Care Home: Hays House

Similar services:

• Hunters Care Centre
• Manor Lodge
• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma

What the care home does well People maintain family contact and staff encourage family and friends to join in with activities and any outings. People receive a varied and wholesome diet that they are able to influence. There are policies and procedures in place to manage complaints and people should be confident that their concerns will be listened to and acted upon. The health and safety checks within the home will help protect the people who use this service. What has improved since the last inspection? The star rating for this inspection has changed from good to poor. What the care home could do better: Peoples` needs should be fully assessed and documented effectively prior to admission in order to determine the suitability of placement. Care plans should reflect the individuals` needs and how they will be met. People who live in the home and their families should be involved in this process wherever possible. Systems should be in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the care when required. Some staff require re educating in treating people with dignity and respect and in writing valued written accounts in an objective manner. Medication policies and procedures need to be reviewed to ensure that safe practices are adhered to in the receiving, administering and storing of medication. The arrangements for meeting the social and recreational needs of people who use the service must be further developed to include personal likes, dislikes and capacity. People are able to make minimal choices and have control over their lives. Some choices must be further explored by the staff team. There are some arrangements in place for staff awareness of protecting vulnerable people, however all staff must have relevant training, so that people living in the home are further protected from abuse. At present the home is clean and comfortable. The additional work outlined in the homes refurbishment and redecoration plan should provide a safe, peaceful and well maintained environment for everyone. In general the bedrooms, communal rooms and facilities are suitable to meet the needs of people living in the home, however by revising the use of some areas in the home with regards to storage and hairdressing will mean that peoples privacy and dignity will be further respected. The home needs to promote staffing levels, skill mix of staff and effective daily routines in order to help ensure that peoples individual needs can be met. The recruitment policies and procedures set up in the home need to be adhered to at all times so that people living in the home are supported and protected. The home needs to consistently encourage and support staff with training in order for them to develop their knowledge so that they have the required skills to meet the needs of the people in their care. In order to identify strengths and weaknesses the home should have effective systems in place to audit the services they deliver. Any provisions required to improve the services should be actioned immediately with clear audit trails of how these are met and constantly reviewed. Personal documentation about people living in the home is not kept in a secure place, so that people`s rights and best interests are safeguarded. The registered person must ensure that all staff receive regular supervision. This will help ensure that staff practice is supervised, and that staff receive appropriate training and feel supported. Key inspection report Care homes for older people Name: Address: Hays House Hays House Sedgehill Shaftesbury Dorset SP7 9JR     The quality rating for this care home is:   zero star poor 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: Wendy Kirby     Date: 2 6 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 42 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 42 Information about the care home Name of care home: Address: Hays House Hays House Sedgehill Shaftesbury Dorset SP7 9JR 01747830282 01747830005 hayshouse@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Park Healthcare Ltd Name of registered manager (if applicable) Mr Afta Chiles Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 43 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Hays House is an old country house, parts of which date back to the early Victorian era. The home is situated in eight acres of grounds and accommodation is provided over four floors. A new purpose-built wing was completed in the summer of 2002 and provides ground floor accommodation to the rear of the building. Care Homes for Older People Page 4 of 42 Over 65 43 0 Brief description of the care home The home is owned by Park Healthcare Limited and the responsible individual is Mr R Clarkson, who visits the home on a regular basis. The home is situated off the A350, between the villages of Sedgehill, East Knoyle and Semley. It is three miles north of Shaftesbury and eight miles south of Warminster. The nearest railway station is in Gillingham, Dorset. Care Homes for Older People Page 5 of 42 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: zero star poor 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 Key Inspection which included a visit to the home. The visit was completed by two inspectors and one pharmacy inspector over two days. Prior to the inspection we (The Commission) looked at various pieces of information to gather evidence in preparation for our visit, which included the following: The previous inspection report when the home was rated a 2 star, good service. The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. During our visit we spoke with some of the people who live in the home, visitors, the registered provider, the deputy manager and other staff members who were on duty. Care Homes for Older People Page 6 of 42 We also looked at how effectively staff engage with people in the home and how they were interacting and communicating with each other. We looked at ten individual care files, which included pre-admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day to day running and management of the home. We spent time in all communal areas of the home and most of the bedrooms. We sent surveys Have Your Say to people who live in the home and staff. Comments received form the surveys will be referred to throughout this report. We provided feedback to the registered provider and deputy manager at the end of our visit. Care Homes for Older People Page 7 of 42 What the care home does well: What has improved since the last inspection? What they could do better: Peoples needs should be fully assessed and documented effectively prior to admission in order to determine the suitability of placement. Care plans should reflect the individuals needs and how they will be met. People who live in the home and their families should be involved in this process wherever possible. Systems should be in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the care when required. Some staff require re educating in treating people with dignity and respect and in writing valued written accounts in an objective manner. Medication policies and procedures need to be reviewed to ensure that safe practices are adhered to in the receiving, administering and storing of medication. The arrangements for meeting the social and recreational needs of people who use the service must be further developed to include personal likes, dislikes and capacity. People are able to make