NVQ level 2 in care and that any new starters must commence the training as soon as possible. During the inspection visit three staff files were looked at confirming that the recruitment procedure was followed and staff had the relevant checks in place before commencing work in the home. The manager told us that since the last inspection the mandatory training offered to staff has been maintained. The manager also stated that other diverse needs were looked at and staff have undertaken courses in the following, understanding and working with people who have dementia, ageing ageism, mental capacity and deprivation of liberty. From speaking to two staff members about the training it was clear that they are supported to undertake training that is appropriate to their role. One person said, anything that is identified is applied for, mandatory training is updated regularly, the training is excellent and if we identify an area that requires training, the manager will look into this. Evidence was seen confirming that staff have either undertaken or are booked onto courses in relation to maintaining the health and safety of the people in the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is managed very well, their views are sought and their health and safety is maintained. However, the quality assurance system should extend to other professionals involved in providing care, as this would ensure that the views of all stakeholders are sought. Evidence: Prior to the inspection visit the Annual Quality Assurance Assessment (AQAA) was received giving information about the way the home is run. Surveys were received from 7 people living in the home and 4 from staff. Some comments from people included, the manager is lovely, very approachable and problems are sorted out very quickly. Comments from staff included, the manageress works as a member of the team and so is readily available for advice or help, the management are approachable, I can go and see them at any time. The registered manager is qualified and experienced to run the home and maintains Care Homes for Older People Page 24 of 29 Evidence: her knowledge by attending relevant training courses. The manager told us, I keep my skills up to date by attending relevant training courses. In the last year I have updated my mandatory courses including food hygiene and I have also attended the Mental Capacity Act and Deprivation of Liberty training. Two relatives told us that, the manager is always available, any problems are sorted out quickly, the standard of care is excellent, we are kept fully informed about what is going on. The home has a quality assurance system and seeks the views of people in various ways. Surveys are given to people living in the home and staff, but currently they are not given to professionals ie, GP, social workers or nurses who may visit or come into contact with the home. The manager said that the results of surveys are looked at and corrective action is identified. Residents and relatives meetings are held on a regular basis. The manager and staff told us that supervision is offered on a regular basis, written documentation confirmed this. However, the records are currently kept in the homes of one of the managers and not in the care home. For safety and in order not to breach the Data Protection Act records must be kept in the care home and made available for inspection. Health and safety is ensured by having all of the appropriate maintenance certificates in place. Evidence was seen confirming that staff undertake training in relation to health and safety within their first six months of employment ensuring that staff are knowledgeable and have the necessary skills to deal with emergencies. The home notifies CQC when incidents occur that affect people and internal monitoring visits take place to ensure that peoples welfare and safety are promoted. Equality and diversity is promoted by staff and from what people told us it was clear that staff treat them with respect and dignity. People are fully supported to undertake either activities or events that promote choice and meet diverse needs. The manager told us that people are supported to attend church services and for those who cannot get out, a minister visits the home on a regular basis. She also said that all staff have to undertake training in relation to safeguarding adults and the mental capacity act. 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 Arrangements must be in place to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971 and Misuse of Drugs (Safe Custody) Regulations 1973. These arrangements must also be in accorance with the current guidelines from the Royal Pharmaceutical Society of Great Britain. To ensure that controlled drugs are stored in a secure and safe way. 19/09/2009 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 7 Bed rails should only be used when a risk assessment has been undertaken and an agreement reached with the person, their representative and a health care professional. This would ensure that bed rails are used appropriately and Page 27 of 29 Care Homes for Older People in consultation with others. 2 9 When medication is refused it should be recorded clearly, to ensure that the stock control is accurate and people receive the correct amount of medication. Medication that has a short shelf life when opened should have the date of opening recorded on it. This would ensure that people receive medication safely. People should have the ability/choice to access communal areas within the home. This would promote choice and inclusion for all. The provision of an assisted bath/shower room would promote choice and enable all people to bath/shower when they wished to. The carpet squares in bedroom nine were poorly fitted, worn in places and should be replaced . This would ensure that people live in a well maintained home. The laundry floor should be impermeable, as this would ensure that infection control is well managed. The quality assurance system should involve all stakeholders and their views gathered. This would ensure that the home seeks the views of all people involved in the provision of care to people, including other professionals such as GPs, Community Psychiatric Nurses, District nurses and social workers. Staff supervision records should be held securely within the home and made available at all times for inspection. 3 9 4 19 5 22 6 24 7 8 26 33 9 37 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. Re-publishing this information is in breach of the terms of use of that website. 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