Care Home: Hare Lodge

What the care home does well Hare Lodge provides its residents with a bright and comfortable home. The home is well maintained and there is a good programme of maintenance, refurbishment and decoration. From talking to staff, residents and one visitor at the present time the home has sufficient staff to meet the present needs of the residents. New staff undergo skills for care induction within the first six weeks of their employment to give them the basic skills to meet the residents needs. The manager carries out regular formal supervision with staff, which highlights any training needs that may be required. Where the manager is requested to keep residents personal allowances for safe keeping, all incoming money and expenditure is individually logged, with residents monies being kept in individual wallets, safely and securely within the home. All equipment and machinery used in the home is regularly maintained and is in good working order. Regular weekly checks are carried out on the fire points. Hot water is delivered at a safe temperature. What has improved since the last inspection? Requirements made at the previous inspection have been met. Care plans and daily reports are now more informative, professional health care visits are appropriately logged and there is good follow through in daily reporting when a resident has been ill. Body maps where bruises are noted by care staff now show the date and time of when body marks are noted. Accident and incident reporting is good, with the manager keeping a matrix of all falls and incidents, and where there are concerns these a reported to the residents general practitioner. Generally residents are requested to sign up to their plan of care and any changes made at review, it was noted that this was not the case for one resident. From viewing a lunch medication medication round and looking at medicines and documentation the inspector found that medicines are now well managed in the home and there were no obvious errors in recording. Throughout the inspection the inspector observed that staff are respecting the privacy and dignity of the residents. There was good interaction between staff and residents. The home has developed an activities programme, where residents can choose daily activities. The inspector observed an activites session taking place after lunch, which residents were obviously enjoying, with much laughter, talking and activity. The activities in the home are still being developed after consultation with residents. Residents also have more contact with the local community, in the form of mini bus rides weekly, staff taking residents out into the local community for shopping trips or to visit the health centre, optician or dentist. Residents are now able to make an informed choice at each mealtime by choosing one of the plated covered meals shown to them. The manager is working hard to get at least 50% of the staff with an NVQ level 2 qualification. At the present time 47% of staff have achieved this qualification, with more staff waiting to sign up for this course. Mandatory training has much improved with nearly all staff have completed, Moving and Handling, Fire Safety, Food Hygiene, Safeguarding Vulnerable Adults and Infection Control. On the day of this inspection twelve staff in the home were starting a modular course on Dementia Awareness, with the intention that all care and ancillary staff will have completed this by the end of the year. All staff who administer medication have received training. What the care home could do better: There still some improvements that need to be made and the manager is aware that while daily records have improved, there is still more room for improvement, especially for recording personal hygiene tasks. While each care plan has generic and individual risk assessments these only outline the level of risk and do not give staff the actions they need to take to help reduce the level of risk for the resident. It was noted during this inspection that a complaint made, had not be appropriately logged into the complaints file. There is also some improvement that could be made in regard to infection control procedures by ensuring that liquid soap is used in all communal hand washing facilities throughout the home. It was noted that to reduce risk to residents who may wish to use the secure garden area, that improvements are made to the external door from the summer room into the garden, so that residents do not have to step over the bottom of the door frame. Key inspection report Care homes for older people Name: Address: Hare Lodge 57 Harebeating Drive Hailsham East Sussex BN27 1JE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: June Davies     Date: 1 8 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Hare Lodge 57 Harebeating Drive Hailsham East Sussex BN27 1JE 01323849913 F/P01323849913 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Harebeating Care Company (Holdings) Ltd care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 32. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Hare Lodge is a large, detached, purpose built care home situated in a residential area of Hailsham, approximately one mile from the town centre. Accommodation is provided on two floors and a shaft lift is available to assist those residents who may have mobility problems. The home is registered to accommodate up to 32 older people with a dementia type illness. The registered owners are the Harebeating Care Company. The home provides care and support to residents who are both privately funded and those who are funded by Local Authorities. The homes fees can be obtained by application to the manager of the home and will depend on the funding arrangements. Additional costs are charged for chiropody, hairdressing, newspapers and dry cleaning at cost. The homes literature states that the aim of the home is to Care Homes for Older People Page 4 of 27 Over 65 0 32 0 9 0 2 2 0 0 9 Brief description of the care home provide a high standard of personalised care and support in a homely and friendly environment which is geared to the needs of individual residents thus enabling those in the homes care to enjoy as much independence and dignity as their own condition will allow them. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out on the 18th August 2009 over a period of 7 hours. During the inspection the inspector spoke with the Acting Regional Manager, the appointed Manager of Hare Lodge, seven member of staff including ancillary staff, two residents and one visitor to the home. The inspector also viewed documentation relating to key standards inspected, observed a lunch time medication round, and joined residents for a lunch time meal. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? Requirements made at the previous inspection have been met. Care plans and daily reports are now more informative, professional health care visits are appropriately logged and there is good follow through in daily reporting when a resident has been ill. Body maps where bruises are noted by care staff now show the date and time of when body marks are noted. Accident and incident reporting is good, with the manager keeping a matrix of all falls and incidents, and where there are concerns these a reported to the residents general practitioner. Generally residents are requested to sign up to their plan of care and any changes made at review, it was noted that this was not the case for one resident. From viewing a lunch medication medication round and looking at medicines and documentation the inspector found that medicines are now well managed in the home and there were no obvious errors in recording. Throughout the inspection the inspector observed that staff are respecting the privacy and dignity of the residents. There was good interaction between staff and residents. The home has developed an activities programme, where residents can choose daily activities. The inspector observed an activites session taking place after lunch, which residents were obviously enjoying, with much laughter, talking and activity. The activities in the home are still being developed after consultation with residents. Residents also have more contact with the local community, in the form of mini bus rides weekly, staff taking residents out into the local community for shopping trips or to visit the health centre, optician or dentist. Residents are now able to make an informed choice at each mealtime by choosing one of the plated covered meals shown to them. The manager is working hard to get at least 50 of the staff with an NVQ level 2 qualification. At the present time 47 of staff have achieved this qualification, with more staff waiting to sign up for this course. Mandatory training has much improved with nearly all staff have completed, Moving and Handling, Fire Safety, Food Hygiene, Safeguarding Vulnerable Adults and Infection Control. On the day of this inspection twelve staff in the home were starting a modular course on Dementia Awareness, with the intention that all care and ancillary staff will have completed this by the end of the year. All staff who administer medication have received training. Care Homes for Older People Page 7 of 27 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessments must be completed for each prospective resident to ensure that the home and staff can meet the residents needs. Evidence: Two residents have been admitted to Hare Lodge since the last key inspection on 9th February 2009. While the format for pre-admission assessments are good, on one preadmission assessment viewed there was not sufficient information to enable an informed decision as to whether the home and staff would be able to meet the prospective residents needs or on which to base a care plan. Manager had knowledge of this resident, but information had not been recorded. A requirement is being made that all pre-admission assessments are carried out to gain as much information as possible and that there is sufficient information to assess if the home and staff are able to meet residents needs and that there is sufficient information on which to base a care plan. Care Homes for Older People Page 10 of 27 Evidence: Hare Lodge does not provide intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide sufficient information as to the health, personal and social care needs of residents, but risk assessments must give staff clearer guidelines as to how the level of risk can be reduced. Evidence: Care plans contained detailed information in regard to each residents, health, personal, and social care needs their preferences and wishes. It was noted that one care plan had not been signed by the resident. While each care plan contained both generic risk assessments and individual risk assessments in relation to the level of risk, there were no clear guidelines for staff as to what steps they should take to help the residents reduce the level of risk. This was discussed with the manager, who will review risk assessments to ensure that staff are given appropriate information to reduce the risks identified. Care plans showed that reviews are carried out monthly and generally the residents sign up to any changes in care. The inspector carried out an audit of medication and observed the lunch time administration of medicines. Administration of medicines are given to residents in a Care Homes for Older People Page 12 of 27 Evidence: safe manner complying with Hare Lodges policies and procedures for administration of medication. All monthly administration records have been correctly completed and there were no gaps. Stock medicines are kept to a minimum. Both medication trolleys and medication fridge are hygienically clean and tidy. The care manager stated that she is responsible for medication and carries out the monthly ordering. The manager carries out weekly monitoring of medication to ensure that it is managed safely and appropriately recorded on receipt, administration and that unused medications are recorded and returned to pharmacy regularly. At the present time the manager is requesting the residents general practitioners carry out a review of medicines. During the inspection the inspector observed staff talking to residents in a friendly and professional manner. At all times staff are respecting the privacy and dignity of residents. One resident said, staff are wonderful, they are very kind and they respect all the residents. One visitor to the home said he is very impressed by the care that staff give to his relative. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities programme is still in developmental stage, and at present resident are offered a variety of activities that they have chosen and are able to choose if they wish to participate in activity sessions. Residents are able to access the local community on a regular basis if they wish to, and are able to visits places of interests. Meals in the home are good and residents are able to make choices in a form that they can relate to. Evidence: The activities on offer to residents have improved since the last inspection, with residents being asked which activity they would like to participate in, and what activities they would like to see on offer. There are many photograph collages scattered around the home showing residents taking part in ball games, cooking and craft activities. At this inspection the residents had chosen a ball game activity in the afternoon. Every Monday afternoon the home has the use of a minibus, and residents can choose to go out to a place of interest if they wish to. Some residents are taken to the local shops and for a walk in the locality. The manager has arranged for external Care Homes for Older People Page 14 of 27 Evidence: entertainers to come into the home to provide entertainment for the residents on a regular basis. Residents relatives and friends are able to visit at any time and can take them out into the community. Residents are able to choose where they entertain their visitors either in one of the communal lounges or in the privacy of their own bedrooms. Where residents choose to follow their religious beliefs, this is supported by the manager. Menus are produced on a four weekly rotating basis, with residents being able to have a good input to the chef in regard to what food they would like to eat, this means that menus can be changed from one week to the next. The inspector observed a lunch time meal. The two choices of meal are plated up and covered and residents are asked to select which one they would like to eat. One resident confirmed that they are able to make choices at each mealtime, and that she liked the idea of showing the choice of meals on offer. Staff were seen sitting at dining room tables with residents discreetly encouraging them to eat. Resident nutrition is recorded monthly and the manager also has a nutrition matrix that indicates if residents are gaining or losing weight. Where there are concerns in regard to weight loss or gain this is reported directly to the residents general practitioner. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints policy and procedure is displayed in the home, but the manager must ensure that all complaints made are recorded. Staff are only recruited to work in the home after vetting, and all staff have attended training for Safeguarding vulnerable adults to prevent residents being placed at risk of abuse. Evidence: Complaints policy and procedure is up to date and displayed in the home. Some residents spoken to could not remember how they would complain, most said they would tell their relatives. Only one resident said that they would talk to the manager or the head of care. There are no recorded complaints in the complaints file, but during the inspection the manager spoke of a neighbour complaining about a residents disco. Discussion took place with the manager who agreed that she would record each complaint in the complaints file along with the investigation and response to the complainant. There has been two safeguarding vulnerable adults referrals since the last inspection. One is now closed and the second while being reported to Safeguarding Vulnerable Adults, Social Services Team, is now being investigated by the acting regional manager of Caring Homes, the company that owns Hare Lodge. The 29 staff working in the home has received Safeguarding Vulnerable Adults Care Homes for Older People Page 16 of 27 Evidence: training. The manager has attended training in relation to the Mental Capacity Act and Deprivation of Liberty, which she is now going to cascade down to the staff. The recruitment process is stringent and all new staff are POVA registered checked prior to taking up employment in the home. Criminal Records Bureau checks are carried out, prior to a new member of staff being allowed to work on their own with residents. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hare Lodge provides comfortable clean accommodation for its residents. Evidence: Hare Lodge provides residents with a bright, clean, homely environment in which to live. On the day of this inspection there was a slight offensive odour on entry into the building, but this had dispersed during the course of the day. There is an on going maintenance and refurbishment programme, and evidence was seen of some bedrooms being fitted with non slip vinyl wood effect flooring. The removal of carpets had been discussed with relevant residents and their relatives. One bathroom on the first floor has been made into an attractive wet room, both manager and staff said that residents now prefer to use this wet room rather than a bathroom. The inspector did note that bar soap was being used in a medical room on the first floor and in one of the communal toilets, liquid soap should be provided in these areas. There was evidence of protective clothing being used by staff, when carrying out personal hygiene and adherence to infection control procedures is generally good. The laundry room is well ordered clean and tidy, with evidence of the laundress taking great care when laundering residents personal clothing. The laundry room is fitted with an industrial washing machine with sluicing facility and there is an industrial tumble drier, although on fine days laundry is put onto outside clothes lines to dry. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the present time are employed in sufficient numbers to safely meet residents needs. Staff recruitment practices are generally good, and do help to protect residents from abuse. The majority of staff have completed all required mandatory training as well as work related training, although there is room for improvement of qualified staff in the home, to ensure that residents receive the best quality of care. Evidence: At the present time staff are employed in sufficient numbers to meet the needs of the residents. The manager is aware that as occupancy levels grow or residents need more one to one assistance the staffing levels in the home will need to be reviewed. Two residents and one visitor confirmed that at present the staffing levels in the home are good and there are sufficient staff on duty to meet the residents needs. At the present time only 47 of care staff have a NVQ level 2 Social Care qualification. The manager stated that she is working hard towards encouraging other staff to sign up for an NVQ course. Care Homes for Older People Page 19 of 27 Evidence: The Inspector looked at the recruitment process by viewing four staff personal files. Each file showed that Protection of Vulnerable Adults register and Criminal Records Bureau checks are carried out. New staff are only deployed to work in the home after the POVA register check has been obtained, and then will not be allowed to work individually with residents until the CRB check is returned. All personnel files viewed showed that the manager had obtained two references prior to the member of staff starting work. It was however noted on one file that the two references were addressed to Whom it may concern, where references should be addressed to the manager. The Caring Company has a qualified trainer who works in all the companys homes but has put in a lot of work at Hare Lodge. Nearly all staff have completed the manadatory training courses, as well as work related training. On the day of the inspection twelve members of staff were starting their Dementai Care training which is called Yesterday, Today and Tomorrow. It is envisaged that all staff including ancillary staff will have completed this training by the end of the year. All staff who administer medication have received medication training. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported by senior staff to ensure that the health, personal and social needs of the residents are met. A good quality assurance system has been developed which helps to provide a good quality of care for the residents. A few improvements could be made to health and safety issues to help prevent residents being placed at risk. Evidence: The appointed manager has been employed as manager of Hare Lodge since the beginning of December 2008. At the present time she is making application to Care Quality Commission for registration and it awaiting her Criminal Records Bureau check to come through. The manager has many years experience at management level and is a qualified Registered Mental Health nurse. It was evident on observing interaction between the residents and the manager, that she is approachable and places great Care Homes for Older People Page 21 of 27 Evidence: emphasis on meeting the residents choices and wishes. All staff spoken to during the course of this inspection spoke highly of the manager, and said they found her to be approachable and knowledgeable. One visitor said that the manager was very approachable and that he was kept informed of any changes in his relatives condition without delay. There is good evidence in the home that the manager has worked hard since the last inspection to meet all the requirements, while there is still some work to be done, the manager recognises what is needed and is working towards compliance and ensuring that residents are not placed at risk. The appointed manager has worked hard on the quality assurance system in the home. Recent questionnaires to residents and staff have been analysed showing positive feedback. The manager is waiting questionnaire responses back from relatives and stakeholders. There is evidence in the home that systems used are regularly monitored by the manager, with particular attention being paid to administration of medication. The home has an up to date action plan, that clearly describes the improvements to be be made and the timescale of completion. There have been regular Health and Safety and Fire Risk Assessments carried out. The Acting Regional Manager has recently spent a lot of time in Hare Lodge, but she also carries out unannounced regulation 26 visits to the home. There is evidence in the home of the regulation 26 monthly reports, and the action plans that have been put in place to correct or improve any issues found. Where residents personal allowance money is kept for safekeeping by the manager a separate account sheet is kept for each resident and all incoming and outgoing monies are recorded. Each residents money is kept in a separate wallet, safely and securely within the home. All staff now receive regular formal supervision at least six times per year. All supervision forms are kept securely in the office. The manager has a supervision plan that shows when each supervision is due. There is evidence that all appliances or machinery used in the home has an up to date maintenance certificate. The inspector observed that there is a risk to residents when wishing to go into the garden via the sun room as the door frame is not level with floor and external pathway and therefore residents have to step over it to get access to garden area. With exception of this issue all areas of the home are kept in a safe and well maintained condition for residents. Care Homes for Older People Page 22 of 27 Evidence: Accidents and incidents are recorded into two separate books, from these the manager compiles a matrix. From the matrix the manager can see the number of falls or incidents that have occurred each month and any areas of concern are reported in the first instance to residents respective general practitioner. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The registered person shall 21/09/2009 not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so a. needs of the service user have been assessed by a suitable qualified or suitably trained person; b. the registered person has obtained a copy of the assessment; c. there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; d. the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in Care Homes for Older People Page 25 of 27 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 respect of his health and welfare. Pre-admission assessments must contain detailed information to ensure that they can form the basis for a care plan and to ensure that the home and staff are able to meet the residents needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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