Care Home: Hayes Cottage

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What the care home does well Prospective residents are fully assessed prior to admission to ensure the home is able to fully meet their needs. Care plans are in place and provide a fair picture of each resident. Residents receive input from healthcare professionals in a timely manner. Staff care for residents in a gentle, caring and professional manner, and the privacy and dignity of each resident is a high priority at the home. The wishes of residents and their families in respect of end of life care are ascertained and recorded, and the home provides an excellent standard of end of life care, with regular input from the Palliative Care Team. The home has an open visiting policy and visiting is encouraged. Information regarding advocacy services is available and the home is proactive in ensuring the right of each resident to independent representation is respected. The food provision is very good, offering variety and choice to meet the choices of the residents. The complaints procedure is available in the home and complaints are dealt with appropriately. Safeguarding Adults procedures are in place and are followed. The home is being well maintained, and any redecoration and refurbishment needs are addressed promptly. Procedures for infection control are in place and are followed, thus minimising risks. The home is appropriately staffed to meet the needs of the residents, and this is kept under ongoing review. There is a programme of training and the majority of care staff have attained NVQ level 2 or 3 in care. There is an induction programme in place for new staff and they are supported by a mentoring scheme to ensure the training is delivered and understood. Recruitment processes are robust and protect residents. The home is being effectively managed and the management style promotes an atmosphere of openness and good communication. There are clear systems in place for quality assurance and there is ongoing work in this area. Personal monies held on behalf of residents are being well managed and securely stored. Overall health & safety is being well managed at the home. Comments received included: Makes you welcome and comfortable. Hayes Cottage maintains a high standard of care for all clients. The home runs very well. I am happy to be working at Hayes Cottage. The home runs really well, all the staff are dedicated to their jobs. We have great team work. The quality of care is excellent and most residents and their families consider it to be brilliant. Overall it is an excellent service and it is difficult to find scope for improvement. What has improved since the last inspection? For residents on entral feeding regimes, there are clear records now in place. Risk assessments for the use of bedrails are now in place for all residents for whom they are used. Several improvements have been made in the area of medication management. What the care home could do better: Temperature issues were identified in the clinical rooms and action must be taken promptly to address this problem. Although staff receive a good induction training and are offered other training opportunities, health & safety training has not always been kept up to date, and this needs to be addressed. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hayes Cottage Grange Road Hayes Middlesex UB3 2RR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Henderson-Roe     Date: 3 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Hayes Cottage Grange Road Hayes Middlesex UB3 2RR 02085732052 02085735593 hacott@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : HAYES COTTAGE NURSING HOME Limited care home 52 Number of places (if applicable): Under 65 Over 65 52 old age, not falling within any other category Additional conditions: 0 The maximum number of the service users who can be accommodated is: 52 The registered provider may provide the following category of service only: Care home with nursing - Code N 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 Date of last inspection Brief description of the care home Hayes Cottage Nursing Home was previously the Hayes Cottage Hospital. The building has been developed and extended to its present condition. The home provides accommodation for 51 residents. One unit is designated to the provision of palliative care. There are 49 single rooms and 1 double room. There are several sitting areas to include a conservatory, plus a main dining room. The garden is well maintained and has chairs, tables and parasols for the use of residents and their visitors. The home is situated in a residential area of Hayes. It is well maintained and has a good atmosphere. The Beck Theatre is within walking distance from the home. There are shops and local amenities plus Hillingdon Hospital close to the home. There is a very Care Homes for Older People Page 4 of 29 Brief description of the care home homely atmosphere throughout and residents have the opportunity to take part in activities as part of the daily routine. 42 residents were accommodated at the home at the time of inspection. The home fees range from £619.80 to £875 per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 was an unannounced inspection carried out as part of the regulatory process. A total of 20 hours was spent on the inspection process, and was carried out by 2 Inspectors. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Residents, staff and visitors on each unit were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents, staff and health & social care professionals have also been used to inform this report. The home has a Registered Manager, who has been promoted to Director of Nursing & Quality, plus a new manager is in post and has applied for registration with CQC. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? For residents on entral feeding regimes, there are clear records now in place. Risk assessments for the use of bedrails are now in place for all residents for whom they are used. Several improvements have been made in the area of medication management. Care Homes for Older People Page 8 of 29 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are assessed prior to admission to ensure that the home can meet their needs. Evidence: The home has a pre-inspection assessment document that is comprehensive and provides a good picture of the resident and their needs. These are completed for all the general nursing residents, either by the home staff or, in some cases they are faxed to the hospital for completion and the home then reviews the documentation to ascertain if the home can meet the individuals needs. Copies of the social services assessment are also obtained where available. For residents being admitted for palliative care the referral and assessment is sent through directly from the palliative care team, who has already identified that the home is suitable to meet the residents needs. Care Homes for Older People Page 11 of 29 Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user plans are in place for each resident, providing staff with a picture of their needs. Healthcare needs are being met, thus helping residents to maintain optimum well-being. Medications are being well managed at the home, however temperature issues indicate that medications are not always being stored at a safe temperature, which could pose a risk to residents. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity, and recognising individuality. The end of life care provision at the home is excellent, with effective care and management from the multi-disciplinary team to ensure residents and their families receive the input, care and support they need. Evidence: We viewed a total of 5 service user plans in the home. Overall these had been well completed and provided a picture of each resident and their needs. There was evidence of input from residents and/or their representatives into the documentation. Care plans had been completed for each identified need, and the documentation had been reviewed monthly or whenever there had been a change in the residents Care Homes for Older People Page 13 of 29 Evidence: condition. Risk assessments for falls were in place and had been updated following any falls. It was noted that the care plan documentation currently in use is somewhat generic and not personalised to the individual. New service user plan documentation has been formulated by the Registered Manager and we viewed this and found it to be comprehensive and person centered so that the new documentation will be much better personalised to each individual. We were also informed that the new documentation will be implemented in August 2009 following staff training. We shall view this in detail at the next inspection. Assessments were in place for pressure sore risk, nutrition, continence and moving and handling, and where a problem had been identified a care plan had been completed. Where weight loss had been noted a referral via the GP to the dietician had been made and there was evidence of this being addressed promptly. At the time of inspection no residents had pressure sores, and pressure relieving equipment was seen in use throughout the home. Staff were seen carrying out moving and handling procedures correctly. Bedrail assessments and consents for their use were in place. For residents on entral feeding regimes a form had been devised to clearly record all details in respect of the feed given each day. There was evidence of input from healthcare professionals to include GP, dietician, speech and language therapist, occupational therapist, palliative care team, chiropodist and optician. Records are maintained of all healthcare professional visits. We viewed the medication management for the home. A list of registered nurse signatures and initials was available on each unit. A photograph of each resident together with allergy and other relevant information was available. The home uses a 28 day monitored dosage system (MDS) for the majority of the medications in use. We viewed the medication administration record (MAR) sheets and records of receipts had been recorded in most instances, and due to the fact that the new 28 day cycle had only begun on the first day of inspection, some omissions in receipts noted were corrected at the time of inspection. Where necessary, stock balances of medications that had been brought forward from the previous month and we carried out a stock check on some boxed medications and these were found to be correct. On the first day of inspection there was an issue with the recording of any disposal of single medications in the event of it being refused by a resident. Action was taken to address this by the second day of inspection. Correct lancing devices for blood glucose monitoring were in use in the home. Controlled drugs were being well managed and on the palliative care unit care is taken to ensure that appropriate medications to meet the changing needs of the residents are available. There was an issue identified with the room temperature in the medication rooms, which was regularly above 25 degrees centigrade. There is planned action to address this with the installation of air conditioning in both areas. The Registered Manager agreed to inform CQC when this Care Homes for Older People Page 14 of 29 Evidence: has been completed. The minimum and maximum temperatures for the medications fridge were being recorded, however the actual temperature was not, and new thermometers have been ordered. It was agreed that all staff carrying the temperature monitoring would be trained in the use of the new thermometers to ensure all the temperatures are being correctly recorded. Dates of opening had been recorded on liquid and boxed medications to include eye drops and creams. For medications with specific administration instructions, these had been clearly recorded on the MAR. Where a medication had been omitted the correct coding had been used to identify the reason for omission. For residents on warfarin therapy the most recent blood test results had been kept with the MAR and where the current dose was made up of more than one strength of tablet this had been clearly recorded. All registered nurses have an annual medication management assessment, which is very thorough and covers all aspects of medication practice. With the exception of temperature issues, medication are being well managed at the home. Staff were seen caring for residents in a gentle, friendly and professional manner, respecting their individuality, privacy and dignity. Residents spoken with expressed their satisfaction with the care they receive at the home and said that the staff were very good and looked after them well. There was excellent interaction between residents and staff, and staff clearly listen to the residents and have a good understanding of their roles and how they work to enhance the overall care provision at the home. Bedrooms are very personalised and residents are well dressed to reflect individuality. There was a very good atmosphere throughout the home and it was clear that staff go the extra mile to ensure everyone feels cared for and valued. The home has a specialist palliative care unit and receives referrals direct from the Primary Care Trust Palliative Care Team. We spoke with the palliative care consultant who said that the home provides exemplary care for the residents and their families, and is an excellent example of palliative care provision. Relatives