Care Home: Handsworth Methodist Home

What the care home does well Service users` needs are assessed before they move to the home to ensure that the staff team have the necessary skills and, where appropriate, access to equipment to ensure that the identified needs can be met. Written care plans were comprehensive and clearly addressed spiritual and social needs as well as physical and medical needs. Staff presented as having a good understanding of the needs of the individual service users. Good links are maintained with community-based medical services. This means people living at the home have access to appropriate and timely medical intervention. The procedure for administering medication is followed well, which enhances the health and safety of service users. A varied range of activities are available for service users to participate in and the staff team strive to be innovative in the way in which social and emotional needs are addressed. The spiritual aspect of an individual`s daily life is considered to be highly significant, but with the absence of any imposed dogma. Service users are safe, in that they are protected from abuse or exploitation. Service users and their representatives are confident that any complaint will be listened to and dealt with appropriately. The building and environment at Handsworth is pleasant and well maintained with a range of different communal areas including well maintained grounds. The staff team are well-trained, competent and on duty in sufficient numbers, to meet the identified needs of the service users. Service users` and their representatives` views are sought in connection with any improvements or changes to the way in which individual care needs are met or the general running of the home. Service users and visitors who we spoke to were very positive about the care provided by the staff team. Comments included -- "it is a wonderful home"; "I visit nearly every day and the residents are treated like people"; "I would rather [relative] was in here than anywhere else"; the people are nice, the food is good, I have recommended it". Staff were also positive about the way in which they undertook their work and the standard maintained by their colleagues. One member of staff told us "I`d quite like to stay here when I am old". What has improved since the last inspection? No requirements were made at the last key inspection. All the good practice recommendations had been addressed. A higher percentage of care staff had successfully completed NVQ II.Decoration and refurbishment had continued. The previously good standards of care had been continued. What the care home could do better: More clarity in the records may be achieved by clear dating of amendments to any written assessment or care plan. This is to avoid any ambiguity in connection with what the current and up to date identified needs of each individual service user and the strategy for meeting those needs. A record should be maintained of the exploration of omissions in information given by prospective employees. This is to ensure that the management can demonstrate that all reasonable steps are taken to recruit only staff who are suitable to work with vulnerable service users. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Handsworth Methodist Home West Road Bowdon Altrincham Cheshire WA14 2LA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Steve Chick     Date: 2 7 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Handsworth Methodist Home West Road Bowdon Altrincham Cheshire WA14 2LA 01619285314 01619299048 home.bow@mha.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Methodist Homes for the Aged care home 43 Number of places (if applicable): Under 65 Over 65 43 old age, not falling within any other category Additional conditions: 0 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 floowing categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 43 Date of last inspection Brief description of the care home Handsworth Methodist Home provides residential accommodation with personal care for up to 41 residents within the category of old age. Handsworth is a private care home owned by Methodist Homes for the Aged. Handsworth is a large, purpose built property set in pleasant grounds that are enclosed and accessible to residents. The home is situated in a quiet residential area of Bowdon, within easy reach of a post office, general store, church and local public house. The village of Hale is a short distance away and Altrincham is the nearest main town. The home is conveniently situated for local transport services and main motorway links. Care Homes for Older People Page 4 of 28 Brief description of the care home The home is arranged over three floors and a passenger lift provides access to all floors. All bedrooms are single and have en-suite facilities. Communal areas consist of a large dining room, several lounges, a conservatory and an activities room, and tea bays on each floor. Fees charged for this service were between 478.00 and 588 pounds per week. There are no additional charges made. Care Homes for Older People Page 5 of 28 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: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. We (the Care Quality Commission) undertook a key inspection, which included an unannounced visit to the home. This meant that no one at Handsworth knew that the visit was going to take place. All the key inspection standards were assessed at the site visit. For the purpose of this inspection two service users were interviewed in private, as were two relatives of service users, one visiting health care professional and three staff members. Additionally discussions took place with the manager and one relative who Care Homes for Older People Page 6 of 28 was happy for the discussion to take place with the manager present. We also looked at information we have about how the service has managed any complaints, what the service has told us about things that have happened in the service, these are called notifications and any relevant information from other organisations. Before the site visit, we asked for surveys to be sent out to residents, relatives and staff, asking what they thought about the care at the home. 11 residents, 10 relatives and 10 staff returned their surveys to us. Some of the information from these surveys is included in the report. We also asked the management of the home to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA). This is a legal requirement. The AQAA told us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, some of these comments have been included in the report. We undertook a tour of the building and looked at a selection of service user and staff records as well as other documentation, including staff rotas, medication records and the complaints log. Since the previous inspection we have completed an Annual Service Review (ASR). The ASR does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection. The ASR did not make us change our opinion of the service. We have not received any complaints or allegations about the service since our last Key Inspection. What the care home does well: What has improved since the last inspection? No requirements were made at the last key inspection. All the good practice recommendations had been addressed. A higher percentage of care staff had successfully completed NVQ II. Care Homes for Older People Page 8 of 28 Decoration and refurbishment had continued. The previously good standards of care had been continued. