Care Home: Haven Lea Residential Care Home

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What the care home does well Haven Lea has a stable care staff team many who have worked in the service for several years. During our visit staff spoken with showed a genuinely caring attitude and told us that they thought that staff were a good team. Staff felt that they were supported by a manager who listened to their opinions and supported them in their roles. People living in the home are able to make their bedrooms their own. All bedrooms had family pictures and ornaments available. Some had furniture that they had been brought from their previous home. The service is decorated in a style in keeping with what people would have in their own homes. All people wishing to move in the home are offered the chance to look around before they move in. Assessments are done in order that people wishing to move in have their needs looked at in order to make sure that the home can decide if it can meet people`s physical needs. What has improved since the last inspection? The manager and the staff have worked hard on improving the medications management. These were seen to have significantly improved. People are now receiving their medications in a manner that maintains their safety and supports their individual needs. Since the last visit the manager has put into place care plans for people living in the home. These are available to staff in order to provide them with instructions on how to support the people living in the home. What the care home could do better: The service has not developed any active plans that look at the quality of the support provided. The service will find it difficult to maintain quality improvements without making sure that the manager is aware of the areas that need to be improved. They have introduced audits (checks) on medications but these need to be further developed in order that the recognise and address any areas to be developed. Policies and procedures available to the staff team are out of date and do not reflect the correct guidance that staff need not. Other documentation such as information to people wishing to move into the home is out of date. Training for the staff is in need of further development and there is little to show that staff members that have had training that keeps them up to date. or provides them with training that meets the assessed needs of people living in the home. The daily lifestyle available such as menus and activities is not taken from the expressed views of people living in the service. There is limited opportunities for them to influence both these aspects. Where people are less able to express an opinion staff have no written preferences that would help them support the decisions of the individual. The service does not always notify us of incidents that are detrimental to the health and welfare of people living in the service. The home owner has not completed a written record of monthly unannounced visits to review quality in the service that gather people who live in the homes views and the staff. Key inspection report Care homes for older people Name: Address: Haven Lea Residential Care Home Shaw Lane Prescot Knowsley Merseyside L35 5BZ     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: Julie Garrity     Date: 2 3 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Haven Lea Residential Care Home Shaw Lane Prescot Knowsley Merseyside L35 5BZ 0151-430-8434 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): misslbrown@hotmail.com York Valley Limited Name of registered manager (if applicable) Mrs Linda Brown Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 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: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home Haven Lea is a purpose built home which provides personal care (non-nursing) to thirty older people. The service is owned by a company called York Valley ltd and is the only home for the company. Accommodation is on two floors with a passenger lift serving all floors. Havenlea has its own private garden at the rear od the building. Parking is Care Homes for Older People Page 4 of 28 Over 65 30 0 0 30 2 3 1 0 2 0 0 9 Brief description of the care home availiable at the fron t of the buiding for visitors. The service in a residential arae of Prescot and is close to Whiston hospital. There are local bus routes and train station within walking distance. Information about the service is in the managers office and is availiable upon request to people wishing to view the service. Fees are charged at the local council rate. 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 visit to the home started at 10.00 and took place over 3 days. We spoke with a total of eight people who live in the home, seven members of staff, two relatives, the manager. and the deputy manager. The manager completed a document known as an Annual Quality Assurance Assessment (AQAA). This documented is completed and sent to us by the home before we visit. The AQAA tells us what the home does well and what their plans are to increase the quality of the home. When we visited the home we looked at many of the records these included care records, staff records, medications, policies and procedures, menus, duty rota, staff training and activities records. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support Care Homes for Older People Page 6 of 28 them to make informed decisions in line with their choices. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The service has not developed any active plans that look at the quality of the support provided. The service will find it difficult to maintain quality improvements without making sure that the manager is aware of the areas that need to be improved. They have introduced audits (checks) on medications but these need to be further developed in order that the recognise and address any areas to be developed. Policies and procedures available to the staff team are out of date and do not reflect the correct guidance that staff need not. Other documentation such as information to people wishing to move into the home is out of date. Training for the staff is in need of further development and there is little to show that staff members that have had training that keeps them up to date. or provides them with training that meets the assessed needs of people living in the home. The daily lifestyle available such as menus and activities is not taken from the expressed views of people living in the service. There is limited opportunities for them to influence both these aspects. Where people are less able to express an opinion staff have no written preferences that would help them support the decisions of the individual. Care Homes for Older People Page 8 of 28 The service does not always notify us of incidents that are detrimental to the health and welfare of people living in the service. The home owner has not completed a written record of monthly unannounced visits to review quality in the service that gather people who live in the homes views and the staff. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager makes sure that peoples needs are looked at before they move in. Evidence: The AQAA for the service told us that, The registered manager or senior member of staff, would carry out a Daily living and needs assessment. This is done prior to any admissions to determine service users needs, this covers 15 elements of care. Following this assessment service user are also offered to spend a day within the home so that they can be observed by the care team. We looked at five peoples assessments (a review of peoples needs), all had received the opportunity to have their needs reviewed before they moved into Havenlea. This is done in order for the staff to decide if the individuals needs can be met by the service. Assessment documentation seen did include the opportunity to look at peoples social needs and food choices. In all of the assessments looked at these details were very Care Homes for Older People Page 11 of 28 Evidence: brief and did not cover equality and diversity needs such as did they wish to manage their own medications or take into account changes in practice such as the Mental Capacity Act. The manager told us that they now did do assessments on people who came for respite and for those returning from hospital. This good practice as it supports the manager to determine if they can meet still peoples individual needs. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been put into place in how the service looks after peoples medications. Care plans that are instructions to staff on how to support people are not person centred and do not always support staff to meet peoples preferred choices. Evidence: We spoke to people living in the home. The majority told us that they were happy living in the home. We looked at care records for people living in the service. These records were used to give information to staff about how to support people living in Havenlea. All people living in the service now had a care plan available. We looked at these and saw that they were not all written to the same standard. Some of the plans repeated the same information in several places, others had no specific details about the service that the person was to receive. We also saw that some of the plans instructed the staff to provide the same support to two different people. This meant that staff had guidance that was not specific to the individual or specific on how to meet person living in the services needs. Risk assessments that identified areas that needed further planning such as risk of Care Homes for Older People Page 13 of 28 Evidence: falls, development of pressure ulcers and moving and handling were not always correctly completed. On at least two occasions peoples risks were identified as at risk but this information had not been used into the plan. We saw that although plans were reviewed monthly staff reviewed the events that had happened to the individual but did not always review whether the plan available continued to meet the persons needs. Changes in condition were not always added to the plan as the persons needs changed. Needs were described as problem, this is not a good practice approach as peoples needs, skills or areas for support should not be viewed as a problem. We discussed these areas with the manager who explained that staff were just getting used to writing plans the way that they do now. She told us that staff will be receiving further training in writing care plans and that she may review the format that they use as she is not convinced that it works for Havenlea. It was evident that the manager had consider how best to communicate with staff and was working on ways to make sure that people who live in the service and staff work together to meet peoples needs. We looked at how medicines are handled administered and recorded. To do this we spoke with the manager, staff and people living in the home as well as looking at sample of medication records and stock. Overall, significant improvements were noted in all areas of handling recording and administering medication within the home. Medicines were stored securely to help prevent them from being misused. Medication Administration Records (MARs) were unclear on the first day and showed errors in giving medication. On our return to the service MARs were much and showed that medicines had since been given to people correctly. The manager had recently started to carry out audits (checks) on how medicines were handled within the home. Checks made so far were very basic and we discussed how to further develop these in order to audit the whole of the medicines service provided by the home. Some people chose to look after their own medicines and staff supported them to do this safely. One person commented Ive always looked after my own medicines and its good that the girls help me to keep doing this. On the first part of our visit the risk assessment regarding this did not reflect the support that staff needed to give in order for him to manage this safely. On our return the manager had consulted with the individual and between them had written a risk assessment and plan that met the persons needs and assisted the staff to maintain their safety. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routine in place in Havenlea do not always take into account peoples personal preference, needs or choices. Evidence: All people moving into the home have their nutritional needs looked at. There is no record of what their particular choices of food are. There are nutritional risk assessments but are not always reflected in the care plan as such staff are not always checking peoples weight properly People in the home are asked on admission about some of their preferences and choices, social activities are not always looked at. The information in the assessments is very brief and is not used to develop lifestyle choices for people living in the service. We discussed with the manager how this could be improved she told us that she will make sure that menus and activities are influenced by peoples preferences. When we observed staff during the mealtimes. These were not well organised. We watched a member of staff assist an individual to eat without any conversation. The person was not asked what they would like to eat nor was the food on the plate explained to them. Other people were asked what parts of the meal they would like such as potatoes. The menu did not show alternative diets such as a diabetic. Care Homes for Older People Page 15 of 28 Evidence: Assessments for the home showed that some of the people living in the home had special diets as part of their assessed needs. Staff spoken with told us that breakfast and supper is available. This information was not available in any format to people living in the home to meet their needs. The menus in the service do not show a choice of food and do not provide people living in the service with the opportunity to make a choice. The staff told us that they worked out the day before what to have the next day. As such people are then not offered an opportunity to influence the choices of meals available. The staff told us that they ask people what