minimal choices and have control over their lives. Some choices must be further explored by the staff team. There are some arrangements in place for staff awareness of protecting vulnerable people, however all staff must have relevant training, so that people living in the home are further protected from abuse. At present the home is clean and comfortable. The additional work outlined in the homes refurbishment and redecoration plan should provide a safe, peaceful and well maintained environment for everyone. In general the bedrooms, communal rooms and facilities are suitable to meet the needs of people living in the home, however by revising the use of some areas in the home with regards to storage and hairdressing will mean that peoples privacy and dignity will be further respected. Care Homes for Older People Page 8 of 42 The home needs to promote staffing levels, skill mix of staff and effective daily routines in order to help ensure that peoples individual needs can be met. The recruitment policies and procedures set up in the home need to be adhered to at all times so that people living in the home are supported and protected. The home needs to consistently encourage and support staff with training in order for them to develop their knowledge so that they have the required skills to meet the needs of the people in their care. In order to identify strengths and weaknesses the home should have effective systems in place to audit the services they deliver. Any provisions required to improve the services should be actioned immediately with clear audit trails of how these are met and constantly reviewed. Personal documentation about people living in the home is not kept in a secure place, so that peoples rights and best interests are safeguarded. The registered person must ensure that all staff receive regular supervision. This will help ensure that staff practice is supervised, and that staff receive appropriate training and feel supported. 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 42 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 42 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are not assessed or documented effectively prior to admission in order to determine the suitability of placement. Evidence: At the previous inspection in 2008, the judgement in this outcome was rated as good. A recent in house audit tells us that in some cases pre admission assessments had not been conducted. It also told us that where assessments had been done they had not been recorded. We did see some evidence of pre admission assessments in place but it looked as if they had recently been written for people that had lived in the home for some time. There was no continuity in the type of format being used and we could see that the home had experimented with various types of pre admission assessments without actually choosing one that they felt was effective. Where possible the home had obtained comprehensive assessments and care plans from other health and social care Care Homes for Older People Page 11 of 42 Evidence: professionals involved, for example, social workers and hospital staff. The newly appointed deputy clearly demonstrated the importance of thorough pre admission assessments in order to ensure that the home can meet individual needs. We also discussed the importance of ensuring that if the home admits people with high dependency needs then staffing levels need to be reviewed in order to meet those needs effectively. Pre admission assessment formats need to be comprehensive covering all activities of daily living, a full health screen and personal history background. The information gathered pre-admission should provide a sound benchmark of the persons ability, state of health prior to admission and subsequent needs when they move into the home. The format needs to include sections that relate to The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The deputy told us that in the future people wishing to live in the home, family and carers will be involved in the pre admission assessment wherever possible and all the information will be used to determine the suitability of the placement. Later in the report evidence will show that the dependency levels of the majority of people living in the home are very high. These people need support with personal care, continence management, eating and drinking and assistance with mobility and transfers at varying levels. The dependency levels in most cases are where people living in the home have deteriorated. However poor pre admission assessments may have had some impact on why dependency levels are so high and subsequently the home has failed to recognise that the staffing levels and daily routines currently in place do not meet the needs of the people effectively and that peoples care is compromised. Care Homes for Older People Page 12 of 42 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care of people living in the home could be compromised because the care documentation does not reflect peoples needs and how they wish to be cared for. People are not always protected by the homes policies and procedures when dealing with medication. Although we saw some good practice, all staff would benefit from a training update in promoting peoples dignity and respect. Evidence: From the pre admission assessments the staff should be able to develop a set of basic care plans based on identified needs. During the first months trial period the plans should be reviewed regularly and developed accordingly to ensure person centered care. Care plans should be completed with regards to health and social needs including, psychological, emotional, and cultural needs in order to demonstrate that the home takes an holistic approach to the provision of care. Care Homes for Older People Page 13 of 42 Evidence: We looked at ten care files on the first day of the inspection. As mentioned previously in the report the formats used varied from person to person and each file varied in quality, dependent on the person who had completed it. Not all plans were well written and there was limited or no information at all to tell us what care people required, including personal preferences and likes and dislikes. We did not know if the care that people were receiving was person centered and that specific requests and routines of the people living in the home were being respected and actioned. This is very poor practice and does not demonstrate that people are involved in deciding how they wish to receive care and how they want to live their lives in the home. The home was unable to clearly demonstrate that there was consistency in assessing, planning and evaluating care as required. The homes recent audit also supports our findings. We spoke with a visiting social care professional who was conducting reviews for two people living in the home, she told us that she could not make any sense of the care files or the information contained in them. Although the care documentation was poor we did speak to and observe people living in the home. People told us that they were happy and cared for, people looked comfortable and relaxed. In most cases people we saw were dressed carefully, hair was combed, people had been shaved, spectacles, hearing aids and dentures were in place. We saw some evidence that health care needs are monitored and documented in peoples care files. Nutritional assessments are completed but not always reviewed, some people are weighed as part of this review. In addition to this care plans need to be written