spoken with and cards seen from relatives confirmed the excellent palliative care provision. The staffing on the unit is kept under constant review to meet the changing dependencies of the residents and to ensure that all residents have company in their final hours. The home has good input from the palliative care team and have received training from the Macmillan Nurse Team. There is a visitors room where relatives and loved ones can stay overnight. The home uses the Liverpool Care Pathway to plan and care effectively for residents in their last days and hours. All residents have an Advanced Care Plan document, which details their wishes in the event of health deterioration. Some of the information on one of the general nursing units needed to be expanded and this was discussed with the registered nurse, who said that this would be done in a sensitive manner. The home is to be commended on the excellent standard of the palliative care they provide. Care Homes for Older People Page 15 of 29 Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provision at the home is varied and provides something for all those who wish to participate, thus meeting the needs of each resident. The arrangements in place for the provision of advocacy services is robust, thus ensuring each residents right to independent representation is respected. The food provision at the home is of a good standard, offering variety and choice with menus to meet the residents preferences. Evidence: The home has a full time activities co-ordinator and there is a weekly activities plan in place. The activities co-ordinator explained that she visits all new residents to discuss their interests and find out what they would like to join in with. During the inspection there were several activities taking place and these included music and movement, quizzes and a visit from children from a local school who sang for the residents. The annual Fete was also being arranged and the residents are involved with the preparations. Residents were sitting out in the garden with sun hats and staff took care to apply sunscreen lotion also. Residents looked animated and stimulated and were clearly enjoying the weather and the activities going on. The home also arranges outings to include pub lunches, the theatre, the seaside and other places of interest. Care Homes for Older People Page 17 of 29 Evidence: Residents can choose whether or not to join in an activity and their choice is respected. The activities co-ordinator maintains a daily record for both group and individual activities. The current service user plans do not include much information regarding residents life history and interests, however the new documentation to be introduced does include a section for this topic. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are always made welcome at the home, and offered refreshments. Representatives are kept up to date with any issues that may arise. Residents can choose to receive visitors in their own rooms or in one of the communal areas, as they so wish. The home has information on display for advocacy services. Age Concern do not now routinely provide advocates, but can be contacted if a situation requiring advocacy services arose. The home also has someone in the role of Residents & Relatives Support Worker, and they will liaise with social services to provide any advocacy services that may be required. This person is also involved with supporting residents in all aspects of daily living. All residents had been assessed under the Deprivation of Liberties Safeguards and no issues had been identified. This is now done routinely as part of the pre-admission process. At the time of inspection the kitchen was being refurbished. An alternative room was in use as a temporary kitchen and menus had been reviewed in line with the current arrangements. Residents and relatives spoken with confirmed that they had been informed about the refurbishment and temporary changes in menu in advance of this happening. Choices were still available and it was clear that much thought had gone into ensuring that all meals continued to be served to a good standard. On the first day of inspection the residents had a barbecue for lunch, with alternatives available for those who did not want this or required a liquidised diet. Residents were enjoying their meal and it was a very social occasion. Drinks and snacks were available throughout the 24 hour period. The weather was very hot at the time of inspection and we noted that staff were being vigilant at ensuring residents were provided with drinks thoughout the day. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has clear complaints and safeguarding adults procedures in place, and these are followed, thus safeguarding residents. Evidence: The home has a complaints procedure and copies are contained within the Service User Guide and Statement of Purpose. There had been no complaints since the last inspection and the management operate an open door policy in order that any issues can be discussed and addressed without delay. The home has procedures in place for safeguarding adults and also follows the Hillingdon protocols. Staff spoken with confirmed that they had received training in this area and were very clear about reporting any concerns, to include Whistle Blowing procedures. The management explained that they had been contacted by the Hillingdon Safeguarding Adults Team to meet with them for updates in this area. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well maintained and provides a homely, clean and fresh environment for residents to live in. Infection control procedures are in place and adhered to, thus minimising the risk of infection. Evidence: We carried out a tour of the home and it was clear that it is being maintained to a good standard, with much thought being put into individualising bedrooms and creating a bright and homely atmosphere throughout. Redecoration and refurbishment plans are in place, to include a record of each room and area of the home with details of what has been done and dates of completion. In addition there is a repairs, renewals and maintenance plan for 2009/10 with clear budgets for each area of work and notes in respect of the ongoing day to day maintenance and repairs. The fire risk assessment had last been updated in January 2009 and there were no fire safety issues noted at the time of inspection. The home has clear infection control procedures in place and provides protective clothing to include gloves and aprons. The home was clean, bright and fresh throughout. Personal laundry is done in-house and linens are contracted out to a local laundry service. The laundry person keeps COSHH records up to date and ensures national