Care Home: Forest Edge Rest Home

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What the care home does well The current nine service users are receiving plenty of one to one attention from staff. It was evident residents and staff felt the home was improving with the new manager. One resident stated, "He is very helpful". Staff are receiving good quality supervision, which they stated they felt was very beneficial. What has improved since the last inspection? This service has been rated poor for the past three inspections. It has now improved to be rated adequate, but it is vital the improvements are sustained and continued. There have been clear improvements regarding health and safety issues for people. The environment has improved and items around the home are stored appropriately. The home has fitted a new kitchen and made improvements to the garden to ensure it is safe for residents. Professionals have ensured aids and equipment are fitted safely. Care plans have improved and are now more personalised. What the care home could do better: The home needs to make sure a manager is registered to ensure there is some continuity in the home. Staffing recruitment needs to ensure all necessary checks have been completed before the person starts working in the home. Care plans must detail in sufficient detail all a persons needs, to ensure staff have adequate information to be able to care for people. All staff must have in-date training in all core areas. Key inspection report Care homes for older people Name: Address: Forest Edge Rest Home Southampton Road Cadnam Hampshire SO40 2NF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Presdee     Date: 2 3 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Forest Edge Rest Home Southampton Road Cadnam Hampshire SO40 2NF 02380813334 02380814963 forest.edge@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): John Henry Hughes,Mrs Linda Susan Hughes Name of registered manager (if applicable) Mr Patrick Godfrey Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 22 The registered person may provide the following category 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 category : Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) old age, not falling within any other category (OP) Date of last inspection 1 6 1 2 2 0 0 9 22 22 0 Over 65 0 0 22 Care Homes for Older People Page 4 of 29 Brief description of the care home Forest Edge is a twenty-two bedded residential care home, opposite a garden centre, situated on the outskirts of the New Forest at Cadnam. The home is just less than four miles from the centre of Totton and close to the New Forest. The home is registered to accommodate twenty-two older people, including people with dementia or mental health problems. Forest Edge has twenty-two single bedrooms, all provided with an en suite toilet. 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: The unannounced inspection took place on 23rd April 2010 between 9:30 AM and 6:20PM. The Commission (we) took two inspectors and were assisted by the manager. The manager is not registered with the commission but in this report will be referred to as the manager. Ten people are currently living in the home; on the day one resident was in hospital. All service users were involved with the inspection, some in more depth than others. Six care staff on duty were part of the inspection. Two visitors visiting the service on the day of the inspection have contributed to this inspection. Surveys prior to the inspection were sent to some people living in the home, health and social care professionals and staff members. At the time of writing this report eight surveys had been received from people living in the home, all had been completed with the help of a relative. Four staff members and two social and health care professionals had returned surveys. In parts of the surveys people are asked to tick boxes with Care Homes for Older People Page 6 of 29 judgements ranging from always, usually, sometimes and never. These are referred to in this report. The home sent us their Annual Quality Assurance Assessment (AQAA) back on time, which detailed information on the home. Paperwork including assessments, care plans, menus, staffing records and safety checks were seen. A tour of the home including all communal areas, the kitchen and all occupied bedrooms was taken on the day. All this information has helped form judgements in this report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 8 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 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. When the home begins to accommodate new residents, we were advised they will have a pre admission assessment before they move into the home, taking into account the views of the residents and others. Evidence: In the AQAA we were informed All residents have undergone a full pre admission assessment. We consult community teams and professionals in order to establish any specialist needs for example occupational therapist, community nurses and physiotherapists etc. Any prospective resident to the home will meet with our key staff team and be able to see communal areas and any unoccupied bedroom. Due to the previous rating the home has been unable to admit any new residents, so it was not possible to look at any new admission forms. The manager explained the home has new documents it will use when looking at pre admission assessments and will contact others involved in the persons care. Care Homes for Older People Page 10 of 29 Evidence: The AQAA informs us the home has a statement of purpose, which contains all the necessary information including information on staffing, client group, social interests catered for, fire arrangements and visiting. The home does not provide intermediate care. Care Homes for Older People Page 11 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. People have care plans detailing their needs and explaining how these needs should be met. People are respected and medication practices ensure people are safe, but care must be taken in the storage of excess medication to follow the homes procedure. Evidence: In the AQAA we were informed Each resident has a detailed care plan which has been written with their involvement and with the views of family, relatives and advocates etc. The care plan has detailed risk assessments. The care plans of two people were looked at in detail, others were looked at in less detail. The manager advised us he has introduced the key worker system and encouraged the key worker to create the care plans. Staff explained they have spent time talking to residents on a one to one basis and advised they have learnt a lot about each resident. Family members have also been contacted to help provide a life history on the person. In one file it was noted the family had provided extensive information with associated photographs. The manager explained this