for people who are nutritionally at risk and how this will be managed, we saw evidence that this is not being done. We saw in some cases, specialist health care support had been sought and referrals made to community dieticians and the speech and language therapists. Monthly written reviews of the care files are not being conducted. Regular care reviews should take place with the people living in the home, which should include family members and key workers whenever possible. This would allow the opportunity to discuss and evaluate care and any issues or concerns people might have. The content in the care files was sparse and the quality of this professional document was very poor. The files were disorganised and the information was out of date. On both days of the inspection all the care files and personal information about people living in the home were unlocked and available for anyone who uses or visits the Care Homes for Older People Page 14 of 42 Evidence: service to see. We also found two care files in the corner of a lounge on the floor. This again reflects on a lack of privacy and dignity for people living in the home. We spoke with the deputy manager and registered provider about their proposals to find an effective new format for care documentation. We discussed with them the importance of incorporating within daily life and within records the wishes and choices of people who live in the home. This should include peoples rights to make decisions in line with MCA legislation. The care plans should contain clear information about how decisions have been reached and who was involved in the process. We would expect to see that Capacity Assessments have been completed and when there is evidence that people lack capacity, records should ensure difficult decisions record that Best Interests have been fully considered, including the potential outcomes for the individual involved. We spoke with staff during our visit and asked questions about sharing information, being kept up to date and understanding peoples needs. It appears that the handover sessions prior to starting a shift were useful and valued by staff, some staff told us that they were not encouraged to access information from the individual care files and were not supported to be involved in writing and contributing in the care documentation. We gathered evidence from people living in the home, relatives and staff with regards to people receiving the care and support they need. The response was both negative and positive dependent on individual experiences. Comments included, My relative receives adequate care but not enough individual care for them to be truly happy, We feel that over the last few months the standard of care has gone down, They give excellent care, We have to take short cuts in personal care sometimes because we havent got enough time, I always give all the care I need to, even if it means that people are not washed and dressed until after dinner and The needs, well being and comfort always come first. We spent time with a gentleman who was visiting their relative at the home, who told us that their family member had lived at the home for over a year. They told us that they visited their relative each day and that they had settled well at the home. They told us that staff support all aspects of care and know the needs of their relative. They believed that their relative was well cared for. Comments included, My relative has been at the home for sometime, I am happy with the care, my relative is safe and the staff are very kind. Our Pharmacist inspector inspected all areas of medicine handling in the home. We Care Homes for Older People Page 15 of 42 Evidence: looked at records and storage, observed practice and talked to nursing staff and people in the home. We saw nurses give medicines to people following a good practice procedure. They were caring and considerate to people who had medicines and spent time with them or went back later if they were not ready. Medicine administration records were signed at the time of administration and gave an accurate record of the medicines people had received. However we did find short falls in the overall management of medicines. Since the last inspection the home had produced self medication risk assessments for people who want to manage their own medicines, but there was no lockable storage available to them in their rooms for either their medicines or valuables. Care plans for the use of medicines prescribed as required or information about how people chose to receive their medicines were not available in the medicine administration records (MAR). This would be particularly useful to nurses who are not familiar with the people in the home. We have received various notifications from the home about repeated medicine errors when agency trained nurses have worked in the hone. One person told us how he had been woken in the night to be given tablets that he did not always require. The MAR charts did not always contain sufficiently detailed information, particularly with regard to the use of creams or eye drops, for example which eye the drops were to be used for or the area the cream was to be applied to. The charts were not being used consistently to record the use of creams and external preparations and no other charts were available, which meant that there was no record of whether people had received their prescribed treatments. Nutritional supplements were signed on the MAR charts as given during the medicine round. We spoke to one person who had been given a supplement that was signed as taken, but they had not actually taken it yet and usually drank it in the afternoon. Another person had a supplement signed for but it was not clear whether they had drunk it that day and whether they always had it exactly as prescribed. Oxygen is stored and used in the home. There were no official hazard signs to show where the oxygen was in the home and no risk assessments for the use and storage of the oxygen cylinders. Storage of medicines was secure except for the controlled drugs cupboard which does not meet current legislation. At least five medicine trolleys are secured and stored in Care Homes for Older People Page 16 of 42 Evidence: hallways and landings. This does compromise the space in these areas, which are regularly used for all staff when using hoists and wheelchairs. There is plenty of unused space in the home and we were told that alternative storage is being looked at. The medicine fridge was consistently reading below the accepted level of 2-C, which could damage some medicines. Staff had recorded these temperatures but had failed to take any appropriate action. The current stocks of homely remedies included one medicine that was out of date and one that had been previously prescribed to a person in the home. Recently the home has started to do monthly medication audits which has helped to see where practice needs to improve, particularly with regards to medication update training for staff. Although the home promotes privacy and dignity, evidence throughout this report supports that this is compromised by some of the poor practices in the home. When we were looking around the home we were shown some bathrooms, one bathroom contained a parker bath. Staff told us that people living in the home do not like getting in this type of bath, whereby people initially sit in the bath and then the bath tips back. This bathroom was very stark and uninviting, walls were bare and no soft furnishings were in place in order to make this area