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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. Service users are only admitted to the home after an appropriate assessment to ensure the home can meet their needs. Evidence: The manager told us in the AQAA that a full assessment of the residents care needs, abilities, interests, health and spiritual needs was carried out prior to admission. This assessment involved the resident and representatives to ensure that the admission was appropriate. We looked at a selection of service users files. All had a copy of an assessment undertaken by the homes staff which included evidence of the involvement of the service user or a representative. The form used to record this assessment also included a statement as to whether or not the identified needs could be met at Handsworth. Care Homes for Older People Page 11 of 28 Evidence: Service users who we asked, confirmed that they had been visited by someone from the home before the final decision to move to the home had been made. Handsworth does not offer intermediate care. Care Homes for Older People Page 12 of 28 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. Service users health, personal and social care needs are met by the consistent implementation of policies and procedures. Staff practices also serve to promote the dignity of the service users. Evidence: We looked at a selection of service users files. All had a written care plan which presented as addressing the service users potential needs in a comprehensive manner. There was documentary evidence that the care plan was periodically reviewed and amendments made if necessary. There was clear evidence in some files that the service user or their representatives had been involved in the creation of the care plan. The process by which amendments were recorded in different parts of the file resulted in potentially conflicting information. For example one record indicated that the service user was responsible for their own eyedrops, but another section of the same file contradicted this. Examples were seen where some updating and amending of Care Homes for Older People Page 13 of 28 Evidence: information was dated whereas others were not. These issues had the potential to create possible uncertainty, for the care staff, as to what the current care needs and care plan was for any specific individual. However, staff who we spoke to, were confident that the overall system for communicating the current needs of service users was effective. The system included staff members personal knowledge of service users and verbal updates at each shift change. Staff who returned a survey to us said that they received up-to-date information about service users either always (9) or usually (1). All said that they believed that there was the right support to meet service users needs. Service users who we interviewed, spoke positively about the way in which their care needs were met. They told us they could influence the way in which care was provided and that their privacy and dignity were maintained. Similarly relatives who we spoke to were very pleased about the way in which the care was provided. For example, one person described the attitude of the staff as diligent competent and caring. Staff told us that treating people with respect and maintaining privacy and dignity was a clear expectation of the management team and that any examples of poor practice would be immediately challenged. Service users who returned a survey to us all said that they received the care and support they needed either always (7) or usually (4). Relatives who returned surveys to us said that the care service met the needs of their relative either always (7) or usually (3) and that important issues about care was communicated to them either always (7) or usually (3). All said that their relatives received the support that they expected. We spoke with one visiting health care professional who was also positive about the standard of care provided by staff at the home. They told us that communication between themselves and staff was good. They said that the staff followed medical care instructions well and raised any concerns at an early stage. There was good documentary evidence that service users have access to the full range of medical services available in the community. All service users and visitors who we spoke to were confident that medical support was appropriately obtained in a timely manner. There was good documentary evidence that service users had their medication periodically reviewed by their GP to ensure it remained appropriate for their needs. Medication presented as being stored appropriately in the home. We looked at a small selection of medication administration records which presented as being appropriately maintained. This meant that the home can provide evidence that the correct Care Homes for Older People Page 14 of 28 Evidence: medication was being given to the correct person in the correct dose and at the correct time. Care Homes for Older People Page 15 of 28 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. An appropriate range of activities was available to service users, and visitors are welcome in the home, which enhances service users fulfilment and social stimulation. The provision of food to maintain service users health and well-being is good. Evidence: The manager told us in the AQAA that the home had a full and varied activity programme running seven days a week which is periodically reviewed following consultation with residents. During the tour of the building at this unannounced visit the noticeboard included information about a residents meeting planned for that day and reflexology sessions. We were told by the manager that activities were planned for each morning and afternoon and the home is looking to extend that to planned evening activities too. These activities were reported as including baking, quizzes and exercise sessions. Examples of artwork completed by residents was on show in the conservatory. We were told that regular prayer meetings take place, and one such meeting was held by visiting clergy during our visit. There