would be part of Care Homes for Older People Page 12 of 29 Evidence: the key workers role to spend time with the resident and talk through the photographs with the information, which had been provided. The care records for a person with physical health problems (diabetes) were examined. Part of the care plan relating to health, medication and pain clearly detailed this person had diabetes which was diet and tablet controlled. The care plan references risk assessment, which details the interventions staff, should follow. The risk assessment states, trained staff to test blood sugar levels and if too low or high to inform GP without delay. There was no guidance given to staff regarding acceptable blood sugar levels nor the frequency that tests should be undertaken. Because there is no written guidance, there is no evidence of the action staff should take should the results be outside the recommended levels. A separate form entitled blood sugar checks was on file. This form was started for the resident on 18 December 2009. There was no evidence of blood sugar checks being carried out since the last recorded date of 4 April 2010. The results of the tests varied between 4.7 on 19 January 2010, and 16.4 on the 4 April 2010. 21/33 recorded blood sugar levels were above 10. Also on file was a nutritional screening needs assessment. Although not part of the care plan, this states that the residents sugar levels are taken on a weekly basis, on Tuesday or as required if there are concerns. Review of the blood sugar checks form demonstrates that these tests are not occurring at this frequency. 4th April 2010 states checked sugar level 16.4. Please be aware of her diet. The written record for 10 April 2010 documents that blood sugars were checked, but this was not recorded on the blood sugar checks form. The manager stated that he spoke to staff during the inspection regarding the blood sugar levels for this resident. Staff said they were aware that her blood sugar levels were usually high. Care plans have now been written from the view point of the person for example, I would like to be woken up at 8 OClock. Peoples file were split into ten sections and the care plan split into a further twelve sections. The care plan had risk assessments where necessary relating to each of the twelve sections. It was noted the risk assessments were very repetitive of the care plan and gave little information on how the risk should be minimised. It was suggested these could be in the same section as the care plan they relate to. All twelve sections have been signed and dated by the key worker and the manager and the resident or their next of kin had signed the care plan. As these had only recently been written it was not possible to establish if they had been reviewed on a monthly basis. The manager advised us all parts of the care plan would be reviewed monthly. Interim care sheets were seen, where someones care plan had changed within the month. It was possible to establish when professionals had visited and there was a record of the outcome of these visits. Weight and bowel charts were maintained. Care Homes for Older People Page 13 of 29 Evidence: It was clear care plans now gave clear information on how to care for a resident. Staff confirmed they felt care plans were now much better and gave a clearer picture of the service users needs. In discussion with the manager he explained, since he had been in the home someone had been in hospital and had needed a greater level of support when they returned home. This was in relation to their emotional wellbeing. Whilst the care plan explained how to support this person it was not possible to establish they had been in hospital and their support needs had changed. It was agreed it was necessary to see the whole picture so staff could recognise if the person started to behave in this way again, steps would be taken to encourage certain parts of their behaviour to help them from deteriorating further. It was clear from care plans viewed people have access to a range of health professionals. These visits are now clearly recorded in care plans with a record maintained of the outcome of this visit. One health professional in a survey had ticked always, when asked does the service act on advice to meet peoples social and health needs. It was noted an occupational therapist had visited since the last inspection and had made a general report; this information now needs to be incorporated into individual care plans. The home has clear information on medication and the drugs procedure is available to all staff. Staff reported they have recently been on further training regrading medication in care homes and felt very competent regarding medication. On this visit the medication trolley kept downstairs and the controlled medication in the home was checked. It was noted medication, which had come into the home for the next months cycle was being stored in a vacant locked bedroom. Some medication waiting to be returned to the pharmacist was also being stored in this room, but had not been recorded in the returns book. One member of staff reported they were aware this was not an appropriate place to store the medication, but claimed the upstairs trolley where is was stored was too hot. The manager stated a suitable storage area would be found. Medication checked matched the records held and records had been completed appropriately. It was noted the medication waiting to be returned matched the records held. All controlled medication was being stored and recorded for appropriately. The stocks held matched the records held. Observations on the day demonstrated staff respect a service users privacy and dignity. All staff were observed to knock on doors before entering. Care plans recorded the preference of how a person wished to be addressed, which staff were aware of. It was noted some service users had their own telephone. One relative Care Homes for Older People Page 14 of 29 Evidence: reported when they visited, their relative was always very well presented, wearing their own clean clothes, which was important to them. One health professional in a survey reported they always see the service user in a private area. 