appear more homely and relaxing. We saw bath rotas on display in the bathrooms. The rotas inform everyone who would be having a bath, who they would be assisted by and when. This information is private and does not demonstrate an understanding of individual choice or treating people with dignity. People we spoke with confirmed the total lack of respect and pleasure that bathing should promote. Comments included, I just go when they come and get me, I never know when it will be and it is not when I would always like to have a bath, and I fit in with the staff, they are always so busy. Staff attend training on induction, which covers aspects such as closing doors and pulling curtains when delivering personal care and knocking on doors and waiting for an invitation to enter before going in to their bedrooms. We saw staff knocking on peoples doors before entering, members of staff spoke respectfully about individuals needs and referred to them in the term of address that they preferred, but this information is not aways recorded in the care files. Care Homes for Older People Page 17 of 42 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 arrangements for meeting the social and recreational needs of people who use the service must be further developed to include personal likes, dislikes and capacity. People are able to make minimal choices and have control over their lives. Some choices must be further explored by the staff team. The home provides meals, which are balanced and meet the dietary needs of people in the home, however, further work is needed to ensure that the nutritional needs of those who require additional support are met. Routines and staffing levels need to be reviewed so that mealtimes are congenial for people and that mealtimes are not hurried. Evidence: One area of the home is a designated reminiscence area, based in the 1940s and has artefacts from the Second World War, including ration books, a flat iron, puzzles and other memorabilia. It was clear that a lot of effort had gone into this area although some people living in the home have been upset by the area as it brought back distressing memories for them. Care Homes for Older People Page 18 of 42 Evidence: It is important that staff have an understanding of the emotional needs of individuals who live at the home and the care planning processes are an essential tool for this. The care planning process provides an opportunity for staff to find out about peoples backgrounds and to also discover information about important and significant events in their life. This further underpins our view that the current care plans in place are not person centered with little evidence of involvement or communication with individuals. The home has two activities coordinators, one full and one part time, both were seen by us during our time at the home. On the first day of our visit one was decorating the dining area with red and white balloons and bunting to celebrate St Georges day. Flags were on the dining table and festive cakes were provided for tea. We were informed that themed days within the home are a regular occurrence to celebrate Saints days. On the second day of our visit the activity coordinator was taken from their normal duties in order to escort a person living in the home to hospital. They were away from the home for a number of hours, taking valuable time away from activities for all the people remaining in the home. This deployment of staff is understandable in emergency situations but should not be relied upon as this has an impact on the activities and social interaction for people. We asked three staff about how people spend their leisure time at the home and they all confirmed to us that group activities within the main lounge are well attended, frequent and are varied. Examples that were given to us by staff, were confirmed within individuals records of activities that had been completed. These showed us that people, who are able to, are involved with activities such as flower arranging, cake making, craft work, including making cards and festive decorations and collages. People also told us of entertainers who visit and perform and that on Tuesday a bird sanctuary were bringing birds of prey who would provide a display. We were also informed of forthcoming arranged trips to the local garden centre and of the plans in place for a forthcoming garden party at the home. One person told us I love it when we go on trips out and I am hoping for plenty more with the warmer weather approaching. Staff also told us that they were proud of the activities for groups of people within the house and trips out of the home for those who are able. Staff told us that they were mindful that the people who were in their rooms did not have access to the same Care Homes for Older People Page 19 of 42 Evidence: events, interaction and support in these areas. We spoke to a relative who told us that as that their relative spent all day in their room and that activities were Not applicable to them. When we explained the potential benefits of one to one support, for example, talking with people, reading to them, hand massage and spending time getting to know someone, they agreed that their relative would benefit and may not feel so isolated. It is strongly recommended that support for people who are not able to participate in group activities should be reviewed. Support in this area should be based upon the wishes, likes and choices as well as abilities of the individual and assumptions should not be made that they are unable to be involved. Some information about daily activities are recorded and maintained in a separate folder to peoples care files. We saw within these records that information had been recorded in order to provide a life synopsis, a record of peoples hobbies and interests as well as their physical capabilities. Information about peoples likes, dislikes, aspirations and how these could be explored with people in order that they were involved with activities of their choice is very limited. The home operates an open door policy for visitors and people are able to see visitors in the privacy of their own rooms and there are several semi private seating areas around the home and in the gardens. We spoke with people who live at the home and they confirmed to us that the home supports them to maintain contact with friends and family and the local community. One person spoken with said, My daughter visits when she can and my family come to see me regularly and are always made welcome by the staff. A relative we spoke with said that the staff were always helpful and kind, cheerful and polite. The size and layout of the dining room makes it possible for everyone to enjoy the social advantages of dining together. The dining room is light and spacious with good quality dining furniture. Staff members supported people that required assistance with eating their meals in a respectful sensitive manner. Staff sat at the same level and assisted them without rushing. Only ten out of thirty people used the dining room for lunch. Staff told us that this was because some people were on best rest all day and that remaining people chose to have meals in their rooms. Care Homes for Older People Page 20 of 42 Evidence: Lunch time was late, the cook told us that lunch had been ready since 1pm, yet people were still waiting for lunch at 1.20pm, one person was banging their knife and fork on the table to indicate that they wanted their food. Care staff told us that lunch was late because they were late