Care Home: Hazlewell

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What the care home does well People are happy living at the home. They feel that their needs are met and they say that they are treated with kindness. The staff are happy and feel well supported. The manager has an excellent knowledge of the people who live at the home and their needs and is very caring. What has improved since the last inspection? There have been improvements to record keeping, to the way in which medication is managed, to the environment and to staff training. What the care home could do better: There are a number of practices which may put people at risk of harm and these need to be changed to make sure people are kept safe. The changes that are needed include providing appropriate equipment to help move people safely, making sure that people are protected from the risk of fire, making sure people have their medication managed appropriately and making sure people are not at risk from hot surfaces and potentially hazardous substances. Key inspection report Care homes for older people Name: Address: Hazlewell 29-31 Hazlewell Road Putney London SW15 6LT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandy Patrick     Date: 1 3 0 5 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 31 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 31 Information about the care home Name of care home: Address: Hazlewell 29-31 Hazlewell Road Putney London SW15 6LT 02087888753 02082485954 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr D Patel Name of registered manager (if applicable) Rosemary Carmen Molloy Type of registration: Number of places registered: care home 29 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: 29 The registered person 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 Hazlewell is a care home providing nursing care for older people. The property consists of two semi-detached Victorian houses that have been joined together to make one home. The home is on three storeys and has been extended to the rear with a large conservatory. There is a large rear garden with a patio area available. Hazlewell is situated in a quiet residential street reasonably close to available shops and transport 0 Over 65 29 Care Homes for Older People Page 4 of 31 Brief description of the care home links in Putney. Information about the home is provided to residents in a written guide. The current fees are £675 per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included an unannounced visit to the home on 13th May 2010. We met with people who live there, staff on duty and the manager. We looked at records, the environment and observed how people were being cared for and supported. We wrote to the manager and asked her to complete a quality self assessment. We wrote to people who live at the home and their representatives and staff and asked them to complete surveys about their experiences. We looked at all of the information we have received about the home since the last key inspection. This included a random inspection which we undertook in March 2010, information from the local authority and other interested parties, and notifications of incidents, complaints and safeguarding alerts. Care Homes for Older People Page 6 of 31 Some of the things people told us about the home were: It is lovely here, lots of nice food and nice people to look after you and a warm bed. Hazlewell looks after all its residents extremely well. The home has a very welcoming atmosphere and the residents seem to feel at home. All the staff are very caring and friendly. I have nothing but praise for the staff. Excellent care for the residents. The home is a pleasant place to work in and the residents are happy. The staff are kind and understanding. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 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. People have the information they need to make a decision about whether they wish to move to the home. They have their needs assessed to make sure the home is the right place for them. Evidence: There is a welcome pack for the home which includes information on the services and facilities there. The manager told us that this is provided for anyone who is interested in moving to the home. We saw copies of this in peoples bedrooms. People told us that they had enough information to help them make a decision about moving to the home. The manager told us that she visits people to make an assessment of their needs before they move to the home and we saw evidence of this in peoples files. We saw that the assessment included information on their wishes and needs and that this was reflected in their care plans. Care Homes for Older People Page 10 of 31 Evidence: People are invited to visit the home before they move there but many people are too frail to do this. However, families and other representatives are able to visit at any time. On the day of the inspection we met the family of someone who needed nursing care who had come to look around the home. The manager spent time with them showing them around and answering their questions. One person has moved to the home since the last inspection. We saw that their needs had been assessed. We saw evidence that the staff had worked with the family to make sure the person received the care and supported they needed to help them settle in at Hazlewell. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home feel that they are well cared for and do not have any concerns about their rights. However, some of the practices do not respect peoples privacy or dignity and need to be reviewed. In general people are kept healthy and their medication is well managed. However, there have been some errors with medication administration and recording which may put people at risk. People are not always being moved using the correct equipment to meet their needs and keep them and the staff safe. Evidence: People told us that they thought they or their relatives were well cared for. One person said, I have always found my relative to be well cared for and they have never had any complaints. Everyone has their needs recorded in a care plan which tells the staff about the support and care they should give. We looked at a sample of these plans. We found that the plans were not indexed and it was sometimes confusing to find information. The manager should make sure plans are organised so that information is clearer and Care