was no compulsion to attend any meeting or activity, although the prayer meeting on the afternoon of our visit was clearly very Care Homes for Older People Page 16 of 28 Evidence: popular and looked forward to by residents. We were told that since the previous inspection what had been the residents laundry room, which was used infrequently, had been converted to a well-equipped hairdressing salon . One room had also been turned into a sensory room equipped with mood lighting, scented candles and soothing music options, where service users could indulge in reflexology with a member of staff who had recently become professionally qualified in this. Service users who returned a survey to us all told us that activities were provided by the home either always (8) or usually (3). Visitors who we spoke to were aware of activities taking place. One told us they felt that the home was strong on activities being imaginative and putting effort into involving service users. Service users who we spoke to felt that the provision of activities was good and cited their enjoyment of taking part in quizzes, exercise classes and knitting. All people who we asked, confirmed that participation in any activity was voluntary, people could spend their time in the communal areas or their own rooms and can make their own decisions about daily routines such as when to get up and went to go to bed. One member of staff, when asked what the best thing about the home was said ... plenty going on and privacy if you want it. Another said in response to the same question, chatting, sitting down and doing something personal for service users. All visitors, service users and staff who we asked, confirmed that there were no unreasonable restrictions on visiting and that people are made to feel welcome by the staff team when they did visit. During this unannounced visit a meal was sampled which was pleasantly presented and tasty. Observation during mealtimes was that they were unhurried, took place in a calm atmosphere in pleasant surroundings, with service users involved in helping themselves to milk and sugar with their drinks. Service users who did need some assistance with eating were being helped in a dignified and appropriate manner. Visitors who we asked felt that the provision of food was good, with one relative describing it as great and another citing the food as amongst the best things about the home. Staff who we asked believed that the food was good, and that there was always a choice. Service users who we asked confirmed that there was enough food, there was a choice and that had been told that if you didnt like a meal you could have something different. Care Homes for Older People Page 17 of 28 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. Service users are protected from abuse or exploitation by the homes policies and practices and are confident that any complaints they may have would be dealt with appropriately. Evidence: We were told in the AQAA that the home had a clear complaints policy which was brought to the attention of service users and their representatives. This written policy has been found to be appropriate on previous occasions and was not looked at during this visit. All relatives who returned a survey to us said they knew how to make a complaint. Of the service users who returned a survey to us nine said that they knew how to make a complaint and two said they did not. All staff who returned surveys to us said that they knew what to do if they became aware of concerns. Relatives who returned surveys to us all said that the care service responded appropriately connection with any raised concerns either always (5) or usually (4). All visitors, service users and staff who we asked were confident that any complaint would be taken seriously by the staff and management of the home. We looked at the complaints log in the home which presented as being appropriately Care Homes for Older People Page 18 of 28 Evidence: maintained to demonstrate how any complaint is investigated. We were told in the AQAA that the home had a robust protection of vulnerable adults policy and procedure which included a confidential freephone whistleblowing line run by external agencies. A copy of the Methodist Housing Association safeguarding of vulnerable adults and training awareness pack was seen on the premises. Staff training records indicated that training in the protection of vulnerable adults was included in the core, mandatory training for all staff. Staff who we spoke to confirmed that they had received training in the protection of vulnerable adults, that they were aware of the need to be vigilant and understood the process for whistleblowing if necessary. Staff who we spoke to also told us they believed service users living at the home were safe. All service users who spoke to, told us that they felt safe at the home. Visitors who we asked were confident that their relatives were protected from abuse or exploitation. One visitor told us that they were confident to trust every member of staff implicitly and another told us that they had watched staff with other residents who are treated equally pleasantly. We were not aware of any complaint or allegation made in connection with Handsworth since our previous key inspection. Care Homes for Older People Page 19 of 28 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 is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant, safe and hygienic environment. Evidence: We were told in the AQAA that the home was well decorated and comfortably furnished and that there was an annual repairs and renewals plan with a budget controlled by the manager. At this unannounced inspection visit we undertook a tour of the building. This included communal areas and a selection of service users bedrooms. We were told that the dining room had been refurbished. Together with the other communal spaces such as the lounge and conservatory the building offered a pleasant living environment. Observation of bedrooms confirmed the information from the manager that people can, subject to health and safety restrictions, personalise their own rooms. Two rooms occupied by a couple had been adapted so that one was a bedroom and the other a living room. As mentioned elsewhere in this report the service users can benefit from a wellequipped hairdressing room and a relaxation room. Care Homes for Older People Page 20 of 28 Evidence: No remedial issues were identified in connection with the physical environment of Handsworth. Throughout the tour, the building presented as clean and tidy with no unpleasant smells. This was confirmed as the usual state of the building by all service users, visitors and staff who were asked. One visitor described the home as a lovely environment and believed that the management and staff were constantly seeking ways to improve both the building