they would like to eat and record this on a wipe clean board. They do not keep records of what peoples choices are that would help them decide on future menus. On the day of the visit people living in the service told us I never know until they tell me and like most of the food, but depends on who is cooking. We looked at the activities available and the ways that staff supported people to have a routine of the choosing. We noticed that there was no particular activities programme available. People were observed to sit were they choose to during the day and arrangements had been made to support a person who chooses to smoke. There is a mini bus available that supports staff to take people out for the day. Records regarding peoples chooses were not in depth and the staff relied on people living in the service telling them what they wished to do. This means that those people unable to verbally express a preference were not offered the same opportunities as those who could tell staff. The manager discussed with us how she intended to expand the opportunities to find peoples personal preferences and choices. These included things such as setting up a vegetable garden, consulting more widely about menus, reviewing menu planning and looking at peoples skills and arrangements to increase and maintain skills. Care Homes for Older People Page 16 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. People living in the service and their families are supported to raise their concerns. Evidence: We looked at how the service investigated concerns. There is a copy of the complaints policy readily available to people living in the service. In discussion with people who live in the home, their relatives and staff all were confident that concerns if raised with the management would be addressed. We looked at the training that staff had received in understanding and reporting serious concerns know as safeguarding. Havenlea is supported to access training in this area and mental capacity by the local authority which supplies this training. We noticed that not all staff had received this training. Following our last visit the service reported a safeguarding concern to the Local authority. Information about this concern was not sent to us and there was no clear records available that told us how the service had addressed this concern. We spoke to staff working in the home the majority were aware of how to recognise serious concerns and what actions would be taken to maintain the safety of people working in the service. Care Homes for Older People Page 17 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. Havenlea is presented in a warm and welcoming manner. There remains areas of the building that need to be developed in order to fully met the needs of the people who live there. Evidence: We toured the service to look at the environment. There is a dining room which is large enough to accommodate everyone at mealtimes should they wish to eat in the dining room. There is a separate lounge which is well used by the people living in the service. A separate conservatory is also available at the front of the building. There are twenty two single rooms and four twin bedrooms. Three of the four twin rooms are used as single bedrooms. We looked at peoples bedrooms with their permission. The majority contained personal items that made the bedrooms very much the persons own space. People living in the service told us that they liked their bedrooms, a very nice room. We looked at bathrooms and found that some of these were damaged and stained. In particular the baths had chipped enamel and the bath hoists were stained. Following our visit the manager sent us information that the baths had been replaced and the bath hoists are to be replaced. We noticed that the toilet for staff did not have a working ventilation system. The washing and hand drying facilities were not suitable. Care Homes for Older People Page 18 of 28 Evidence: In one bathroom there was no facility to wash and dry hands. These presented a significant risk to infections being passed on. The manager told us that she was aware of the issues with the bathrooms and was waiting for these to be addressed by the owner. There was no firm date as to when these and other areas of refurbishment would be done. We were told by the manager that a number of areas are to be refurbished but that she has not been shown any plans for this. We looked at the garden area that the manager wishes to develop in order to supply a raised garden space for people who live in the service to use. One person told us how much they enjoyed gardening and that a raised garden would benefit them greatly. The back of the establishment has a wide veranda area we noticed that this was where staff smoked. The area was littered with numerous cigarette butts, broken furniture and an old fridge. We spoke with the manager about how staff should show more respect for the building as somebodys home and dispose of their cigarettes in a more respectful manner. The manager stated that staff had been asked several times to do this but this would be re-enforced with them in the future. An internal smoking area for people living in the service has been created. On the first day of our visit this was unsafe and did not follow recent legislation known as smoke free England. On the second day of our visit the manager had taken action to make sure that this met legislation and maintained the safety of people living in the home. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment has improved and staff are now checked that they are able to work with people living in the service. Staff training is not up to date and does not include training specific to the assessed needs of people that the service supports. Evidence: On the day of our visit we noticed that service had care staff, the manager a cook and a cleaner available for seventeen people. People living in the service told us that there is lots of staff and staff are really nice and kind, cant ask for anyone nicer. Staff told us that they thought that they had plenty of staff available and that they did not have to rush people living in the home. We looked at the staff files to see how staff were recruited. Of the staff files we looked at some had full checks in place. The manager said that many of the staff stay for so long that they were recruited under a previous manager. This was reflected the records which showed that the majority of the staff had worked in the service for several years. We looked at the recruitment of the most recent member of staff. We noticed that staff were now checked before they were able to start working in Havenlea. Gaps in the working history and issues with the police check had not been explored for existing staff. We discussed with the manager how to review the staff already recruited. We were told that some staff would have new police checks done in order to make sure that they were of good character to work in the home. Care Homes for Older People Page 20 of 28 Evidence: We asked to see the training of the staff are told that there was a matrix (a checklist to show training). We