Care Home: Fir Close Residential Home

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What the care home does well People living in this home live in a comfortable and homely environment with pleasant gardens. People made positive comments overall about the care they receive. A person said "it is just like being at home". People told us they enjoyed going out on trips and have a choice of whether they do so. There were positive comments about the meals provided. People told us they knew how to raise concerns and felt complaints would be responded to. What has improved since the last inspection? There were no specific matters raised at the previous key inspection for improvement. The organisation has an ongoing programme in place for redecoration, refurbishment and maintenance of the house and grounds. For example, we saw a lounge carpet has been replaced and an outdoor decking area has been provided. Staff have had further training opportunities to make sure they have the knowledge and skills to care for people. The manager said they are also in the process of compiling "profiles" that contain more individual information about people who live in the home to make sure people receive more person centred care. What the care home could do better: We made some requirements at this inspection. These are things that must be done to make sure standards are fully met. We said everyone living at the home must have a care plan that clearly identifies all of their needs and wishes. This is so that staff are clear about the help and support people need. Staff also need to make sure that they consistently follow medication procedures and only sign records after making sure medicines have been taken. This will help to make sure people`s health and safety is promoted. We said staff must not commence employment in the home before obtaining a satisfactory criminal record bureau check despite all other checks being obtained, unless there was a real danger that peoples care would be compromised through insufficient staffing, in which case they must tell us. Although they have told us about some important matters which have occurred they must make sure they include any significant events that have the potential to affect the well being or safety of people the service supports such as staffing issues. We said they must also make sure that they provide us with an annual quality assurance assessment questionnaire when we ask for it so that we have up to date information about how they are improving and developing the service. We also made some recommendations. We recommended care plans should bereviewed so that they show clearly consideration has been given to peoples capacity to make decisions and choices and how their rights and best interests are protected. We also recommended that in peoples best interests any money held in safe keeping in the organisations "residents" account is able to accrue interest. We also recommended that the hours worked in the home by the manager be included on the staff rota so that it accurately reflects the staffing of the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fir Close Residential Home 2 Westgate Louth Lincolnshire LN11 9YH     The quality rating for this care home is:   one star adequate 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: Sue Hayward     Date: 2 1 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: Fir Close Residential Home 2 Westgate Louth Lincolnshire LN11 9YH 01507603882 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Prime Life Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 36 Number of places (if applicable): Under 65 Over 65 0 14 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 22 0 Fir Close Care Centre is owned by Prime Life Limited who have 50 care homes throughout the country. The home is made up of two detached buildings, which are named Riverview and Fieldview, both set in the same grounds. The home offers residential care for 36 older people over the age of 65, this includes 22 service users who have care needs associated with dementia. Fir Close offers both short-term and long-term care, nursing care is not provided. Fir Close has large extended private gardens and a large car park at the side of the care home. The home itself is set in the centre of Louth and, therefore, can be reached easily by local transport services. The service users staying in the home are provided with a minibus for transport to hospital appointments and for local shopping. Care Homes for Older People Page 4 of 29 Brief description of the care home Up to date information about the service including a copy of the most recent inspection report and the range of fees can be obtained from the manager. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission. (CQC). The visit lasted approximately seven hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. The Commission are trying to improve the way that we engage with people who use services so that we gain a real understanding of their views and experiences of social care services. During this inspection we used a method of working where an expert by Care Homes for Older People Page 6 of 29 experience visited the home as part of the inspection. This is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert met and talked to several people living at the home. The care received by three people was followed on this occasion through checking their records. In addition we checked the care plan of one other person. We spoke to people who use the service, a visitor, staff and the manager who was present for most of the visit. In addition we saw the bedrooms of people who gave us permission to do so as well as checking some of the communal areas in the home such as lounges, dining rooms, bathrooms and toilets. Prior to the visit we sent out surveys to people who use the service and included a survey for them to give to their friends and relatives if they wished. We also sent surveys to be distributed to a range of staff. The comments we received were used to plan the inspection and produce this