Care Home: Grindley House Care Home

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What the care home does well People told us that the staff are `very good and helpful`, and that they enjoy the food. People told us they are satisfied with the accommodation and feel comfortable. Staff told us the manager is helpful and supportive. What has improved since the last inspection? Information recorded in the AQAA tells us of the changes made to the service `Changes have been made to a communal lounge to provide a larger TV and rearranged seating to facilitate easier access to this area for service users. The library has been moved to another room, to provide easier access for our service users. We have provided a more sheltered patio area for those service users who enjoy the garden area`. Action has been taken to comply with the three requirements made at the key inspection in May 2009. Care plans have been amended, risk assessments have been completed and changes have been made to the recording of administering medications. What the care home could do better: The service information documents should be reviewed at regular intervals to ensure people have the most up to date information about the service. Documents should be completed for the recording of daily nutrition when a person is having difficulties with eating and drinking. This will ensure that staff have consistent information to provide sufficient daily nourishment. External medicines (creams/ointments) that have short shelf lives upon opening should be dated so the risk is reduced of giving out of date medication. Protocols and details of the `as required` medications should be available for staff reference. This will ensure that people are offered and given medications as they require them. Amendments should be made to the recording of the administration of external creams and lotions. Staff who are applying such preparations should be suitably trained to do so. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. The equipment provided by the home must be in good order and safe to use. All bedroom doors should be provided with a suitable locking facility, to ensure that people have a true choice of whether they wish to secure their room when they are out. For the effective control of the spread of infections and for general hand hygiene purposes, liquid soap and paper towels should be provided in all communal areas and where personal care is provided. The audit of all the staff personnel files of people working at the home must be completed with action taken. The quality assurance and monitoring systems should be expanded to ensure the service operates as it states it does and is run in the best interests of the people living at the home. All staff should be aware of the safe techniques for assisting a person to move from one area to another. This is for the safety and comfort of the person and the staff. For the safety and comfort of people the hot water at outlets accessible to people should be maintained at around 43 degrees Celsius. Key inspection report Care homes for older people Name: Address: Grindley House Care Home Aynsleys Drive Blythe Bridge Stoke on Trent Staffordshire ST11 9HJ     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: Joy Hoelzel     Date: 0 7 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: Grindley House Care Home Aynsleys Drive Blythe Bridge Stoke on Trent Staffordshire ST11 9HJ 01782398919 01782395221 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sudera Care Associates Limited Name of registered manager (if applicable) Marie Elizabeth Bryan Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present drug dependence learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 22 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: Mental disorder, excluding learning disability or dementia - over 65 years of age - (MD(E)) 4 Learning disability - over 65 years of age - (LD(E)) 6 Past or present drug dependence - over 65 years of age - (D(E)) 2 Old age, not falling within any other category (OP) 22 Date of last inspection Care Homes for Older People Page 4 of 29 Over 65 2 6 4 22 0 0 0 0 Brief description of the care home Grindley House is located in Stoke On Trent, Staffordshire and provides a residential service for older people. The detached property is set within its own grounds in a quiet residential area. The home is in walking distance to local amenities, such as pubs, shops and local bus route. The property offers 18 single and two shared bedrooms located on both the ground and first floor. En suite facilities are not provided but all bedrooms have a washbasin. Bathing facilities and toilets are located near to bedrooms and communal areas. The home also provides three lounges, a dining room, kitchen and laundry. All areas of the home are equipped with essential furnishings and fitments to ensure peoples comfort. Equipment and adaptations are provided to promote peoples independence, such as, ramp access to the property, grab rails, assisted baths and a stair lift. People have access to a well-maintained garden at the front and rear of the property. Staffing is provided on a 24 hour basis to ensure people have the necessary support when required. People also have access to relevant healthcare services. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both are available from the home. Care Quality Commission reports for this service are available from the provider or can be obtained from www.cqc.org.uk 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 home did not know that we would be visiting to inspect the service. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. We asked for our Have Your Say, surveys, to be distributed to people living in, working in and visiting the home. Seven were returned from people living in the home (three people that they had help to complete the form) and eight were completed by Care Homes for Older People Page 6 of 29 members of staff. The responses and comments are included in this report. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The registered manager completed this document in March 2010 and returned it to us. Comments from the AQAA are included within this inspection 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: The service information documents should be reviewed at regular intervals to ensure people have the most up to date information about the service. Documents should be completed for the recording of daily nutrition when a person is having difficulties with eating and drinking. This will ensure that staff have consistent information to provide sufficient daily nourishment. External medicines (creams/ointments) that have short shelf lives upon opening should be dated so the risk is reduced of giving out of date medication. Protocols and details of the as required medications should be available for staff reference. This will ensure that people are offered and given medications as they require them. Amendments should be made to the recording of the administration of external creams and lotions. Staff who are applying such preparations should be suitably trained to do so. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. The equipment provided by the home must be in good order and safe to use. All bedroom doors should be provided with a suitable locking facility, to ensure that people have a true choice of whether they wish to secure their room when they are out. For the effective control of the spread of infections and for general hand hygiene Care Homes for Older People Page 8 of 29 purposes, liquid soap and paper towels should be provided in all communal areas and where personal care is provided. The audit of all the staff personnel files of people working at the home must be completed with action taken. The quality assurance and monitoring systems should be expanded to ensure the service operates as it states it does and is run in the best interests of the people living at the home. All staff should be aware of the safe techniques for assisting a person to move from one area to another. This is for the safety and comfort of the person and the staff. For the safety and comfort of people the hot water at outlets accessible to people should be maintained at around 43 degrees Celsius. 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 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. Admissions are not made to the home, until a full needs assessment has been undertaken. This tells the home all about the person and the support they need. Evidence: Information on the home is provided in two documents. The statement of purpose, which sets out what the service offers and the service user guide which offers more information when a person decides to move in. The manager explained that work is in progress to get the documents up to date but could not say when they would be available. We looked at the case file of the person who recently moved into the home. The contents in the file confirmed that information had been sought regarding this persons needs prior to them moving in. Information had been gathered from various sources and the service had completed a full assessment of the persons needs. The manager had met with the person, their family and the social workers prior to offering a Care Homes for Older People Page 11 of 29 Evidence: placement. This gathering of information ensures that the service can be confident of meeting a persons care needs. A visitor to the home told us that their relative had been too poorly to have a look around the home prior to making any decisions. The family had visited and were satisfied with what they saw and made the decision on behalf of their relative. This person said they were willing to leave the decisions to their family members and since moving in had no real concerns. They told us that they found the service copeable. The home does not provide an intermediate care service. 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. There is some information necessary to deliver the persons care, there are gaps in important information and does not consistently reflect the care being delivered. Evidence: The AQAA records information on how the service provides health and personal care We formulate a care plan that ensures best care for individual service users, we include personal wishes on care, promote self help and respect the diverse needs of each person. We selected three case files to look at in depth, with other files looked at briefly to follow up any observations made during the inspection. The information is recorded in two files, one recording the day to day activity and the other file containing risk assessments and core care plans. We saw that the plans had all been updated and reviewed at regular intervals. We did not see that the person or their representatives had been included in formulating or agreeing the plan of care. Generally the plans offered an overview of the care needed and the way the staff Care Homes for Older People Page 13 of 29 Evidence: provide the care. Peoples preferences were recorded, for example, their preferred time of rising, favourite foods, and what they liked to do each day. We saw that one plan documented that a person was underweight. Nutritional risk assessments and a care plan had been completed; the general practitioner had been contacted for advice on this. Additional food supplements had been prescribed. Staff told us that they are monitoring the persons weight at intervals but they are not recording the daily diet offered and taken. The daily report records good diet taken, fair diet taken. As a detailed record is not maintained it was not possible to check what the person had been offered or consumed each day. This daily record would ensure that staff have full details of nutrition and would assist with deciding when additional food or supplements are needed. We saw that staff were recording the fluid intake of this person but these charts were only partially completed, so again it was not possible to establish if sufficient fluids for this person had been offered and taken. The manager explained that they had recently contacted the speech and language therapist for advice when people are having difficulty with eating and drinking. We saw that the prescribed medications are safely stored in trolleys and locked cupboards. Staff explained the procedures and we looked at the medication administration records (MAR) for a selection of people. Some people at the home have been prescribed medications that are to be taken on an as required basis. Staff told us that there are no written protocols or instructions for what triggers the medications to be given or for how often it can be given. We advised that protocols for all as required medications should be available for reference. We saw that the MAR is completed when the as required medications are given. We noted that the prescribing labels on a medication bottle had been altered with the instructions and the quantity of tablets. The manager explained that for this occasional medicine, staff have been transferring some capsules from one bottle to another. We advised that this practice must stop immediately as there is a grave potential for errors to be made. The manager offered an assurance that she would act on our advice immediately. We discussed the administration of creams and lotions; the care staff apply and administers these preparations. These external medicines are kept in the office with the medication trolleys, with staff collecting the creams to administer. Care staff should have training in the safe administration of creams and lotions to ensure they have sufficient knowledge and are competent to do so. The manager confirmed that Care Homes for Older People Page 14 of 29 Evidence: the creams are applied as to the prescribing instructions. However, we saw that the MAR is not being completed, it was not possible to establish when or if the person is receiving the treatment as required. These preparations that may have short shelf lives upon opening were not being dated so there may be a risk that some residents are given out of date medication. Throughout the day we saw that staff were offering choices to people with various activities. Screening is provided in the shared bedrooms to ensure that people have privacy when they are receiving care. We observed that some staff knock on bedroom doors before entering however not all staff are following this practice. The privacy of a person may be compromised by staff entering a private room without being invited. We saw that there are no privacy indicators on the toilet and bathroom doors. There is a potential that someones privacy and dignity could be compromised when using the facilities. 