looked at the staff training and saw that not all staff had up to date training. At least one member of staff had not received training in safeguarding and evidence was not available that confirmed that all staff were up to date in moving and handling. We looked at training specific to the needs of people living in the service such as diabetes, we were told by staff that they had not received training in this area. The service has made arrangements to increase the training for staff in medications and some staff have also had assessments that they are competent to give out medications Care Homes for Older People Page 21 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. The manager had taken sufficient action in order to make sure that medications were managed safely. The quality monitoring arrangements in place are not sufficient for the manager to recognise and increase the quality of the service. Evidence: The manager is registered with the commission. People living in the service, staff and relatives expressed confidence in her a told us that they found her very supportive. There is a deputy in post who undertakes a number of activities. The deputy and manager communicate well with each other in order to provide a good supportive team. The manager told us that as the home is not part of a group she finds it occasionally difficult to keep up to date. A manager from another home in the area had been helping the service increase it quality in particular in relation to the medications. On our first day we found that some of the systems that they had put into place did not support the needs of the people living in the service. On our second day the manager had looked at these areas and decided that they did not increase the quality of the service and removed them. Care Homes for Older People Page 22 of 28 Evidence: The manager discussed with us how they manage peoples funds. They hold small amounts of money only. There are clear records in place regarding this. When the person has more funds the service feels comfortable to hold the funds are given to a relative to put in a bank account. There is no written permission with the individual or evidence that this is in accordance with their wishes. We looked at policies and procedures in the service as noted that these are all dated over three years ago. The manager told us that they were in the process of reviewing these policies in order to bring them up to date. The service does do audits on some areas to increase quality this includes medications. The audits for medications had not identified a number issues on the first day of our and were not effective in recognising and increasing quality. There was no written evidence that any other audits were in place. We looked at the accident records in the service there was no evidence that these had been regularly audited. As part of the quality role the home owner needs to make unannounced monthly visits to the service. We asked to see the records of these visits and two were available they did not detail that the provider had spoken with staff or people living in the service and had not been done monthly. There were no copies of surveys, which forms part of an on-going assessment of quality, made available to us that are sent to people living in the service from the home that helps them recognise and increase the quality of the service. The manager and her team had been concentrating on making the medications safe and increasing the quality of the care planning. On the first day of our visit there was a number of areas that had not been sufficiently managed to make sure that the service met the notice. On the last day of our visit the manager had reviewed the points we raised and had addressed the outstanding issues. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 35 A quality assurance system 26/02/2010 that regularly audits (checks) the service such as accidents, care plans, medications and environments as an example needs to be in place. Stakeholders views of the service need to be found out and used to determine what actions the service intends to take to increase the quality of its service. People who live in the home are safeguarded by a service that supports their individual needs, choices and preferences. 2 9 13 Effective medication audits must be put into place. To make sure medication is handled safely at all times by all staff. 01/12/2009 3 33 26 The owner of the service needs to make monthly unannounced visits that determine the views of people who live in the service, the staff and the environment. A written copy of this needs to be made available to the manager. This needs to be in place in 01/12/2009 Care Homes for Older People Page 24 of 28 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 order to recognise areas of quality and maintain a service that meets peoples needs. 4 33 37 All incidents determental to the care of people living in the service need to be reported to CQC. This is to provide clear information about the ability of the service to recognise and appropriately deal with improving the qulaity of the service. 27/11/2009 Care Homes for Older People Page 25 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 1 Information in the service including the statement of purpose and service users guide needs to be updated, include the necessary information detailed in schedule 1 of the Care Homes Regulations 2001. It also needs to be in formats that meet peoples assessed equality and diversity needs. All people living in the service need to have a care plan that informs staff how to meet individual needs. The plan needs to be reviewed and updated monthly and as peoples needs change. We possible the individual for whom the care plan is written needs to be consulted and agree to the support to be provided. The manager needs to review the arrangements for gaining the personal preferences, choices and needs of people living in the service. People need to have a daily living routine that meets their expressed preferences. This should include the meals provided and daily activities available. A programme of routine maintenance should be in place. The manager needs to check that the environment is maintained to a good standard. Arrangements need to be made to remove the rubbish from the garden, veranda and Page 26 of 28 2 7 3 12 4 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations at the side of the building. 5 30 All staffing files need to be reviewed and gaps in past recruitment reviewed. A risk assessment would identify any potential weaknesses such as missing references. Training for staff needs to reviewed and actions put into place to make sure that all staff have up to date mandatory training and up to date training in the assessed needs of people living in the service. Policies and procedures need to be reviewed and updated in order to give staff clear guidance. 6 30 7 33 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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. Re-publishing this information is in breach of the terms of use of that website. 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