Care Home: Hanford Manor

What the care home does well This is a small home with a homely atmosphere where ongoing relationships are easily established. We observed a positive and open dialogue between people using the service, visitors and staff. We saw and spoke with 3 visiting relatives who confirmed this. They also expressed high levels of satisfaction with the service and none had reservations or complaints about the home. Comments included "I am pleased with the care provided at Hanford Manor". "Mother has settled well and we are pleased with the way staff care for her". Many improvements have been made over recent years in areas of staffing numbers, staff training, the environment, recording and care practice. There are extensive grounds that have also been improved giving good access to all, providing good seating and a summerhouse. This is a favourite of many people during the summer months. There is awareness of and attention to all aspects of health care, any concerns are referred swiftly to health care professionals and the home has a good record of safe administration of medicines. What has improved since the last inspection? Liaison with the Environmental Health Officer and an ongoing contract with a pestcontrol Company has addressed the problem of rodent control in the home. The Manager is aware of the need to inform us under Regulation 37 of any event affecting the lives of people using the service. Improvements have been made in the area of Safeguarding. The home has up to date procedures for referring matters under Safeguarding and awareness of Adult Protection Procedures have improved. The home also obtained a copy of the current Safeguarding Procedures. A programme of supervision for all staff has now been put into place. Staff now receive regular bi-monthly supervision. This provides staff with the support they need to meet the needs of people using the service. Replacement of furniture and beds, together with redecoration and upgrading of the ground floor bathroom has improved presentation in those areas. This is part of the homes ongoing replacement and maintenance programme. Following assessment people are now informed in writing prior to admission that the home can meet their assessed needs. Since the last inspection care plans seen had been reviewed monthly and any changes in health or personal care recorded. A recommendation of the last report to improve the recording and control of prescribed creams has been actioned. What the care home could do better: Footplates should always be in place on wheelchairs to ensure peoples safety. Risk assessments should include signed disclaimers, if people refuse to have the footplates in place. The home should clarify with the hospital whether oral facial exercises, seen with documents in a care plan should be in place. Where bed-guards are provided written consents should be obtained from the person/their representative as appropriate. It is good practice to countersign handwritten additions to MAR (Medication Administration Records) sheets to ensure the prescriber`s instructions are accurate and followed. It is important to record the number of tablets/dose given for variable dose medication. This will ensure the medication system can be audited at any time. Key inspection report Care homes for older people Name: Address: Hanford Manor 85 Church Lane Hanford Stoke on Trent Staffordshire ST4 4QD     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: Peter Dawson     Date: 1 6 0 1 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 28 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 28 Information about the care home Name of care home: Address: Hanford Manor 85 Church Lane Hanford Stoke on Trent Staffordshire ST4 4QD 01782642144 01782262956 hanfordmanor@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hanford Care Homes Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 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) 5, Old age, not falling within any other category (OP) 25 Date of last inspection Brief description of the care home Hanford Manor is a large detached Georgian property set in its own grounds in the village of Hanford. The home is on a `bus route with easy access to Stoke and Newcastle. There are good parking facilities. The building has been extended and provides accommodation for up to 25 people. Accommodation is on 3 floors and there is a shaft lift providing access to all floors. All bedrooms are for single use and 10 have en-suite facilities. There are 2 lounges overlooking the garden at the front of the building and other recessed areas also providing seating suitable to receive visitors. Care Homes for Older People Page 4 of 28 2 4 0 7 2 0 0 9 5 0 Over 65 0 25 Brief description of the care home One room is the nominated smoking area. There is a large separate dining area and 13 bedrooms also on the ground floor, the remaining bedrooms are on the first floor and 3 on the second floor. There are adequate numbers of bathroom/toilet areas throughout the building. In recent years most areas have been redecorated and refurbished, this includes communal areas and bedrooms. This process is ongoing. The grounds are large, pleasant, peaceful and private. There are patio areas surrounding the building used extensively in the summer months. The weekly fees charged can be obtained directly from Hanford Manor. 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: 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 last key inspection of this service was on 24th July 2009 when mice were found in areas of the home the quality rating of the home was reduced from Good 2 stars to Poor 0 Zero Stars. One of the key areas of focus on this inspection was to check compliance with requirements made at the last inspection. This unannounced Key Inspection was carried out by one inspector on one day from 08:30 - 15:00. The Annual Quality Assurance Assessment (AQAA) was provided for the purposes of the last inspection and therefore not used to inform this one. The AQAA is a legally required self-assessment document completed annually by a service as a statement of the level of service provided. Care Homes for Older People Page 6 of 28 At the time of this inspection there were 21 people in residence, including one in hospital. Most people were seen and we spoke with 10 of them either together or privately. We saw and spoke with 3 visiting relatives and all staff on duty throughout the day. We inspected all the communal areas of the home and a sample of bedrooms were also seen. Records we saw included: Care plans, risk assessments, daily notes, medication records, staffing rotas and staffing records, accident records as well as other documents relating to the inspection process. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? Liaison with the Environmental Health Officer and an ongoing contract with a pestcontrol Company has addressed the problem of rodent control in the home. The Manager is aware of the need to inform us under Regulation 37 of any event affecting the lives of people using the service. Improvements have been made in the area of Safeguarding. The home has up to date procedures for referring matters under Safeguarding and awareness of Adult Protection Procedures have improved. The home also obtained a copy of the current Safeguarding Procedures. A programme of supervision for all staff has now been put into place. Staff now receive regular bi-monthly supervision. This provides staff with the support they need to meet the needs of people using the service. Replacement of furniture and beds, together with redecoration and upgrading of the ground floor bathroom has improved presentation in those areas. This is part of the homes ongoing replacement and maintenance programme. Following assessment people are now informed in writing prior to admission that the home can meet their assessed needs. Since the last inspection care plans seen had been reviewed monthly and any changes in health or personal care recorded. A recommendation of the last report to improve the recording and control of prescribed creams has been actioned. Care Homes for Older People Page 8 of 28 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 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. There is adequate information and opportunity for people to spend time in the home prior to admission so that they can make a judgment about the suitability of the home for themselves. Evidence: A Statement of Purpose and Service Users Guide are available in all bedrooms. A copy is available for visitors by request. The information contained provides adequate information about the home and the services offered. Pre admission procedures are good. People are encouraged to visits prior to admission and can spend time in the home including staying for a meal to allow them the opportunity to made a judgment about the suitability of the home. Many people do come to Hanford Manor for a short-stay prior to permanent admission. People are always assessed in their current setting prior to admission and multi-agency assessments obtained also. Care Homes for Older People Page 11 of 28 Evidence: A recommendation of the last report has been actioned - people are now informed in writing prior to admission that their needs can (or cannot) be met by the home before they are admitted. All people are given contracts/statement of terms and conditions. This includes people who fund their own 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. The health an social care needs of people are known and met by a well trained and supportive staff group. Evidence: We saw a sample of care plans for both recently admitted and longer-term people living in the home. Care plans contain detailed information about the health and personal care needs of people. There are nutritional assessments with details of diet, weight and the support needed for eating and drinking and waterlow to indicate the risk of pressure damage. We saw assessments for continence, moving and handling and the support required for personal care. Interventions by health care professionals are recorded. Improvements were noted in the information to record daily notes/summary of care and support provided. The home report good support and good relationships with the District Nursing Service. This was later confirmed in discussions with a member of the Nursing Service Care Homes for Older People Page 13 of 28 Evidence: who felt the home had a pro-active approach to health care. The Nursing Service visit daily to administer Insulin to 2 people and currently are involved in providing some wound care and taking blood samples. There is no one with pressure damage in the home at this time. We saw nutritional assessments, reviewed and monitored to ensure people had the appropriate support in eating and drinking. Other risk assessments in relation to health and daily living were in place. There was no risk assessment relating to the use of a wheelchair for a person we saw being transported without foot plates in place. Staff told the person to lift your feet as she was transported. This is a potentially dangerous practice. A risk assessment must be completed including a disclaimer if the person refuses to have the footrests in place. Care plans are generally reviewed monthly and staff spoken with had detailed knowledge of the needs of the people they were supporting. We saw information concerning oral care, chiropody, continence and moving and handling risks. We looked at information concerning falls that had occurred in the home - an example being a person who had a fall the previous night and had a head injury. A dry dressing had been applied and the person observed overnight. The District Nurse had been contacted to see the person on the day of the inspection. We saw an entry in the Accident Book giving details of the fall and actions taken. We checked a sample of other accidents that had occurred in the home and these were well documented and appropriate actions had been taken. We saw that bed guards had been provided in some instances following falls from bed. A person who had a bed guard whilst in hospital had continued to have one fitted to her bed. A written consent must be obtained from the person/their family before providing a bed guard in the home. Bed guards with the required protectors were seen in the home. We saw a good and comprehensive care plan for a person admitted from hospital 1 month prior to the inspection. This person had had a stroke prior to hospital admission and there was some small residual speech needs as a result. We saw a leaflet in her notes about oral facial exercises. The home were unaware of this leaflet and will contact the hospital to see if the exercises should be in place. We noticed particularly good care for a person with advanced dementia with repetitive behaviours and a propensity to wander in the home. Staff were all seen to make very positive, supportive and reassuring approaches to this person