report. We also sent out an annual quality assurance questionnaire (AQAA) to the manager. This gives us important information about the services own assessment of how well it is meeting standards and is used to plan the inspection. Despite a reminder, this was not returned. We therefore used the information they had provided us with last year. General feedback on the outcomes of the visit were given to the manager and her line manager. What the care home does well: What has improved since the last inspection? What they could do better: We made some requirements at this inspection. These are things that must be done to make sure standards are fully met. We said everyone living at the home must have a care plan that clearly identifies all of their needs and wishes. This is so that staff are clear about the help and support people need. Staff also need to make sure that they consistently follow medication procedures and only sign records after making sure medicines have been taken. This will help to make sure peoples health and safety is promoted. We said staff must not commence employment in the home before obtaining a satisfactory criminal record bureau check despite all other checks being obtained, unless there was a real danger that peoples care would be compromised through insufficient staffing, in which case they must tell us. Although they have told us about some important matters which have occurred they must make sure they include any significant events that have the potential to affect the well being or safety of people the service supports such as staffing issues. We said they must also make sure that they provide us with an annual quality assurance assessment questionnaire when we ask for it so that we have up to date information about how they are improving and developing the service. We also made some recommendations. We recommended care plans should be Care Homes for Older People Page 8 of 29 reviewed so that they show clearly consideration has been given to peoples capacity to make decisions and choices and how their rights and best interests are protected. We also recommended that in peoples best interests any money held in safe keeping in the organisations residents account is able to accrue interest. We also recommended that the hours worked in the home by the manager be included on the staff rota so that it accurately reflects the staffing of the home. 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. The process to assess and introduce people to the service is satisfactory and there is sufficient information available so they know what they can expect from the service. Evidence: We checked the records of 3 people resident at the service including 2 who had been admitted to within the past 12 months. The manager said she usually assessed people and staff comments also confirmed this. We were told that this included visiting people in their home environment or at hospital prior to their admission. However, a care plan showed the date of assessment as being the same date of admission. During the assessment period it is decided whether or not the service is able meet peoples individual needs. Staff told us that people are welcome to visit the home to look round. Information about service users obtained from other health professionals was also seen on the care records checked, for example there was a care plan in place from Lincolnshire Adult Care Services. Care Homes for Older People Page 11 of 29 Evidence: Of the records we checked all contained a statement of purpose in written format. It was discussed with the manager, (as there are people with differing communication needs), that it be provided in altrnative formats which she agreed to do. For example in larger print for people with sight difficulties. (We checked the records of 3 people the service supports including a person with a visual impairment and one with learning disabilities however the statement of purpose on file was only in written format). The manager however, showed us a pack of information which she said was given to all service users about the home. This included some information that also included pictures to illustrate the written information. Although the manager said a copy of the most recent inspection report was usually kept on display in the home she was unable to be locate it on the day of the visit. A copy was available in the managers office. Comments from people who use the service varied as to whether they felt they had enough information about the service to help them to decide whether or not to move in, 3 did, 1 did not and 2 people were not sure whether they had received information about their terms and conditions of residency. There was information available in the home to tell people about the terms and conditions of residency although individual contracts were not seen on the records of the people we checked. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not sufficiently person centred to identify all peoples needs and wishes. Medication procedures are not being followed consistently to make sure people are kept safe. Evidence: The care records of 3 people the service supports with a range of needs were checked on this occasion. Care plans were in place for them all and showed that they were reviewed at least monthly. People told us they knew that records were kept about them and a relative confirmed that her relatives care plan had also been discussed with her. Care plans covered areas such as physical health, mobility, nutrition and personal hygiene needs. They also identified areas of risk that had been assessed. The amount of detail varied in them for example information about peoples wishes after death was contained in one care plan but not another and there was no clear evidence to show that peoples capacity to make decisions about significant matters had been assessed Care Homes for Older People Page 13 of 29 Evidence: even though there was information to show this may be necessary. For example where the service is holding money for some of the people the service supports