finishing giving personal care. There was some sort of allocation with regards to staff assisting with lunch in the dining room or taking meals to people in their rooms. The geography and the large expanse of the home means that staff spend a lot of time carrying meals to people and can detract time away from assisting and supporting people. We also saw that to save time staff were taking the main course and the pudding on the same tray at the same time. This is very poor practice and means that peoples puddings are cold by the time they get round to eating them. We observed some lunches served in peoples rooms. We saw two people eating lunch together, they both said that the food is alright but not special. At least seven soft diets seen were being given to people by carers, the tray was taken to the person with the main and dessert served together, the person was fed, the tray was brought back and the next one taken. Carers spent very little time with each person and there was little personal interaction. The routines and possible deployment of additional staff at meal times needs to be reviewed in order to ensure that people receive meals in a timely manner and are supported and assisted as required. We saw jugs of juices, beakers and glasses and these were being handed to people whilst waiting for lunch. Later when we visited people in their rooms we saw that jugs of fluid had also been provided for individual use. Fluid and nutritional intake and output charts were in place for people who needed to be monitored. The entries were fairly good and trained staff told us that they were auditing charts at the end of each shift and giving feedback to staff about any shortfalls. Relatives have told us that glasses and water are not always available in peoples rooms. Squashes, cordials and fizzy drinks that relatives have provided are left untouched for weeks where staff have not opened them for people and encouraged or supported people to drink them. Time was spent with a cook and an assistant cook, they were able to demonstrate a good understanding of the dietary needs of people living at the home. Both cooks discussed with us the menus within the home, this is a six week menu that reflects seasonal trends and availability of produce. The menus were varied and alternatives Care Homes for Older People Page 21 of 42 Evidence: are provided if people want something else. Meals incorporated fresh fruit and vegetables which are delivered to the home each day. The cook stated that she goes around seeing people weekly in order to talk to them about their likes and dislikes and to talk with them about what was on the menu and take orders including alternatives if necessary. One person we spoke with stated that they like the food and would ask for something else if they were not happy with the meal provided. Another person stated that they like the food and that they had plenty of choice. Both of the catering staff we spoke with had been employed at the home for a number of years, one cook had attended various training courses including Advanced Food Hygiene, Manual Handling and Fire safety. Both told us that they were looking forward to commencing a National Vocational Qualification (NVQ)level 2 in Catering. We will review progress in this area when we next visit the home. In March 2010 the home was awarded a four star in food and hygiene by Wiltshire County Council Environmental Health department, we saw the report for this and saw that the report recommended that the cupboard shelves underneath the sinks required repair in order to make cleaning easier. When we were in the kitchen we saw that this work had been completed. When we asked the cooks what did they feel they did well, they said that, We provide good meals, people enjoy the food and its nice spending time finding about their likes and dislikes. When we asked them what they felt the home could do better they said Communication, we used to have regular staff meetings and supervision but its all a bit sketchy now. Care Homes for Older People Page 22 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place to manage complaints and people can be confident that their concerns will be listened to and acted upon. There are arrangements in place for staff training and awareness of protecting vulnerable adults so that people living in the home are further protected from abuse. However some of the staff would benefit from an update in the training. Evidence: A review of the complaints book at the home showed that seven formal complaints have been made since the last inspection. Records show that the complaints were satisfactorily investigated and resolved by the acting manager in post at the time and appropriate action had been taken. Over the past six months we have received several anonymous complaints from staff. As much as people may wish to remain anonymous when raising concerns it can compromise the effectiveness of any investigation. Potentially there could have been more positive outcomes if staff had approached the management directly. We were told by the deputy manager and the registered provider that there is an open door policy for all people who use the service. They are committed to encourage an open culture within the home so that people feel comfortable and able to make a complaint or a suggestion without fear of reprisals. People can discuss any concerns or Care Homes for Older People Page 23 of 42 Evidence: issues with the management before they potentially escalate into complaints. There is evidence to support that some staff have embraced this approach and communicate with management when required. We are mindful that several recent changes in management have had an effect on communication and that the lack of continuity has affected trust and confidence among staff. We also have written evidence that the home has conducted various meetings with different departments of staff. Effective communication and regular updates with staff is paramount in order to relieve anxieties and frustrations that staff may have. Four out of six surveys told us that people knew how to make a formal complaint. One relative told us that they had no complaints to make about the service provided and that although they did not know who the current manager was, they would would ask to speak with someone in charge if they had any concerns. During this visit we saw that staff were friendly, polite and caring in their approach. They were seen to be supportive. We saw them listening to people and answering questions, providing reassurance and information as requested. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and the understanding of their role in protecting vulnerable adults who live at the home. We were told that the home actively promotes staff training and education in the protection of vulnerable adults on induction and on an annual basis. We spoke with staff who confirmed that they had received this training in the past, however some staff would benefit from an update. A number of staff have either completed or are enrolled on the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Care Homes for Older People Page 24 of 42 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. At present the home is clean and comfortable. The additional work outlined in the homes refurbishment and redecoration plan should provide a safe, peaceful and well maintained environment for everyone. In general the bedrooms, communal rooms and facilities are suitable to meet the needs of people living in the home, however by revising the use of some areas in the home with regards to storage and hairdressing will mean that peoples privacy and dignity will be further respected. Evidence: Hays House is a large detached house built in the 19th century, which is approached up a long tree lined drive and provides parking for several cars. The house is surrounded by its own extensive gardens and adjoining fields, affording people in the home countryside views and plenty of wildlife. The home retains many original features lending character and homeliness, including ornate fireplaces, cornices and ceiling roses. People were sitting in these rooms throughout and the day, resting peacefully reading newspapers, and talking among friends. There are areas in the home that look tired, worn and are in need of refurbishment Care Homes for Older People Page 25 of 42 Evidence: and redecoration, including, some communal rooms, bedrooms, windows, stairways, landings and hallways. Some of the carpets were poor and rucked up, causing a potential tripping hazard. Attention must be given to these areas. Peoples communal space is compromised with clutter such as hoists, battery chargers, wheelchairs and hoists. In one lounge we saw that hoist slings were hung up on the wall, this is a potential risk for cross infection. The rooms are for the use of people living in the home and should not be used as storage areas for equipment. The deputy manager told us that they were currently looking at more effective ways of storage. Some people had been supported to personalise their bedrooms and they looked homely and pleasant to stay in. Some bedrooms were bare, stark and institutionlised. The standard of some of the bedroom furniture and soft furnishings were poor. As we mentioned previously in the report people are not provided with a lockable facility to keep their personal possessions secure. We also noted that there were a lot of instructional notices to staff on prominent display, these notices, if required should be in the staff room on a notice board, not in the areas that people who live in the home use. We also saw notices in the toilets and bathrooms asking staff not to empty commode plans in these areas. The sluicing facilities in the home are not suitable and need to be reviewed. There is a potential risk of cross infection because staff are having to carry used commode pans through the house in order to use the sluice facilities available. There have been concerns about emergency call bells, there have been problems with one area of the home where staff were unable to be alerted when calls were made. We saw a quote for work to be undertaken to address this, the registered provider confirmed to us that this had been dealt with. No concerns were noted by us during this visit, call bells were responded to promptly by staff. Specialist equipment has been obtained for individuals following identified need which included mobility, sensory aids, continence aids and equipment to assist with manual handling. We did note that there are a number of people who are frail and spend a great deal of time in their beds. We saw that bed rails were in place and information about this equipment use is briefly noted within some care plans, however there were no risk assessments for the use of this equipment and consent for equipments use was not in place. The home must ensure that a risk assessment is completed in order to ensure that the Care Homes for Older People Page 26 of 42 Evidence: equipment is safe for use and appropriate, furthermore wherever possible, consent for the use of this equipment should be obtained and recorded to evidence that it is for safety measures rather that being used as a form of restraint. At present there are no facilities for the hairdresser who is having to cut and set peoples hair in lounge areas, which means that individuals privacy and dignity is compromised for both the people having their hair done and the people using the lounges for their stated purpose. The deputy manager and registered provider are currently compiling an improvement plan for the environment with regards to the above issues. Care Homes for Older People Page 27 of 42 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not promote staffing levels, skill mix of staff or effective daily routines in order to help ensure that peoples individual needs can be met. The recruitment policies and procedures set up in the home need to be adhered to at all times so that people living in the home are supported and protected. When appropriate training has been provided to staff it will help ensure that staff have the skills, knowledge and resources to meet peoples needs. Evidence: Having had previous management experience in care homes the deputy manager told us that he understood that staffing levels should be indicative of the needs and levels of care required and confirmed that levels of staff should increase when dependency levels increase. Evidence tells us that at times care is compromised and that people may not receive care how they want to. Many staff felt that they rushed when delivering personal care and that they had to cut corners in order to get all the work done. Other staff felt that it was better to take your time and not rush people but this meant that some were often offered lunch having only just got out of bed. Care Homes for Older People Page 28 of 42 Evidence: The care files did not contain enough information for us to determine the levels of dependency in the hone, however staff were able to confirm that levels were relatively high and that most people living in the home, needed help with washing and dressing, managing continence, mobility and help, supervision or prompting to eat their meals. We were unable to ascertain if staffing levels were adequate because some of the shortfalls in care relate to the size and geography of the home and the ineffectiveness of daily routines. We were also told that some of the problems were related to lack of direction from the RGNs on the floor and that organisation of the workload and allocation needed to be reviewed. The deputy and registered manager agreed that the dependency levels need to be assessed for everyone living in the home, people must receive care in a timely manner and the choice of how they wish to receive care must be documented and respected. Daily routines also need to be observed and reviewed. If these provisions indicate that there are not enough staff on duty, then levels must increase. We do know that due to the recent frailty of a management presence in the home, at least seventeen staff have left the home. This has compromised existing permanent staff in the home and although agency has been used, continuity of care has been compromised. We know that the home has commenced a large recruitment campaign to address this. It is paramount that the home is vigilant in taking their time in this process so that they can find the right person for the job where they have the right skills and attitude to look after and care for people. Recruitment of suitable staff will help ensure that staff are able to fulfill the roles and responsibilities expected of them. We asked people in our surveys, Are staff available when you need them?. One person said, Always, four replied, Sometimes and one replied, Never. Comments included, They need more staff to give more time for individual attention, they could assist people who are able to walk to the toilet, but I see them use a wheelchair because it is quicker, I feel that good caring staff are under pressure, Sometimes it appears that there are too few staff on duty and They need to get enough staff to meet the residents demands. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, references, protection of vulnerable adults checks and satisfactory Criminal Record Bureau disclosures. On one recent occasion we felt that procedures had been compromised and that one Care Homes for Older People Page 29 of 42 Evidence: new recruit was employed before satisfactory references and proof of suitability in experience and competency had not been sought. Within four days of being employed the person was dismissed, however people living at the home and staff were potentially put at risk due to the poor recruitment procedure for this one particular individual. We spoke with staff about training and also reviewed staff files and the training matrix. The matrix had fifty staff and the majority had not received annual mandatory training for example protection of vulnerable adults, first aid and basic food hygiene. According to the homes matrix thirty three staff had not completed safeguarding of vulnerable adults training and only eight staff had completed basic food hygiene including kitchen staff. In respect of specialist training we would expect that staff are provided with training in order to support people living at the home with more complex needs and conditions. When we reviewed the training matrix we saw that only seven staff have completed dementia awareness training and out of those, four staff completed the training in 2008. No staff have completed training about the DoLS or MCA legislation. According to their records only one staff member has received training about diabetes or pressure area care. Some training had recently taken place, twenty nine staff completed Dignity in care training in February 2010 and a further three training dates are planned. Fourteen staff have completed training in palliative care. It is recommended that a full audit of the training requirements of staff is completed and any shortfalls, in both mandatory and specialist training, should be prioritised and addressed. Despite the upheaval to staff with regards to several changes in management, a core group of permanent staff were very committed to people living in the home and each other. They were very receptive to our visit, respectful of the inspection process and happy to share their feelings with us. We received some positive comments about staff including, The attention people get from staff is good, The quality of care at night is very good, My relative talks about the girls with affection and enjoys a good banter, The staff are always friendly and welcoming and The carers are marvelous. Care Homes for Older People Page 30 of 42 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although we have identified serious concerns detailed throughout this report we are satisfied peoples needs and best interests are central to the current management approach in the home. The home needs to improve its quality assurance by introducing continuous monitoring of polices, procedures and practices in order to ensure that the home is run in the best interests of the people who use the service. The health and safety checks within the home will help protect the people who use this service Evidence: The home has had various management changes over the past six months, which has had an impact on the quality of services provided to people living in the home. The home does not currently have a registered manager in post. A newly appointed manager will be commencing at Hays House by the end of May. He has previous Care Homes for Older People Page 31 of 42 Evidence: experience in managing care homes and in the interim has been liaising and meeting with the recently appointed deputy manager and registered provider. During our inspection we were satisfied that there was a very open management response to inspection and the development of the service. The registered provider and the recently appointed deputy manager are aware of the areas of deficit within the service and have identified short, medium and long term priorities in order to improve the quality of service. These include revised care planning processes and documentation, a review of duties, daily routines and responsibilities of staff and staff training and supervision. There needs to be clear lines of accountability within the home and that everyone takes responsibility in fulfilling their duties as described in their job description. Despite the outcome of this inspection, we believe that the existing staff compliment are a stable team that are committed to providing quality of care for the benefit of the people in their care. Comments received from people who live at the home during our visit were, I am at home here, Staff are always busy, but are always kindness itself. Comments from relatives of people who live at the home were, My relative is well looked after, I have no complaints at this time, the home has been through a lot of managers during the past few months, hopefully now a new manager is in post things will be more settled. Staff told us that supervision was not regular and that there have been a number of changes in working practices in the home due to differing management approaches. When we spoke to the registered provider about staff supervision we were informed that a process for this had been implemented, however the evidence for this was not available to us because the file had gone missing. We reviewed staff files and the only evidence we found that formal, recorded, supervision had taken place, had occurred a number of years ago. The home must ensure that staff receive supervision at the required frequency in order to ensure they are fully aware of their roles and responsibilities, that they feel supported and so that they are given the support and training they need to fulfill their duties. The deputy manager is aware of the importance of clear direction and communication in order to ensure quality of services provided and continuity of care. We were told that reviewing staff roles, staff supervision and training was a priority for the home and action would be taken to address any shortfalls. Regular audits of policies, procedures and practices in the home would help ensure Care Homes for Older People Page 32 of 42 Evidence: that there are effective and valued systems in place. Such reviews should include, care documentation, medication and training. Another way of continuous self monitoring of the services and quality provided by the home are through Regulation 26 visits. A responsible individual appointed by the registered provider should conduct the visits monthly, which must be unannounced. They should include looking at such things like care documentation, procedures and practices in the home and talking to staff and people living in the home. By following this legal requirement they would then be able to make judgements of the care and services provided and address any evident concerns and issues such as those that have been identified at this inspection. We saw that information is now recorded to demonstrate that accidents and incidents, which affect the wellbeing of individuals who live at the home are risk managed appropriately. Accident reports are fully completed and the home identifies how risks can be reduced and strategies have been implemented to reduce the likelihood of these occurring. Furthermore incidents and accidents have been consistently reported to us. We saw that incidents had been dealt