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 who use the service can be assured that they will be supported to follow personal interests and activities. Evidence: The AQAA records - We have employed an activities coordinator to provide an interesting and varied programme to enhance daily life skills and a social activities programme. We have outings and activities that all service users are encouraged to join, with extra staff support for those less able, but we understand that some people are content with their own company and respect their choice of lifestyle. We have social activities including gentle exercise, quiz and knowledge sessions, film shows, and discussion groups on most days, and staff spend quality time with those who are frail or on bed rest, chatting with them, giving gentle massage and tactile support where appropriate. Six people living at the home completed our survey and indicated that there are activities available for them to enjoy. One person made an additional comment of The staff take me out when I need to go. People told us that they feel there is enough to do at the home and that there is Care Homes for Older People Page 16 of 29 Evidence: always something for them to do. A selection of activities that may be available for people is displayed in the main hall. A specific programme is not arranged (except for outside entertainers or trips to places of interest) as staff facilitate activities to the preferences of people each day. On the day of the inspection some people were participating in Holy Communion and a short religious service. Other people were watching the television whilst others were in their private rooms. A visitor told us that they were satisfied with the visiting arrangements and said they could visit at times to suit their relative and there was no restriction on how long they could stay. The main front door to the home is kept locked at all times for the security of the premises. Staff answer the door and allow access. People have free access to the communal areas and their private rooms to use as they wish. Five of the seven people completing our survey indicated that usually they like the meals that are prepared for them. One person made a comment of more fish and chicken on the menu would be good. People on the day of our inspection told us that they enjoyed the food and if they did have a criticism it was that too much is put on the plates. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be assured that any concerns they may have will be listened to and any action will be taken. Evidence: The AQAA records- We have a clear accessible Complaints Procedure and Policy which gives information on how the process works. During the past twelve months the service has additionally - Instigated a grumble book, where comments and requests are recorded on issues of a minor nature. We record how we have dealt with the issue. The AQAA records that the service has not received any concerns, complaints or allegations within the last twelve months. We, the commission, have not received any concerns since the last key inspection. Staff told us the action they would take if they had any concerns or suspicions of any wrong doings and confirmed they had recent training in this area. The complaints procedure is clearly displayed at the entrance to the home and is included in the service information documents. Several people told us they would speak with the manager or staff if they had any concerns or complaints. But currently they have no concerns with the care or the service provided. Two people were unaware of the complaints procedure. One person living at the home told us that they were able to Care Homes for Older People Page 18 of 29 Evidence: sort things out if they had any concerns. The home offers a facility for residents to deposit personal monies for safekeeping. Information regarding the maximum amounts for which the service will be responsible for is not currently included in the statement of purpose. The manager explained the systems in place for ensuring the safety of the money and accuracy of the accounting records. We looked at a selection of balance sheets and discussed various options with the manager to further reduce the risk of errors occurring with peoples money. 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. The home provides a physical environment that is appropriate for the people who live there. Evidence: Grindley House is a large detached property situated in a quiet residential area. The AQAA informs us - The House and surrounding gardens are well-maintained, we have a rolling programme of repair, re-decoration. The Home is clean, safe and comfortable and our service users are encouraged to personalise their rooms to their own taste. The public areas are available to all and meet the diverse needs of the user, ie. wheelchair access and sensory needs, and people are free to use any of the public rooms. People completing our survey told us the home is always fresh and clean. People told us that they were satisfied with the accommodation and said that they were comfortable. We looked at a selection of bedrooms during our tour of the building and found the rooms were well furnished and personalised to individuals tastes. As there is no passenger lift to access the rooms on the first floor the manager explained that people residing in this area must be able to use the stairs or the two Care Homes for Older People Page 20 of 29 Evidence: stair lifts. We saw that the second of the two stair lifts has a fixed seat so people have to shuffle to the side of the chair and then step off sideways onto the main landing. The manager explained that risk assessments are completed for this. We saw some areas that may potentially be a risk to people. For example not all areas, communal and private, have been supplied with suitable hand wash facilities for effective hand washing and for infection control purposes. The commodes that are in use in the bedrooms are the metal frame type but many have the rubber protectors missing from the feet of the chair. The commodes are removed from the bedrooms each day and taken to the sluice are, situated on the ground floor to be hand washed in an open type sluice. Wooden wedges were seen to be propping open doors at the entrance to the main kitchen. We saw that there are no privacy indicators on the toilet and bathroom doors. There is a potential that someones privacy and dignity could be compromised when using the facilities. We saw that only a few bedrooms have been provided with a locking facility on the door. All bedroom doors should be fitted with a suitable lock to ensure that people have a true choice of whether to lock their door or not. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have confidence in the staff who care for them. Evidence: People told us that the staff are very good and helpful. Visitors told us that the staff are friendly and provide a good service to their relative. We saw staff working positively with the people in their care, they appeared patient, caring and committed to their work. They demonstrated that they have a good understanding of the individual needs of the people living at the home. We looked at the staffing rotas and saw that the staffing levels are maintained with different numbers of staff during the day and night. The manager explained the differing levels and stated that the numbers of staff are sufficient to meet the needs of the people. The AQAA informs us that of the twenty permanent care staff, sixteen have been trained at National Vocational Qualification in care at levels 2 and 3. We sampled the files of three staff holding various positions within the home. The manager explained that the files are currently being re organised so that one file contains the recruitment, training, supervision and appraisal information. We saw that Care Homes for Older People Page 22 of 29 Evidence: the information essential to ensuring suitable people are working at the home had been requested. The manager confirmed that staff have received the mandatory training and that further training through out the year is being organised. All eight staff members completing our survey indicated that they received sufficient training to enable them to do their job. 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 who use the service can be assured that the manager is developing systems that monitor practice and compliance with the plans, policies and procedures of the home. Evidence: The registered manager has been at the home for a considerable period of time. People told us that the manager was kind, caring and supportive. The manager discussed the many changes that have been made since the last inspection and acknowledges that there are more changes to be made. The AQAA contains information that is fully supported by appropriate evidence. It includes a level of understanding about the importance of equality and diversity and shows how they have listened to residents. The views and opinions stated by those that use our service, or support our service users are important to us, and we act upon our Quality Assurance findings to help improve our service. Families, friends and representatives Care Homes for Older People Page 24 of 29 Evidence: continue to be encouraged to be active in promoting the wellbeing of each service user, staff strongly support those service users who may not have a high level of outside support. The manager acknowledges that the quality assurance and monitoring of the service is minimal but confirms that it is developing. The home offers a facility for residents to deposit personal monies for safekeeping. Information regarding the maximum amounts for which the service will be responsible for is not currently included in the statement of purpose. The manager explained the systems in place for ensuring the safety of the money and accuracy of the accounting records. We looked at a selection of balance sheets and discussed various options with the manager to further reduce the risk of errors occurring with peoples money. Records, documents and certificates were available for inspection to ensure that the weekly, monthly and annual health and safety checks are being carried out. Again the manager explained that work is in progress to reorganise the paperwork and make them more easily accessible for inspection upon request. We observed a person having great difficulty standing and having problems moving. We saw staff assisting this person to stand up using the underarm method. This underarm method and technique has been condemned as a dangerous method for a period of years. Staff told us that they had received recent training in moving and handling, and if this is the case they are either not receiving the correct training or not putting the training into practice. We saw some monitoring records for the testing of the hot water outlets. The temperature was recorded at around 38 degrees Celsius. There was no record of the temperature of the hot water outlet in the shower. For the safety and comfort of people the hot water should be maintained at around 43 degrees Celsius. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The audit of all the personnel files of people working at the home must be completed with action taken. This will ensure that people living at the home are supported safely. 28/05/2010 2 38 12 Arrangements must be in place for a safe system of moving, handling and transferring people. This will ensure that people are not put at risk of harm. 28/05/2010 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 8 A record should be maintained of a persons daily food intake to ensure staff have consistent information for supporting people with nutrition. Protocols and details of the as required medications should Page 27 of 29 2 9 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 be available for staff reference. This will ensure that people are offered and given medications as they require them. 3 9 Amendments and changes should not be made to the prescribing labels of medications. This will reduce the risk of errors occuring. Amendments should be made to the recording of the administration of external creams and lotions. Staff who are applying such preparations should be suitably trained to do so. External medications (creams/ointments) that have short shelf lives upon opening should be dated and discarded within the guidelines. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. For the privacy of people in their own rooms all staff should be instructed to follow the homes procedure for entering rooms. The equipment provided by the home must be in good order and safe to use. All bedroom doors should be provided with a suitable locking facility, to ensure that people have a true choice of whether they wish to secure their room when they are out. To prevent the possible spread of infections, automatic sluice disinfectors should be available for washing the commode pots. Suitable hand wash facilities (liquid soap, paper towels and lidded disposal bins) should be available in communal areas and at the point of the delivery of care. The quality assurance and monitoring systems should be expanded to ensure the service operates as it states it does and is run in the best interests of the people living at the home. For the safety and comfort of people, the hot water at outlets accessible to people should be maintained at around 43 degrees Celsius. 4 9 5 9 6 10 7 10 8 9 24 24 10 26 11 26 12 33 13 38 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. 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. 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