Care Home: Grafton Lodge

What the care home does well People living in this home told us "It`s a lovely place to live", "the staff are wonderful" and "the food is very nice". The home makes sure that each person has their needs assessed in full before they move into the home. Care plans and risk assessments are in place that allow people the choice about how they receive the care they need. There are plenty of activities for people to take part in should they choose to do so. Complaints and concerns are listened to and acted upon by the home. People told us "I have never had to complain about anything it`s wonderful living here". The home environment is clean and welcoming. There is ample room for people to relax. Staff have been trained and understand the needs of the people living here. One person told us "the staff are so very kind I would be lost without them". What has improved since the last inspection? The home has developed the person centred approach to care. This means that people are getting the individual care and attention they need at Grafton Lodge. What the care home could do better: The home has good systems in place for the ordering, administration and safe keeping of medication. We have made recommendations that would improve this further. Key inspection report Care homes for older people Name: Address: Grafton Lodge Grafton Road Oldbury West Midlands B68 8BJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mandy Beck     Date: 3 0 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Grafton Lodge Grafton Road Oldbury West Midlands B68 8BJ 01215593889 01215590708 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.sandwell.gov.uk Sandwell Metropolitan Borough Council Name of registered manager (if applicable) Miss Joanne Gill Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Age: Dementia (DE) age 55 and above The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 36 Date of last inspection Brief description of the care home Grafton Lodge is owned by Sandwell Metropolitan Borough Council and aims to provide an individual approach to care for older people with mental health needs, the majority being with moderate to severe forms of dementia. The home is situated 2 miles from Oldbury and within easy access of Blackheath, Dudley and Birmingham and approximately 2 miles from the M5, junction 2. Rowley railway station is within walking distance and a number of bus routes (449, 88, 123) frequently pass the unit in Grafton Care Homes for Older People Page 4 of 27 Over 65 0 36 Brief description of the care home Road. Local amenities are within walking distance of Grafton Lodge, these include a church, shops, post office, take away food outlets, golf course, public house, restaurants and a doctors surgery. Grafton Lodge has 36 single bedrooms, (including one en-suite room) set out in two 18 bedded units, one on each floor. Five beds are for respite care on the upstairs unit. There is a passenger lift, and various aids and adaptations. To the rear of the property is a patio and garden, which provides residents with an outdoor area. Car parking space is available at the side of the building. The home has its own transport. A range of services are available at Grafton Lodge, which are detailed in the homes Service User Guide. People are asked to contact the service directly for information about the fees it charges for residency. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home, they were given no prior notice. We looked at all the information that we have received, or asked for, since the last key inspection. This included, the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. The information we have about how the home has managed any complaints. What the home has told us about things that have happened there, these are called notifications and are legal requirement. The previous key inspection and the results of any other visits that we have made to the home in the last 12 months. Relevant information from other organisations. We also spent time talking to the people who use the service and to the staff who Care Homes for Older People Page 6 of 27 support them. We looked at the care of three people who use this service in depth. This is part of our case tracking process and helps us make judgements about the homes abilities to meet peoples needs. We completed a Short Observational Framework Inspection (SOFI). SOFI is designed to give us an opportunity to record our observations during the inspection of care homes where people have dementia. SOFI offers first hand experience of sitting alongside people who use the service for a couple of hours in a communal space within the care home. It gives an insight into their general well being during this time, and also into the staff interaction with the people who use the service. Care Homes for Older People Page 7 of 27 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 27 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 27 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 choosing to use this service will have their needs assessed in full before they agree to move in. Evidence: We looked at the needs assessments of three people living in the home as part of our case tracking process. We found that each person was visited either at home or in hospital prior to their admission. This gave both the person and the home the opportunity to discuss their needs and whether or not the home could meet them. We spoke to people about moving into the home. They told us they are very good, they made sure that everything was right for me. We asked if people had a chance to visit the home before they made their decision about moving in. People said I visited Grafton Lodge and was made to feel welcome and impressed by the attitude of the staff and the congenial atmosphere. My daughter came in my behalf and what a good choice she made. Care Homes for Older People Page 10 of 27 Evidence: The home does not provide intermediate care services. Care Homes for Older People Page 11 of 27 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. People living in this home have the support they need in order to meet their personal and healthcare needs. Medication practises are safe but minor improvements are needed in order to further protect people. Evidence: We looked at the care plans of three people as part of our case tracking process. This process enables us to make decisions about how the home is meeting the needs of the people living there. We found that in each case people had their care planned appropriately and that this care was kept under regular review