with appropriately and action taken to support those who live at the home. We viewed the fire logbook for the home. The home was completing the appropriate checks on the fire equipment and the recording of fire drills and the testing of equipment were satisfactory. We saw the fire panel in working order. We saw that there were a number of staff that had not received fire safety training and this was discussed with the deputy manager. We saw that thirty five staff have completed the training and further fire safety training has been arranged for April and May 2010. It is essential that this training in undertaken by all, at the required intervals in order to ensure that staff are fully aware of their role and responsibility in this area. We saw that the home had a comprehensive household risk assessment in place. This assessment identified the hazards and who might be at harm and how. The assessments need to record what the home is already doing, what further action is necessary, what action is being taken and by whom. We noted that this assessment had been completed in January 2010 and a number of hazards were recorded. The registered person must review this risk assessment to ensure that all appropriate measures have been taken to ensure that the environment in which people live and work is safe. The homes records showed all necessary service contracts were up to date including, gas and electrical services and passenger lifts. Care Homes for Older People Page 33 of 42 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 34 of 42 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 3 14 People must not move into 24/05/2010 the home without having a full needs assessment. This will help ensure that the home can fully meet the identified needs of people wishing to move into the home. The Registered Person must 19/07/2010 ensure that there are written person centered care plans that details how each need is going to be met and must ensure that these are kept under review. This will help ensure that people are receiving care in a way that they prefer and that their needs are current. The Registered Person must 19/07/2010 make suitable arrangements to ensure accurate records are kept of peoples conditions, their healthcare and nutritional care. Page 35 of 42 2 7 15 3 8 17 Care Homes for Older People 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 This is so that an accurate audit trail of someones care can be demonstrated and inspected by other healthcare professionals if required. This is also necessary so that qualified nurses meet their responsibilities under the Nursing and Midwifery Council Code. 4 9 13 All controlled drugs must be stored in a cupboard that meets the standard set out in the Misuse of Drugs and Misuse of Drugs Safe Custody Regulations. This will ensure that the home meets current legislation and all medicines are stored securely. 17/06/2010 5 9 13 The storage of oxygen must 31/05/2010 be robustly risk assessed and clearly signed. This will ensure the safety of people in the home. All medicines must be stored 31/05/2010 appropriately and discarded before the expiry date. This includes refrigerated items and homely remedies. 6 9 13 Care Homes for Older People Page 36 of 42 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 This will ensure that all medicines are safe and suitable for use. 7 9 13 The accurate use of all 17/06/2010 prescribed items, including creams, eye preparations and nutritional supplements, must be recorded. This will ensure that there is a record of all the treatment a person receives. 8 10 12 The care home should be conducted in a manner that respects the privacy and dignity for people living in the home. This will help ensure that people feel that they are treated with respect and that their right to privacy is upheld. Routines of daily living and activities need to be flexible and varied and must suit individuals expectations, preferences and capacity. This will help promote that people in the home are able to live the lifes they choose 24/05/2010 9 12 12 17/06/2010 Care Homes for Older People Page 37 of 42 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 10 15 12 The registered person must make sure that mealtimes are unhurried and that where necessary people are supported appropriately. This will help ensure that people receive a wholesome balanced diet in a timely dignified manner. 26/05/2010 11 19 26 The registered provider must fully audit the environment and submit to CQC a refurbishment and redecoration improvement plan, detailing the the concerns identified in the report and the action to be taken with set timescales. This will help ensure that people live in a safe, well maintained environment. 19/07/2010 12 24 12 Each person must be provided with a lockable facility in there rooms. This is so that they have a secure place to store, medication, money and valuables. 16/06/2010 13 27 18 Daily routines need to be 26/05/2010 reviewed and additional care staff hours may need to be deployed. This is so that peoples Care Homes for Older People Page 38 of 42 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 lifestyles match their expectations and preferences. They must be satisfied that their social, cultural, religious and recreational needs can be met. 14 29 19 Before a person starts work 24/05/2010 in the home, all the information and documentation specified in Schedule 2 of the Care Homes Regulations 2001 must be obtained. This is to ensure that people are protected through robust recruitment procedures. The Registered person must ensure that staff training is up to date and that training is relevant to the needs of the people living in the home. This will help ensure that staff have the skills and knowledge to meet peoples needs. 16 31 8 The home must appoint a 17/06/2010 suitably qualified and competent person to manage the home and apply to us to be considered for registration. This will help to make sure that the home is 19/07/2010 15 30 18 Care Homes for Older People Page 39 of 42 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 run in the best interests of the people who use the service. 17 33 24 The home needs to start improving its quality assurance by introducing continuous monitoring of polices, procedures and practices. This will help ensure that the home is run in the best interests of the people who use the service. 18 36 18 The registered person must ensure that all staff receive regular supervision This will help ensure that staff practice is supervised, staff receive appropriate training and feel supported. Personal documentation about people living in the home must be kept in a secure place. This will help ensure that peoples rights and best interests are safeguarded 19/07/2010 19/07/2010 19 37 17 26/05/2010 Care Homes for Older People Page 40 of 42 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 9 Information relevant to the use of medicines for individual people should be kept with the medicine administration records. The service should make sure that all staff continue with the Mental Capacity Act and Deprivation of Liberty training. Staff would benefit from a training update in protecting vulnerable people. The homes refurbishment process must look at ways of utilising space in the home so that people living maintain, privacy, dignity and dont have their personal space impinged upon. 2 3 4 13 18 19 Care Homes for Older People Page 41 of 42 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 42 of 42 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!