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. People can choose to take part in a range of social activities, which try to meet individual needs. People have choices at meal times, which are relaxed and assistance is given if necessary. Evidence: On the day it was clear a range of activities were taking place throughout the day, which residents reported they enjoyed. Some residents had freshly painted nails, which they explained the staff had done for them. On the noticeboard in the lounge there was information on a range of activities, some of which relatives and visitors were invited to attend. Visits to the garden centre opposite the home were also on offer for any resident who wished to go. We were advised one resident regularly goes out to a religious service, and recently a religious service was offered in the home. Details of peoples choices regarding social activities had not been included in care plans. However the manager showed us a written plan which he was creating for one service user, which went into great detail and he explained he was going to create this sort of plan for each person. Three service users reported some residents go to bed in the early evening and there is no one around the communal areas of the home. The manager reported some residents like to go to bed between six and seven oclock, this was noted in the care plans of three people. Care Homes for Older People Page 16 of 29 Evidence: Visitors on the day confirmed they could visit at any time and were always made welcome. One visitor confirmed they thought their relative was very well looked after and the staff were marvellous. In a survey one relative stated,I am made to feel very welcome, always offered a cup of tea. On the day 0f the inspection fish with mashed potatoes and vegetables was served for lunch. Residents spoken to stated they enjoyed the meals in the home. One resident confirmed there was always a choice and they were asked daily what they wanted. It was clear people could choose where they had their meals. At lunch time some had their meal in their room, whilst others sat at the dining table, whilst others sat in the lounge with their meal on a pull up table. At tea time it was noticed one carer spent time encouraging one service user to eat their tea in a patient and relaxed manner. In a survey one resident stated, Food is good and plentiful. Another comment included, Meals could be more appropriate for elderly people, meals are rarely the same as published. 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 can be sure there is sufficient information and staff have the knowledge to ensure all complaints would be dealt with correctly and any safeguarding concerns would be passed on appropriately. Evidence: In the AQAA we were informed The home has a clear and concise complaint policy that is available and on view throughout the home. Complaints are a standard agenda item at residents meetings. All staff are aware of the complaints procedure and know how to action and report a complaint. In surveys when asked, Would know what to do if someone has concerns about the home?, all staff stated they would know what to do. All surveys from residents also confirmed they would know how to make a formal complaint and would be able to speak to someone if they were not happy. We were advised the home has not received any complaints since the last inspection. In the AQAA we were advised, Staff have training in protection or safeguarding of vulnerable adults. Staff are aware of the data protection act and work within this. Six members of staff confirmed they had received training regarding abuse and adult protection. All had some awareness of the differing types of abuse and of adult protection procedures. One member of staff stated if the manager was away and they were not aware what to do they would consult the policy and procedure information, Care Homes for Older People Page 18 of 29 Evidence: which was available to them. Hampshire County Council continue to monitor safeguarding concerns, which have been referred to them. 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 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 clean well maintained home, which they can make their own. Evidence: A tour of all the registered bedrooms and communal areas was undertaken. It was noticed much of the environment and areas identified at the last inspection had now been improved. Appropriate pictorial signage had been put up on bathroom and dining room doors, to aid residents. All rooms had appropriate lighting, all aids had been assessed by an occupational therapist. The temperature of the hot water was tested and found to be set at an acceptable standard. The nurse call system is portable and can be taken around the home and into the garden. It was noted two bedroom doors did not have any form of identification on them, unlike all the other bedroom doors in the home. In one bedroom it was noted the push down tap did not stay on for long enough. In two rooms there was an odd smell, which was hard to identify. In one bedroom, it was noted the bed linen was not clean, it was agreed this would be changed immediately. All other areas of the home were clean. In surveys when asked, Is the home fresh and clean? All but one resident had ticked always, the other person had ticked, usually. Whilst walking around it was noted in bedrooms there were messages regarding peoples care in reference to their mouth hygiene and fitting sheets to pressure mattress. This information should remain private and confidential and should be part Care Homes for Older People Page 20 of 29 Evidence: of the care plan and be kept with other information. Residents currently make main use of the lounge/dining room at the front of the house. It was noted this has lots of information displayed and a trolley is available to residents. This is loaded with jugs of juice, fresh fruit, sweets and biscuits which people can help themselves to. Residents enjoyed the conversations and light banter with staff. Activities on the day took place in this room, both with staff and an outside entertainer. It was noted the clock displayed the incorrect date. People were spoken to in their own rooms; most had been personalised by residents. They stated they did not want to join in the activities and preferred to stay in their rooms. One resident enjoyed watching television, another enjoyed reading and stated the library visited the home. Another resident had bird feeders outside of her room , which over looked the garden and she stated she enjoyed seeing all the different birds. The home has an attractive and well maintained back garden. This has appropriate furniture and a fenced fish pond. The home has also created a sensory courtyard garden. This has attractive flower tubs, fountain, chimes and bird feeders and suitable seating. It was noted the window pane in the door leading to the garden was cracked and was in need of replacing. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has well motivated staff on duty to meet peoples needs. Not all staff have up to date training to ensure they are working in line with current legislation. Recruitment checks are not satisfactorily carried out to ensure the safety of service users. Evidence: In the AQAA we were advised, The home is currently managed by an interim manager who is supported by 5 senior staff members, 5 carers a chef, domestic and office administrator. The duty rota was seen, which detailed peoples names, job roles and hours worked. It was noted the duty rota was not dated and for two people it had two roles recorded although we were advised both people only work in one role. All staff members spoken to stated there was adequate staff on duty to meet peoples needs. This was reinforced by residents on the day who were all complimenetary about the staff. In surveys when asked, Do you receive the care and support you need? All but one service user had ticked always, the other person had ticked usually. When asked the question, Are the staff available when you need them? All except one had ticked always and the other had ticked usually. A comment from a relative in a survey included, The management and staff are very caring. There seems to be a good rapport between staff and residents, staff are very aware of individual needs. In the AQAA we were advised the home has eleven memebers of staff, six who have Care Homes for Older People Page 22 of 29 Evidence: achieved a National Vocational Qualification (NVQ) Level 2. Staff spoken to felt they received adequate training and thought this was an area which would improve with the new manager. A training matrix had been completed and this highlighted the areas where staff needed training. It was noted training was out of date for three people in moving and handling, food safety, for four people in first aid and for two people in infection control. It was not possible to establish from the files seen that all staff had received an induction in line with skills for care. The manager reported he was aware of this and had already started an induction programme, which would be in line with skills for care. The recruitment records of three people were viewed. From this it could be established all staff complete an application form, with details of previous employment and qualifications gained. For one person it was noted their employment history stopped at 2006, no details were recorded on this. It was also noted for this person one reference was a telephone reference and the other was the manager of the home at that time. It was also noted for another person their CRB (criminal reference bureau) check was not on their staff file but was later found in filing. For another person it was dificult to establish when they had started working in the home. It was also noted for another person some of the information to identify them was in a different name to other information. We were advised this information related to their name before and after marriage. However without a copy of the marriage certificate and photo identification it was difficult to evidence this. It was also noted the company who the providers had employed to complete a monthly audit had been in the home and had discussions with residents in their rooms without any checks being undertaken by 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are still without a registered manager but the person in post is having a positive influence on the home. Health and safety issues are improving but there are still concerns in some areas which could mean peoples need are not met in a safe way. Evidence: In the AQAA we were advised the home had employed an interim manager who had the relevant experience and qualifications. We were advised on the day by the manager he is now going to apply to become the registered manager long term for the home. It was clear from conversations with residents, staff and a visitor they felt he was making very positive changes in the home. One resident reported, He is very helpful. Comments from staff included, Phenomenal change, Home is a lot better, and Management is very good. Staff accepted there had been problems in the home but all felt the home and morale was improving. Whilst it was clear there are improvements with the current manager, it is imperative the home has a registered manager to continue with improvements and bring some continuity to the home. Care Homes for Older People Page 24 of 29 Evidence: The home has annual surveys it sends out to professionals to seek the views of those who professionally visit the service. The manager reported he had held several residents meetings, staff meetings and has also met with visitors to the home. It was noted all these meetings had been minuted. Action plans had been devised and sent out to those who had attended. The providers have also employed a company to call into the home on a monthly basis to help with monthly regulation 26 reports. We were advised the home does not become involved with any of the finances of service users. We were advised some residents manage their own money and others have help from family members. From discussions with staff it was clear a propramme of supervision had begun with the new manager. Records were seen demonstrating this was recorded and signed by both parties. Staff reported they had felt the supervison was very helpful and positive. Health and safety issues for residents have improved. It was noted hot water temperatures were set at a safe level, bathrooms were now safe to use and the kitchen had been refitted. Whilst there were clear improvements it is also clear there are still further areas which still need attention, even though the home only has ten residents. Care plans have improved but there have been areas highlighted in section two, which still need improving. The storage of medication new into the home and waiting to be returned was not acceptable. Information on peoples care needs should not be displayed on walls in peoples rooms. Attention must be given if people need clean bedding. The broken glass window panes must be replaced. Staff must have indate training in the core areas. The accident book was seen, which demonstrated accidents were not being recorded in the order they happened. The manager did report accidents are now going to be reviewed each quarter. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 31 8 The registered providers must appoint a registered manager to improve the areas of the home which have been identified as deficient. The home needs a manager to ensure the home is run in a safe manner for the protection and safety of service users. 15/03/2010 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 29 19 Staff must not work in the home unsupervised until all the necessary checks have been completed. Without all the necessary checks being completed it is not possible to establish staff are safe to work with residents. 18/06/2010 2 30 18 All staff must have in-date training in the key areas of infection control, basic food hygiene, first aid and moving and handling. Staff must have in date training to ensure they are working to safe and current practices in line with legislation. 18/06/2010 3 30 18 All staff must undergo an induction in line with Skills for Care 18/06/2010 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Staff must be given the opportunity to have a basic understanding of what their job entails. 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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