in the services residents account. Although care plans were in place they were not always reflecting fully the needs and wishes of the people the service supports. A concern was raised on the day about a service user needing the use of a heightened toilet seat in a bathroom. Staff had inconsistent views as to whether this was necessary or not and the care plan did not identify this need although the manager confirmed that it was necessary. We observed how staff administer medication. We saw that they wore gloves when they did this, which is good practice however, they did not always check to make sure people had taken their medication prior to signing records to confirm they had. We have been notified in the past 12 months of two issues arising about medication, one in relation to incorrect administration and of a missing dose of medication. The manager provided satisfactory confirmation of the action taken to address these matters. Staff told us that they had had training about the handling and administration of medicines. A comment was made in a survey we received that the service sometimes runs out of my pain killers. This was discussed with a staff member on the day who said it had been due to a re-ordering error. Whilst we were told that a pharmacist visits the service periodically to check the medication systems in place the manager was unable to locate the report of the most recent visit. The expert by experience who accompanied us on this visit spent time talking to with people who use the service. They told her that they were satisfied with the care provided and felt their needs were being met. They confirmed that they receive visits from the district nurse and general practitioners and that optical and chiropody services are available. She observed that people generally looked well cared for although it was noticed staff did not always knock on bedroom doors before entering the room. She said a service user had said you could be sat on the toilet and they would still walk in. The manager agreed to remind staff about making sure peoples privacy was always respected. Care Homes for Older People Page 14 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. People the service supports receive well balanced meals which meet their dietary needs and individual preferences. There are some activities and recreational events for people to participate in and people have their choices and independence respected. Visitors are made welcome. Evidence: Peoples comments varied as to whether there were activities, which they felt they could participate in. For example, I enjoy going out on trips with the home and we go out on the bus and play bingo to a comment made to the expert by experience that activities were few and far between and some nostalgia afternoons would be welcomed. Records were in place to show the range of activities which take place such as bingo, video and musical afternoons, a quiz, sing-along, trip to Cleethorpes and a luncheon had taken place with another service within the organisation in January. People told us that they had a choice as to whether or not they took part in the events arranged and had the opportunity to do some light household tasks and go out for walks when they Care Homes for Older People Page 15 of 29 Evidence: wanted. Peoples comments about the meals provided were mainly positive such as just the odd few times I dont like them but most of the time its good. The expert by experience said people who use the service had assured her the meals were all very good and she saw that people were offered a choice of menu and second helpings. One person made a comment, which showed that the main meal was served in the evening cos it was how country folks have it. Menus were seen and are also in pictures to show people the choice of meals although no records were produced to show the range of vegetables or desserts offered. The chef agreed to record this in future. However, in the Field View unit, which caters for some people with dementia care needs it was noticed that although there were a range of photographs of food on display on a noticeboard in the dining area they did not relate to the food provision of the day. This may be confusing for people. We looked at the most recent report from East Lindsey District Council environmental health department and noted Fir Close has a 1 star/fair rating for their food provision. Visitors, were noticed to be greeted in a friendly and welcoming way by staff. Care Homes for Older People Page 16 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. There is a satisfactory process in place to make sure people know how to and feel able to raise concerns. Evidence: We saw that there was a procedure on display informing people how to raise complaints. Comments from people who use the service to the expert by experience confirmed people knew the importance of making complaints and who to complain to. The comments we received in surveys which were returned to us also confirmed this. People told us they felt safe and secure in their environment, especially those who had keys to their rooms. All said they were able to speak freely. Staff told us they have training about safeguarding adults procedures and literature was seen in the home about this. Records of any complaints raised were in place and checked on the day of the visit. Two complaints had been recorded in the past year although it was not clear from the records whether or not the matters had been satisfactorily resolved although the manager confirmed they had been. We have had two complaints raised with us which we asked the provider to look into. They provided us with a response which indicated they acted appropriately to investigate the concerns. There have also been two safeguarding adults matters made since the last key inspection. A complaint was also raised with the manager during our Care Homes for Older People Page 17 of 29 Evidence: visit and we saw that she gave assurances that the matter would be looked into. We checked the records of recruitment of two staff to make sure a thorough process had been followed. Records showed that references, proof of identity and a protection of vulnerable adults register check had been obtained prior to appointment but before obtaining the outcome of a criminal record bureau check. The manager confirmed neither staff member had worked unsupervised during this time. There was also information available to show that staff participate in an induction training programme on starting employment and are given information about their expected code of conduct and a staff handbook with policies and procedures. 