infection control policies are adhered to. Care Homes for Older People Page 20 of 29 Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately staffed to meet the changing needs of the residents at all times. Staff receive the training and mentorship they need to provide them with the skills and knowledge to care for residents effectively. There are robust employment procedures in place and these are adhered to, thus protecting residents. Evidence: At the time of inspection the home was being staffed to meet the needs of the residents. We were informed that the Team Leader on the palliative care unit has the autonomy to increase the staffing levels in accordance with changes in resident dependency. We did not receive any comments in respect of the staffing, and staff were available to answer call bells without delay. There is a good skill mix of registered nurses and care staff on each unit. The home was clean and fresh and employs kitchen, domestic, maintenance and office staff in such numbers as to meet the overall needs of the home. The home also takes student nurses and social work students on clinical placement to provide them with the opportunity to enhance their learning and development in health and social care. The home has 28 permanent care staff and 25 have attained NVQ in care level 2 or 3, and it was clear from observing staff interaction with the residents that the staff have the skills and knowledge to care for the residents effectively and to a high standard. Care Homes for Older People Page 22 of 29 Evidence: The home has sourced funding for some of the care staff to undertake their nurse training and this shows the homes commitment to the career development of their staff. It was very clear that the staff work well as a team and value highly the wellbeing of the residents in their care. We viewed 3 sets of staff employment records and these contained the information required under Schedule 2 of the Care Homes Regulations 2001. It was noted that for a new member of staff a recent photograph was needed, and the Registered Manager said this would be addressed without delay. The home has an induction programme that incorporated the Skills for Care common induction standards. All new staff are appointed a mentor and co-mentor, to work alongside and provide new staff with the support and guidance they need to learn all aspects of their role. Staff spoken with confirmed that they had completed induction training and did receive training in topics relevant to the diagnoses and needs of the residents. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being effectively managed to promote good outcomes for the residents, staff and visitors. Quality assurance systems are in place and being further improved to ensure an ongoing process of audit and review, thus enhancing the quality throughout the home. There are robust procedures in place for the management of residents monies, and these are adhered to, thus protecting residents interests. Overall heath and safety is being well managed, providing a safe environment for residents, staff and visitors. Shortfalls in health & safety training should be easy to address. Evidence: The home has a Registered Manager who has been promoted to Director of Nursing & Quality to cover this home and also 2 other care provisions. A new Manager was appointed in April 2009 and she has applied for registration with CQC. The Registered Manager still works within the home and has been instrumental in developing the new care plan documentation to be introduced. The Manager is a first level registered nurse Care Homes for Older People Page 24 of 29 Evidence: who has experience working with the elderly and also working as part of a management team in a hospital environment for over 2 years. She also has undertaken several training courses relevant to the needs of the residents and to her role, and intends to complete an NVQ 4 equivalent qualification in management. The home has a system in place for quality assurance. Regulation 26 visits are carried out on behalf of the Registered Person and reports are available. Staff meetings are held regularly to include heads of department, clinical staff, senior nursing staff, nursing staff and care staff. For residents with complex care needs case conferences are held to discuss and plan future care management. Audits are carried out to include medications, care planning and the environment. Resident and relatives surveys had recently been carried out and the Registered Manager explained that the results were to be collated and published. The company has also set up a Quality Improvement Strategy Group who are taking the lead in the development and implementation of robust quality assurance systems. The home holds personal monies on behalf of residents and clear records of income and expenditure are maintained. Lists for chiropody and hairdressing identify each resident who has received each service, plus receipts are maintained for all other expenditure. Procedures are in place for the management of residents personal monies and are adhered to. We sampled maintenance and servicing records and those viewed were up to date. The fire risk assessment was last reviewed in January 2009 and risk assessments were in place for equipment and safe working practices. Fire drills are carried out at the required intervals and records are maintained. Kitchen records had been maintained to include fridge and freezer temperatures, and these were within safe range. We viewed the health and safety training matrix and it was evident that not all staff had undertaken all health & safety training in a timely manner on commencing work at the home, plus some updates appeared overdue. The Registered Manager said that this had already been identified and the training programme did confirm that training had been planned to address the shortfalls. Overall health & safety is being well managed at the home. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 There must be a clear record 14/07/2009 of minimum, maximum and actual fridge temperatures. This is to ensure medications that require refrigeration are stored at the required temperature. 2 9 13 The temperature in the clinical rooms must be maintained below 25 degrees centigrade. To ensure medications are being stored at a safe temperature. 14/07/2009 3 38 18 Training and updates in health & safety topics must be carried out in line with current legislation and good practice guidance. To keep staff kowledge up to date and ensure that residents are protected. 01/08/2009 Care Homes for Older People Page 27 of 29 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 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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