Homes for Older People Page 12 of 31 Evidence: more accessible. We saw that plans included information on peoples different health and personal needs and that these were regularly reviewed and updated. We saw that some of the information in care plans would benefit from greater clarity. For example, one persons care plan for continence care did not state how often their pad should be changed or the type of pad they used. The care plan also gave some conflicting information about whether the person was catheretised or not. We saw that wounds were recorded but some of the information on wounds and wound care was not clear. For example one persons care plan referred to a specific wound, but recording on the progress and treatment of this was periodic. There were no photographs of the wound to accompany the plan. One body map chart had been used to show different wounds. There should be individual charts for each different wound or injury. The manager told us that she was reviewing and updating all care plans and the way information was recorded. We saw that the risks that people face had been assessed and these assessments were reviewed and updated. We saw that peoples next of kin had signed their agreement to assessments. Everyone is registered with a local GP and sees other health care professionals as needed. We saw evidence of regular consultations from professionals and saw that they advice was included in care plans. The manager told us that they had a good relationship with other health professionals who offered support and advice. People who live at the home told us that they felt they had their medical needs met. A registered nurse is on duty at all times. Some people are unable to leave their beds because of the severity of their condition. We saw that the staff attended these people and that their care plans showed how staff should make sure their needs were met. The manager told us that their bedroom doors were left open so that the staff could make visual checks on their wellbeing throughout the day. The manager needs to make sure that their privacy is also maintained and that they or their families have consented to having their bedroom doors left open. In March 2010, the local primary care trust assessed the moving and handling needs of everyone who lived at the home. They found that the home did not have sufficient equipment to safely meet the needs of the people there. They found that 8 people Care Homes for Older People Page 13 of 31 Evidence: needed to have special beds which could be moved up and down so that these people could get in and out of bed safely. They also found that one of the hoists used at the home did not meet their safety standards and that there needed to be a different type of hoist. And they found that new slings for the hoists, which met peoples individual needs, should be purchased so that people could be moved safely and comfortably. This equipment has not yet been provided for the people living at the home and needs to be to make sure they are safely and appropriately moved. There is an appropriate procedure for managing medication and all staff who administer this are trained. We saw that medication was stored securely. Most records of medication administration were accurate and up to date. However we found two incidents where medication had been signed as given but had not been administered and was still in the original packaging. We found one persons medication had expired the day before our inspection. We found that there were a number of jars containing unlabeled medication awaiting disposal. There was no record of what the jars contained. We saw that the staff were kind to people and generally showed them respect and genuine fondness. People were supported to eat their lunch appropriately and were given choices about what they ate and whether they wished to go to the dining room. The staff addressed people individually by their preferred names. However we heard the staff referring to people by their bedroom door number when talking to each other. We saw that some care plans also referred to people by their bedroom numbers. This is unacceptable. All records and all communication by staff should refer to people by their preferred name and never by a number. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to receive visitors and are well fed being offered freshly prepared food. They are able to pursue a variety of social activities, but they also have times when they are not supported to do a specific activity or follow individual interests. Evidence: The home is equipped with games and puzzles which people who live at the home can play if they wish. There is a TV and music system in the main lounge, where the majority of people spend most of the day. Some people have hobbies which they pursue. We met one person who told us they liked to read and another person who cared for their doll. There is not a plan of organised activities for each day and the staff tend to use the equipment for ad hoc activities with the group and individuals. On the afternoon of our visit one member of staff supported people to take part in a needlework activity. People seemed to like the relaxed approach to activities and as the home was not at full occupancy at the time of the inspection this seemed to work well. However, there were long periods of time when people did not seem to be doing anything. This may have been their choice but we did not see the staff offering them different things to do. The staff need to be more proactive and make sure people are getting the support they need to do whatever they want. At one point during the day both the television and radio were on in the lounge, making it hard to concentrate on Care Homes for Older People Page 15 of 31 Evidence: either. The staff need to be aware of this and make sure the choice for either television or music is made by the majority of people in the room. People may also appreciate a slightly more structured approach to activities with a plan of events which they know in advance so that they can choose whether to participate or not. There are some organised special events and these include a church service every two months. Recently the local photographic society organised a slide show and local school girls visited the home to offer support for people to pursue individual interests. People told us that they enjoyed these events. The manager told us that a lot of the time people