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. People live in a comfortable and homely environment which is suitable for their needs. Evidence: The comments we received from people who use the service were mostly positive about the overall cleanliness of the bedrooms, one was less complimentary. Comments about the lounge and other communal areas also varied for example the bedrooms are clean but the lounge is often not so fresh and the worst thing is the lounge, it could just do with a little tidying up in a few places. People who use the service and their relatives were complimentary about the housekeeping staff although a comment was made that there was too much work for them. We were told that there are 2 cleaners employed Monday to Friday who work from 08:00 to 12:30. People the service supports told us the cleaning lady is very good, and will water plants and change flower water without being asked. At the weekends care staff carry out some housekeeping duties. Staff also made comments that they felt the decorating should be done more frequently. We saw that the manager was in the process of decorating the staircase during out visit. She also confirmed that they have support from a maintenance person for 8 hours a week. Staff told us that they have a specific book to record any maintenance issues and that they are dealt with promptly. Care Homes for Older People Page 19 of 29 Evidence: Lounges were seen in both units as was a sample of bathrooms and bedrooms. One service user referred to the lounge as a little rough round the edges but its home. Bedrooms are able to be personalised with peoples own personal effects and were clean and tidy. No unpleasant odours were noted. Areas of the home are showing signs of wear and tear but we were told there is a programme in place to decorate and refurbish rooms. For example new carpets were seen in a lounge. We saw that there was various equipment in the home to assist people who may have specific needs such as hoists and handrails and heightened toilet seats. The manager said that other equipment is on order such as mattress protectors. She also agreed to ensure a further heightened toilet seat was provided to an upstairs bathroom. They told us they have a range of policies and procedures in place for staff to follow such as infection control. The service is visited periodically by an Environmental Health officer and Fire Safety officer. We checked to make sure that fire fighting equipment had been serviced and noted it was last checked in January 2009. Gloves and aprons were seen around the home for staff to use to make sure that good hygiene practices are followed. A staff member confirmed that they had had training about infection control. Laundry facilities were satisfactory and are equipped with industrial washing machines and dryers. The expert by experience said that peoples comments had indicated that they were happy with the laundry arrangements. 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. Sufficient staff, who are well trained are employed to meet the current needs of people the service supports. Evidence: The expert by experience found staff to be approachable, amenable and friendly. She noticed that staff were in and out of the lounge throughout the morning and had a very good rapport with service users with much laughing, joking and leg pulling. Comments made to her were that staff were prompt when answering call bells. Comments varied about whether staffing levels consistently met peoples needs, for example, the staff are so busy I think they need more staff. Its hard for them to come straight away and often it is too late and more staff would help, to Mum gets all the help she needs and 10 out of 10 for the effort they make they do work well. Staff comments showed that they were of the opinion that staffing levels were generally sufficient to meet the current needs of the people the service supports although it was said an additional staff member in the morning would help to make sure they were able to give quality time to service users. A sample of staff training records were checked. They showed that staff had had training in March 2009 about food safety and catering and health and safety. Staff members further confirmed they had had a range of training which for example had Care Homes for Older People Page 21 of 29 Evidence: included dementia care, fire training and health and safety. Some staff have also achieved a nationally accredited vocational award in care. Rotas and staff comments confirmed there are 5 staff on duty between the hours of 08:00 - 20:00, 3 staff in Riverside and 2 in Field View and at night there are 2 staff and 1 in Field view with one staff member sleeping in and on call. The manager told us she was also working at another Prime Life service as a qualified nurse although we noticed rotas did not show when she was working at Fir Close. She said senior staff took responsibility in her absence and that she was always at the end of a telephone if needed. Staff comments confirmed this. They also confirmed that they felt supported and valued in the work they do. We checked the records of of recruitment of 2 staff who had recently been employed which were well organised. Information showed that they had completed an application form, provided proof of identity and references and protection of vulnerable adults (POVA) checks and criminal record bureau checks had been obtained as part of the recruitment process. However, we noted in both instances that people had commenced their employment after receipt of a POVA check but prior to receipt of a satisfactory CRB. The manager confirmed that they had been supervised during this period but that there had been no exceptional circumstances such as staffing shortages which had necessitated this. 