by the home and other healthcare professionals. People had care plans and risk assessments that looked at their individual needs in relation to pressure area care, moving and handling, nutrition and falls prevention. There were care plans that specifically looked at peoples mental health needs such as dementia, depression and challenging behaviour. One persons care plan showed they were at high risk of harm because of the behaviour they were displaying. The home has worked with the multi agency team to develop a care plan that recognises the risks to this person and the clear steps staff must take to keep them safe. The care plan is kept under regular review by the multi Care Homes for Older People Page 12 of 27 Evidence: agency team. We have recommended that the care plan is updated to include more specific details of the type of assistance staff should give when physical aggression takes place. People are assessed for their risk of malnutrition upon admission and this is kept under review by the home. Where people are considered to be at risk, we found the home had taken appropriate action to address this and seek the advice of the doctor or the dietitian. In addition to nutritional screening the home also keeps peoples weight under review and therefore able to take action when unplanned weight loss or gain occurs. We noted in one persons file that a moving and handling assessment has been reviewed regularly but had not included information about two falls this person had had. An entry in the daily contact sheet read found on floor four members of staff to pick him up. There was no mention of this on the evaluation of the risk assessment or any information about how staff should move him if he should fall again. For instance, the plan should include the use of hoist, size of sling or lifting belt where appropriate. There was plenty of evidence to show that people are regularly seen by their doctors, district nurses and other community services as needed. We looked at medication systems within the home. We found that generally they were good and practises keep people safe from harm. We have made some recommendations for the home to consider. We have said that when staff complete a handwritten entry onto the Medication Administration Record (MAR) two staff should sign this entry. This will reduce the risk of errors in transcribing occurring. We also found that on both the ground and first floor the temperature of the medication storage room was too high. The recommended temperature is 25oC and the home should take steps to make sure they do not exceed this. This will ensure that medication is being kept in accordance with manufacturers instructions. We also looked at the storage of controlled drugs in the home. At present there are no people taking this type of medication. We have told the manager that the current storage facilities for controlled drugs would not meet the recent changes in legislation and the home should consider replacing the controlled drugs cupboards. People living in this home rely upon staff to meet most of their needs and to maintain their privacy and dignity at all times. We saw during this inspection that people were spoken to appropriately and in their preferred term of address. Staff are given training during their induction that focuses on privacy and dignity. We saw staff spending time with people, when people were upset or distressed they offered them comfort. We also saw staff have a good rapport with the people who live here and there were some very positive interactions. Care Homes for Older People Page 13 of 27 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 encouraged to take part in as much or as little activity as they choose in this home. Staff are available to support people in leading active lives. Mealtimes are an unhurried and relaxing occasion and staff will be at hand to offer support to people. Evidence: The home has a dedicated activity coordinator who tries to engage all of the people in the home in the activities provided. We were told we are trying to develop the activity programme even further. We dont make people join in if they dont want to. We are going to the Tea party in the near future this has been organised with Sandwell Third Age Arts (STAA). We also spoke to people in the home who said we like to watch the film in the afternoon so I can doze off to it. I like the music they play because I like to sing along to it. Other staff we spoke to said we have loads of equipment and we have the activity room for arts and crafts but more DVDs and films would be good. The manager told us that there are plans for some staff to complete further training that is specifically designed to teach staff about activities for people with dementia. Staff told us about recent activities that have included themed evening such as an Italian, French and VE night. There are photographs of all the entertainment and outings on display throughout the home. The home recognises the importance of maintaining contact with family and friends Care Homes for Older People Page 14 of 27 Evidence: and welcomes visitors. Relatives are encouraged to visit when they want to. The communal lounge is where most people spend their day, seating for visitors would be limited in here. People do have the option of visiting their relative in the privacy of their own bedrooms. People are encouraged to personalise their own rooms with their own possessions. Some of the rooms we saw had been decorated in this way and were homely and welcoming. The home recognises the importance of supporting people with making choices about their lives. They have also recognised that most of the people living in this home have varying degrees of dementia and have taken steps to introduce Mental Capacity Act assessments. These assessments determine the level of competency and capacity people have in being able to make choices about their lives and their care whilst in the home. The home is proactive in seeking assistance from other professional bodies in this instance. We took the opportunity to sit with people at lunchtime and have a meal. There was a choice of two meals on the menu but other alternatives were offered to people as well. It was particularly pleasing to see that when people did not understand what staff had said to them, a plate of each meal was shown to the person to help them make a choice. Those people who needed assistance during mealtimes were helped in a discreet and sensitive manner by the care staff. People were not rushed and staff assisted them at a pace to suit the person. We observed staff try for