and services for residents. Service users and some visitors also specifically mentioned the very pleasant gardens as being a positive attribute of the environment of the home. Care Homes for Older People Page 21 of 28 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 numbers and skills mix of appropriately recruited staff on duty, promotes the independence and well-being of service users. Evidence: The manager told us that current staffing levels were planned on the basis of four carers plus a senior between 07:00 and 14:30, three carers plus a senior between 14:30 and 21:30 and three staff on between 21:30 and 07:00. Senior hours extended by 15 minutes at the beginning and end of each shift to ensure effective handover of relevant information. We were given a copy of the staff rota for the week ending 23rd of August 2009, as confirmation that these staffing levels are usually achieved. Staff who returned surveys to us, all said that there were enough staff either always (8) or usually (2). Staff who we asked, also told us they believed that there were usually enough staff on duty to meet the needs of the service users. Were told in the AQAA (which was written in May 2009) that 72 of the care staff held NVQ II or above. The NVQ in care is a nationally recognised qualification which is intended to increase the knowledge and skills of carers so that they may undertake their caring duties more competently. A selection of training records was looked at which confirmed that the information given about NVQ and other training was Care Homes for Older People Page 22 of 28 Evidence: accurate. Staff told us that appropriate training was available and that they were encouraged and supported to undertake further training. Staff also told us that managers and colleagues were supportive and that they could always ask for assistance if necessary. The manager maintained a training matrix which was a record to enable the quick identification of which staff member had received which training and if any staff required access to specific training opportunities. Staff who returned a survey to us all said that they had received training which was relevant, kept them up to date and helped meet service users needs. Relatives who returned a survey to us told us that staff at the right skills and experience either always (7) or usually (2). We looked at a sample of staff files relating to recently recruited staff, in connection with the process for vetting potential staff members. These demonstrated that appropriate references and criminal records bureau disclosures had been obtained. In one example seen the application form included some gaps in the applicants employment history. It was reported that these gaps had been satisfactorily explored at interview, but not recorded. All service users and visitors who we spoke to were complimentary about the staff teams attitude and skills. Comments included not one [staff member] who I would not be pleased and proud to call a friend; staff are very helpful: top of the list is the carers ... hear them talking in a kind considerate way; staff are good ... always a nice atmosphere ... enjoy coming into the home. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is competent to run the home, use the quality audit systems and implement the health and safety procedures for the benefit of service users and staff. Evidence: The manager has considerable experience of management in the care sector and has appropriate professional qualifications. This information has been checked on previous occasions and was not rechecked at this visit. The manager was aware of new legislation relating to the Deprivation Of Liberty safeguarding procedures and told us she had not needed to make any applications. There was good documentary evidence of routine quality assurance processes being used to influence the daily running of the home. Surveys are undertaken with residents. We looked at the action plan which had been generated following an analysis of the survey results in 2008. There was also documentary evidence that Care Homes for Older People Page 24 of 28 Evidence: issues raised through this process were being addressed. Internal quality audits were also undertaken by members of the staff team. The records of these indicated that they were undertaken thoroughly and staff were able to constructively criticise identified practice when necessary. We looked at a small selection of records relating to money held on behalf of service users. These presented as being predominantly well maintained to account for any purchases made on behalf of any service user. In one example seen a newspaper bill was recorded as having been paid although the receipt from the newsagent could not be located at the time of this visit. We were told in the AQAA that equipment in the home was serviced and tested as recommended by the manufacturer. We were also told that there was a comprehensive health and safety policy and that staff had received training in the prevention and control of infection. During the tour of the building bed rails were seen to be fitted to one service users bed. The use of bed rails can be beneficial to aid the safety of individual service users. However their incorrect use can be a severe hazard and consequently they must never be used without a thorough risk assessment having been undertaken. The manager was confident that such a risk assessment would have been done although at the time of this visit a record of that assessment could not be located. We looked at a small selection of records relating to the maintenance of equipment. This included the lift and the fire detection and alarm systems. These presented as being appropriately maintained. Staff who we asked confirmed that personal protective equipment, such as disposable gloves and aprons, were always available and worn to minimise the risk of cross infection. Care Homes for Older People Page 25 of 28 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 28 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 38 13 The registered person must ensure that no bed rail is in use without a corresponding risk assessment to demonstrated safe use for the specific service user and the correct fitting for the specific bed. This is to ensure that the known preventable risks associated with the use of bed rails are minimised for the health and well-being of the service user. 16/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The responsible person should consider reviewing the way in which amended or updated information is recorded in service users files. This should be with a view to ensuring that the current circumstances of each service user is consistently evidenced in each part of the recording system. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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