throughout the day. One member of staff said We need to talk to him and get him to respond, otherwise he would not talk and he would lose his communication skills Care Homes for Older People Page 14 of 28 Evidence: The home have a good record of safe administration of medicines and we looked again at the medication system in operation. Some concerns about creams without prescription labels or exceeding their product life were identified on the last inspection and recommendations made. We found on this visit that creams were clearly identified and within their product life. We examined MAR (Medicaton Administration Records) sheets. Some handwritten changes to medication during the medication cycle were entered on MAR sheets. It is recommended that handwritten additions to MAR sheets are countersigned by another member of staff to ensure their accuracy and safety. We found that variable dose medication did not record the number of tablets given, an example was warfarin prescribed 1 or 2 mg during the week - the amount of medication actually given in these instances should be recorded. This will also allow an audit of the system that has a reducing count of medication. It was pleasing to see that the home had initiated a review of anti-psychotic medication with the GP/Consultant. This related to a person with dementia who likes to wander around the home during the day. The medication was reduced and eliminated over a 3 week period and there were noticeable improvements in the persons general presentation and also his safety. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities are provided to meet peoples individual needs. People are positive about the food provided for them. Evidence: A range of internal and external activities are provided including: reminiscence, art, craft, music. Newspapers and magazines are provided to promote conversation and allow individuals to update themselves about events in the wider world. The home has developed community contacts with local schools and churches - some people attend church and related social events, young people from the local school visit weekly in term time to spend time, engage and befriend people in the home. This is a well established practice and works well in this home. External visits include shopping trips, concert and theatre trips in small groups are arranged to meet demand. There is no formal activity programme and events are often spontaneous. There has been some improvement in the recording of activities, although some records showed only monthly or two-weekly events. Staff do spend time talking to people, although they do not necessarily see this in activity terms. People spoken with said that they were happy with the activities provided. The Manager said they there was currently a review of activities taking place - people using the service and staff were being Care Homes for Older People Page 16 of 28 Evidence: consulted to see is they were satisfied with the options on offer and what additions or alternatives people may prefer. Chosen lifestyles were evident - few people had risen at the start of the inspection at 8.30 and came to the dining room for breakfast during the course of the morning. People said that they went to bed and got up when they wished. We saw people accessing their bedrooms throughout the day. There was adequate heating on this very cold day to allow people to do this comfortably. People moved between the lounge, recessed areas and smoking room as they wished. Several people made comments about the food provided - all expressing satisfaction with the choice and quality. We saw 3 main dishes on offer for the mid-day meal, with choice of 3 sweets. People said that they enjoyed the food. Some comments made at the last inspection about special diets were followed up - there were special soft food or diabetic diets in place with attractive alternatives. We saw 3 visitors throughout the day. All were spoken with and made positive comments about the care their relatives were receiving at Hanford Manor. The son of a person admitted for respite care said that his mother had settled very well and staff had helped her considerably. He was surprised that she had settled so soon as she had great reservations about coming to the home. 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. Improved awareness and handling of Safeguarding issues has further ensured people are protected. Evidence: At the time of the last inspection there had been an unusual amount of safeguarding referrals and not all had been referred immediately to Social Care & Health. We made a requirement to ensure immediate referrals in future. Since the last inspection one referral was made under safeguarding procedures - but this was referred swiftly and no further action was necessary. The home are aware of the need to make urgent referrals as they occur. All staff have had training in Safeguarding and following a recommendation the home has obtained a copy of the Stoke and Staffordshire Safeguarding procedures clearly outlining the procedures to be followed in relation to suspected or actual abuse. The Manager is attending a course Safeguarding for Managers this month (January 2010). There is a complaints procedure in place in the home and all people using the service have a copy of this. The home have received 3 complaints since the last inspection relating to night care, communication with a relative and medication. These have all been dealt with swiftly and appropriately and outcomes confirmed in writing. In Care Homes for Older People Page 18 of 28 Evidence: relation to the complaint about night care, the Manager introduced a system of scanners to identify the actions and monitoring of people throughout the night. Staff feel positive about this and that it confirms the close monitoring they carry out during the night. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Continued close working with the EHO will ensure the problem of vermin in the home will be eliminated. Evidence: There has been a continual programme of improvements and upgrading of the environment over recent years. Maintenance and improvements with a 5 year plan have been carried out. the improvements have been noticeable in all areas of the home including all communal areas and the majority of bedrooms, the kitchen, dining and bathing areas. Upgrading has included necessary replacement of furniture and equipment. The external area has also been improved. The grounds are extensive and provide a pleasant, private area where people can sit or walk. A summerhouse has recently been provided and is used extensively during the summer months. People enjoy these facilities and all areas of the grounds are accessible to everyone including those in wheelchairs. Since the last inspection some bedrooms have been upgraded with new furniture and soft furnishings. Some beds have required replacement. The ground floor bathroom has been refurbished with a new suite. New scanners have been introduced to record night events - checking everyone 1.5 hourly with codes to record checks such as: bed guard checks, fluid intake, elimination. Care Homes for Older People Page 20 of 28 Evidence: At the time of the last inspection in July 2009 following complaints, the Environmental Health Officer (EHO) found mice present extensively in the building. This presented a serious risk to infection control measures in the home. A rodent control contractor was commissioned to deal with this. The home now have an ongoing contract with that contractor and the indications are that in the past few weeks no mice have been caught - although this is being monitored by the EHO. 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. People using the service are supported by sufficient numbers of well recruited and trained staff. Evidence: At the time of the last inspection the staffing levels had been increased. The home were previously exposed when only 2 staff were on duty in the evenings. The increase has continued, there are now 3 staff on duty at that time. The number of staff has also been increased on the morning shift ranging from 3-5 staff on a phased basis. The night staffing levels are satisfactory and have remained the same. The staffing levels throughout the 24 hour period are now 5:3:2. The increased staff numbers have made a considerable difference to the level of support that people receive and also ensures greater safety for people. The home has a good record of staff training. We looked at the homes training matrix and found that all statutory and other training had taken place. The home previously used local colleges for training but there has been a move towards private company training. Training events posted for staff in the home for January - November 2010 included: Record keeping, safeguarding, infection control, food safety, dementia, fire training and moving and handling. Individual records evidenced a well trained staff group. Care Homes for Older People Page 22 of 28 Evidence: The staff group has remained quite static since the last inspection. We examined a sample of staff files and found that all checks and references had been obtained for each person prior to employment and other required documents were in place. We spoke to all staff on duty during the inspection day. All seemed relaxed and committed. They had good knowledge of the needs of people using the service and clear about the support they needed to maintain their health and well-being. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Continued cooperation with the Environmental Health Officer will secure the environment and ensure peoples health and well-being is protected. Evidence: The Registered Manager takes a positive lead in the home and she is readily available to people using the service and visitors on a daily basis. Continuous improvement has been a key part of the approach of the Manager with investment in staff training, the building and quality of care. She is also a Director of the company owning the home. The views of relatives are sought on a 6 monthly basis but there has been a poor response. The Manager is currently reviewing the questionnaires/feedback forms for this purpose. Feedback from professionals involved with the home should also be considered. Outcomes of previous surveys have been included in the homes 6 monthly Newsletter. At the time of the last inspection we had been made aware by the Environmental Care Homes for Older People Page 24 of 28 Evidence: Health Officer of mice infestation in the home. This seriously breached infection control procedures in the home and created anxiety and potential harm to people using the service. We had not been informed by the home of the infestation. - We therefore made 2 requirements arising from that situation: For the Registered Person to undertake appropriate consultation with the EHO to resolve the matter and to notify us under Regulation 37 of any event adversely affecting the wellbeing and safety of people using the service. The home have cooperated with the EHO. There is a an ongoing contract in place with a rodent control company that regularly checks progress. There have been no further incidents that may affect the wellbeing of people that should be notified to us. The Manager is aware of the need to do this in the future. We are in contact with the EHO and whilst there appears to us to be improvements in rodent control, the EHO will ultimately decide when this is fully under control and whether any further action needs to be taken. At the time of the last inspection there was no formal supervision programme for staff. This has been addressed with regular supervision for all staff including staff appraisals. Some aspects of recording were considered poor, but on this inspection we found improvements. The many positive improvements made in this home in recent years have been overshadowed by the recent infection control issues. We hope that this matter is soon resolved and finalised. 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 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 Footrests must be used at all times to ensure the safety of the person. A risk assessment should be in place with a signed disclaimer if footrests are refused. Written consents must be obtained for the use of bed guards from the person or their representative prior to use. Clarify with hospital staff the need for oral facial exercises to ensure that the person is having the required treatment. Handwritten entries on MAR sheets should be witnessed to ensure accuracy and variable dose medication should record the number of tablets given to allow an audit of the system. Continued consultation with the Environmental Health Officer will ensure the previously identified infestation will be resolved. 2 3 4 7 8 9 5 19 Care Homes for Older People Page 27 of 28 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. 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. 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