over an hour using various ways to encourage one person to eat. We saw staff trying to retain peoples skills, for example a carer put food onto a persons fork then handed them the fork so that they could feed themselves. We have recommended the home considers displaying a menu for peoples information. We did observe people on both floors asking what was for dinner before it arrived. A menu may provide an added source of information for people. The manager told us this was already being considered along with a larger notice board that would tell people this information. This was a very positive experience and was seen on both floors of the home. Care Homes for Older People Page 15 of 27 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 this home can be confident their concerns will be listened to and acted upon. Staff have the knowledge and understanding to keep people free from harm. Evidence: The home has a clear and accessible complaints procedure. A copy of the complaints procedure is available in the reception area of the home and also in the service user guide. The home keeps records of all investigations and outcomes. People are encouraged to speak to the manager or any member of staff if they are unhappy about any aspect of the service they receive. We spoke to people in the home they told us I have never had anything to moan about here but the staff are lovely they do anything for us. The home approaches complaints in a positive manner and views them as a learning process. The manager told us we will always listen to any bodys concerns and take action to put them right we will learn from this so that we can make the service better. Over the last 12 months the home has received six complaints. Each complaint was fully investigated and records were kept. The Care Quality Commission has not received any complaints or concerns about the service. We looked at systems in place for the safeguarding of vulnerable adults. All of the staff we spoke to told us they had had training in safeguarding procedures. They were able to tell us about the different types of abuse and what they would do if an allegation was made to them. The home responds appropriately to any allegations or Care Homes for Older People Page 16 of 27 Evidence: incidents and reports them to the local authority safeguarding team. The manager is fully aware of her role and responsbility in keeping people safe and free from harm in this home. We also looked at the use of restraint in this home. At present the only restraint currently in use are baffle locks on doors. People are given codes to doors should they wish to go out and it does not place them at risk. From time to time people in the home can display some behaviour that can be challenging. We looked at one persons care plan for this challenging behaviour. We found that more description is needed so that staff have a very clear guide when dealing with challenging behaviour. For instance, the care plan says the person is aggressive. It does not describe what sort of aggression may be displayed or the action that would be expected from the care staff. We have recommended that this be inlcuded into the care plan as this will make sure all staff are very clear about the actions they will need to take in order to keep the person and themselves safe. We spoke to staff about the care of this particular person they told us, when we did our dementia training we looked at challenging behaviour and how to deal with it. Its important to put yourself in their shoes because after all if they didnt need help they wouldnt be here. We looked at recruitment and saw that the home is taking appropriate precautions for preventing unsuitable people from working with vulnerable adults. This includes a check against the protection of vulnerable adults (PoVA) list and a Criminal Records Bureau disclosure (CRB). Care Homes for Older People Page 17 of 27 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 well maintained and comfortable home. Evidence: We looked at most of the home during this inspection. Generally the physical environment can make it difficult for staff to observe peoples whereabouts. Staff said the layout is not perfect, we have to do our best with it but we manage ok. The home is clean and tidy. We saw that recently there have been improvements to the corridors and in some peoples bedrooms. The ground floor entrance area has been redecorated and now resembles a shop. Some of the people living in the home were involved in making the props and doing some of the painting. The shop acts as a reminiscence aid for some people and this aids communication between people. Lounges and dining rooms are well equipped and decorated pleasantly making them relaxing places to sit, watch television, listen to music and to eat meals. We looked at the garden, which is well maintained and again people have been involved in planting up the pots and making the area a pleasant place to sit and relax. We spoke to some people who told us this is a lovely place to live. People are encouraged to personalise their own bedrooms as much as they want. We saw that several people had taken this opportunity to make their room their own. The manager has also told us in the Annual Quality Assurance Assessment (AQAA) that there is an ongoing refurbishment plan for bedrooms and the replacement of old and dated furniture. Care Homes for Older People Page 18 of 27 Evidence: The home is able to provide laundry services on site, and there are other infection control measures in place such as liquid soap, antibacterial handwash and paper towels available for use. Staff are also supplied with gloves and aprons as necessary. We were also told that staff undertake training in infection control. Care Homes for Older People Page 19 of 27 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 has sufficient numbers of staff on duty to meet the needs of the people living there. People can feel confident that staff will understand their needs and be able to support them appropriately. Evidence: The home provides staffing in appropriate numbers to meet peoples needs. Care workers are supported by housekeeping, maintenance and kitchen staff. We observed during this inspection carers showing a person centred approach in keeping with the care of people with dementia. Their approach unfailingly was one of facilitation, recognition and celebration of peoples achievements. They all showed a knowledge of a range of ways a person with dementia might be supported. We spent time talking to staff who told us we could always do with more staff but we are happy