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 service is generally being managed so that the health and welfare of people who live at the home is promoted and there are satisfactory systems in place to obtain the views of people the service supports about the quality of the service obtained. Evidence: There has been a change of registered manager since the last key inspection. She is a registered nurse and has previous experience working in other Prime Life services. Comments from service users showed that they knew who was in charge and that the manager was approachable. Comments raised with the expert by experience showed that the manager in particular and staff valued service user views on matters and if a request for something was not always possible the manager would find an alternative or meet us halfway. Staff made comments which indicated they felt valued and supported and receive supervision and appraisals periodically of their performance. The manager told us that she is currently also working as a qualified nurse in a another Prime Life service, and had been doing for the past couple of weeks. She said Care Homes for Older People Page 23 of 29 Evidence: that despite this she is always available at the end of a telephone if staff at Fir Close need support and guidance and senior staff take responsibility in her absence. Staff comments confirmed this. The managers hours worked in the home were not demonstrated on the staff rotas checked. There were records in place to show how the service is monitored for example questionnaires are given to service users and their relatives/representatives to comment on the service (a relatives comments confirmed this although records did not contain dates of when). Staff meeting minutes and records to show various audits which take place were seen, for example, of care plans, medication and kitchen audits. Records were also in place to show when visits from a company representative took place and the areas that were checked. We also saw information which showed that they intend to improve the way they monitor the service by obtaining views about the quality of the service from other professionals who have an interest in the service. On this occasion we did not receive the annual quality assurance assessment (AQAA) questionnaire we requested despite us sending a reminder about this. The manager said she had forwarded it to Prime Life head office for checking, but as yet we have not received it. The previous AQAA received in July 2008 confirmed that the service have a range of policies and procedures in relation to health and safety matters and we saw that these were available to be referred to in the office. Within this document they also told us that checks are made of equipment to make sure it is in good working order for example the heating system was last checked in April 2008. Whilst there are records in place to show risk assessments of the environment have been undertaken we noticed that this did not include an unguarded radiator in the unit known as Field View nor of one of the external exits of the premises and this was raised with the manager who agreed to make sure both matters were addressed. We have been kept up to date of some significant events that have occurred but not of a disciplinary matter which took place. We saw there is a satisfactory system in place to record any financial transactions of peoples whose money is managed through Prime Lifes residents account although it was understood this is a non-interest bearing account. 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 7 13 A comprehensive person centred plan must be completed for each person the service supports which identifies individual needs and wishes and details fully how they are to be met. This is to make sure people who use the service receive the care they need. 31/07/2009 2 9 13 The procedures for recording 31/07/2009 medication after it has been administered must be followed consistently. This is to make sure that people the service supports are kept safe and healthy. 3 29 19 Staff must not be employed without obtaining a satisfactory criminals record bureau check prior to their employment unless there are exceptional circumstances. 31/07/2009 Care Homes for Older People Page 26 of 29 This is to make sure people are well protected. 4 33 24 A report must be provided to 31/07/2009 the Care Quality Commission when requested in the form of an Annual Quality Assurance Assessment of the service. This is to make sure we have up to date information to show the service is being well monitored and how it is incorporating the views of people who use the service into its plans for developing the service. 5 37 37 The Care Quality 31/07/2009 Commission must be notified without delay of the occurrence of any incident described in Regulation 37 of the Care Homes Regulations, 2001. This is to make sure that peoples rights and best interests are being safeguarded. 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 To make sure that peoples rights and choices have been properly incorporated into peoples care plans it is recommended that they are all reviewed and where the need for a best interest assessment is necessary appropriate records are kept to show how this has been assessed and managed. Care Homes for Older People Page 27 of 29 2 27 In order that rotas show accurately how the home is staffed the hours worked by the managers hours should be included on the rota. In order to protect peoples best interests it is recommended that money held in safe keeping on behalf of people who use the service are placed in accounts which can accrue interest. 3 35 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. 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