enough no complaints. People using the service said they are wonderful, so kind to us all. Care staff are continuing with their National Vocational Qualifications (NVQ) in care. The home has told us in their AQAA 70 of the current care staff group have completed this training. This means that staff are being trained and will have the knowledge and skills they need to carry out their duties. We looked at the recruitment practises within the home. We said in our last report the home had very good systems in place for recruitment, it was pleasing to see that this practise has continued. No member of staff is permitted to begin working in the home Care Homes for Older People Page 20 of 27 Evidence: without the necessary and required safety checks in place. This includes obtaining two references for each person, check against the PoVA list and CRB disclosures. All new workers in this home are expected to complete a structured induction. The home gives each new worker introductory training to care practises and the running of the home. They are also given training in fire safety, infection control, food hygiene and moving and handling. This in house training serves as a basis introduction to caring. Once this is completed new workers are enrolled on to a two day induction course that meets the skills for care induction standards. Care Homes for Older People Page 21 of 27 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. People live in a home that is well managed and run in their best interests. Evidence: There has been no change in the management of this home during past twelve months. Ms Joanne Gill continues to run the home and supports the people who live there, their families and the staff. People have told us they feel that the manager is approachable and able to sort out any problems, concerns or worries they may have. The home continues to develop its quality assurance systems so that they can be sure they are running a home in the best interests of the people living there. This includes regular staff, resident and relative meetings. These meetings give people an opportunity to discuss their views about how the home is meeting its obligations to the people living there. People also have the opportunity to complete surveys to give feedback if they choose to do so. The home completes an Annual Quality Assurance Assessment (AQAA) every year. The AQAA is very comprehensive and is always completed before the due date. The information contained in this AQAA is fully supported by our findings during this inspection. The home has demonstrated a high Care Homes for Older People Page 22 of 27 Evidence: level of self awareness and recognises the areas that still need to improve, for example the environment and person centred care planning. The home has also trained a number of staff in the use of Dementia Care Mapping, this is an audit tool to help the home judge the quality of care, staff interactions and the wellbeing of people with dementia. The home has policies and procedures in place for the management of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. Managers and staff have received training in and understand the Mental Capacity Act and its code of practise. We found no evidence to suggest that people living in this home were being deprived of their liberty during this inspection. People are supported to look after their money should they choose to do so. The home has told us in their AQAA The personal allowances are kept in individual boxes for all service users and records and receipts are kept for all transactions. Receipts are given for the receipt of any monies. The manager regularly undertakes an audit of the residents monies to ensure accurate records are maintained. A safe is available in the main office for residents to store their valuables. A register of stored items is kept and a receipt is provided for each person. A lockable drawer is also provided in each bedroom for people to keep small amounts of money safe. People are advised not to bring valuables into the home or to insure them adequately. The fire procedures are displayed throughout the home by the fire extinguishers. The home has a fire alarm system. All staff receive training in fire procedures at least twice a year. Fire equipment is routinely maintained and tested. Fire drills are carried out on a regular basis to ensure staff know what to do in case of a fire. All staff receive training in basic first aid and there is a qualified first aider on duty at all times. Staff are aware of their responsibilities in terms of dealing with and recording all accidents. Accident records are routinely analysed with a view to identifying any patterns and altering practise if needed. The manager is aware of her responsibilities in terms of informing the Health & Safety Executive and Care Quality Commission in relation to accidents or serious incidents. A First Aid box is provided in the home. We also spot checked maintenance records of hot water temperatures, fire systems and electrics. All were in order and records show they are maintained on a regular basis. Care Homes for Older People Page 23 of 27 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 24 of 27 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 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 Care plans for the management of peoples challenging behaviour should include specific details of the type of assistance they will need Internal and external medications should be stored separately from one another. The medication trolleys must be secured to the walls when not in use. The home must take action to reduce the temperature of the medication storage rooms. The temperature must not exceed 25oC. The home should keep daily records of the temperature to demonstrate that peoples medication is being stored as per manufacturers instructions. When staff handwrite entries onto the MAR sheet two staff should check and sign the entry. This will reduce the risk of errors in transcribing occurring. The home should consider providing Menus so that people know what the meal choices are for that day. The home should increase the numbers of staff who have first aid training this will include night staff. Page 25 of 27 2 3 4 9 9 9 5 9 6 7 15 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 8 38 The home should make sure that all staff are involved in fire drills, especially night staff. This will ensure that all staff are clear about what action to take should the fire alarm be raised. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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