just enjoyed chatting with staff and having their nails painted, or staff reading to them. We did not see this take place on the day of our inspection. The staff need to make sure they are available to offer this kind of support. We saw that care plans referred to some individual social needs and hobbies. However we did not see evidence that people were supported to pursue these. The staff need to make sure they know about peoples individual likes and preferences and there needs to be a plan of care which tells the staff what they should do to help people meet these social needs. The manager told us that she had recently purchased some publications which had ideas for new activities. She also told us that she is going to keep a record of each persons activities each day to make sure this is monitored and they are getting the support they need. The manager told us about some ideas she had for introducing new activities and special events. Some people have made their own private arrangements for physiotherapy and massage. People told us that special events were celebrated and the cook told us that she always made a cake and they had a party for peoples birthdays. The manager has started making special signs for bedroom doors which show peoples hobbies or past interests. We saw that visitors were welcome throughout the day and the manager and staff demonstrated that they valued the importance of family and friends. Some visitors who contacted us said that the home was always very welcoming and that they were kept informed. There is a planned menu which offers people a choice of two main meals. We met the Care Homes for Older People Page 16 of 31 Evidence: cook who told us that she knew peoples individual likes and preferences and catered for these. People told us that they liked the food at the home. We saw that fresh ingredients and fruit were available. One person said, my relative always enjoys their food. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to raise concerns and feel confident that these will be investigated appropriately. They feel safe and their are procedures in place to help safeguard them and protect them from abuse. Evidence: There is an appropriate complaints procedure and copies of this are given to people who live at the home, their representatives and staff. We saw copies of the procedure within staff handbooks and the homes welcome pack. People told us that they knew what to do and who to speak to if they were unhappy about anything. There is a record of all complaints and concerns and the action taken to investigate these. The home has its own procedures on whistle blowing and abuse. They also have a copy of the local authoritys safeguarding procedures. The manager has worked with the local authority to help investigate suspected safeguarding alerts. We saw evidence that the staff had been trained in protection of vulnerable people and that their recruitment included checks on their suitability. Care Homes for Older People Page 18 of 31 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. People are generally happy with the environment and feel that it is kept clean. However, some damage to the building and equipment means that people may be at risk if these are not attended to. Evidence: The home has a pleasant atmosphere and is warm and welcoming. Communal areas are equipped with comfortable furniture and the home was clean and fresh throughout the day of our visit. People have personalised their own bedrooms. People told us that they felt the home was always clean and fresh. Since the last inspection the owner has undertaken work to fix some of the problems we identified with the environment. These include repairing water damaged ceilings and cracks to the walls in two bedrooms. However, some of this work was not complete. We saw that some of the cracks had not been repaired and the manager told us that there was still a problem with water damage during wetter weather. The areas of repair need painting. We saw that the ceiling in another room was badly bowing, stained and cracked indicated water damage. This area must be made safe. There are other areas of decoration and repair that need attending to. These include cracked tiles in one bedroom, painting in some rooms and worn carpets. Care Homes for Older People Page 19 of 31 Evidence: The frame around one toilet was broken and had been taped by way of repair. However, someone using the frame could be at risk if the repair did not hold and the frame broke further or collapsed. This frame needed to be replaced to make sure people using it are not at risk. The manager told us that a number of the call bells in the home were not working. She assured us that all occupied bedrooms had working call bells, but that some of the empty rooms had bells which needed repair. These need to be repaired before the rooms are occupied. At the time of the inspection we found that all rooms, including unoccupied rooms, were accessible and therefore someone could enter these rooms and then find that they needed assistance. Therefore, the call bells in these rooms should be repaired as soon as possible. Or access to these rooms should be restricted. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by trained, appropriately recruited and well supported staff. Evidence: People told us that the staff were kind and caring. The staff told us that they had the information they needed to do their jobs and to support people living at the home. The staff told us that they had regular individual meetings with the manager to discuss their work and any concerns they had. We saw evidence of this. We saw that all staff met with the manager annually to have their work appraised. The staff told us that they met with other staff and the manager each day to handover information to each other and to discuss any specific needs of the people living at the home. We saw evidence of this. We saw that the manager conducted thorough checks on staff suitability before they are employed at the home. We saw that staff files contained references and criminal record checks. The staff told us that they had been on a range of training and we saw some certificates to evidence training. However records of training were not consistent for all staff. The manager should create a record of all staff training and dates that staff Care Homes for Older People Page 21 of 31 Evidence: need renewal for specific training. We saw evidence that the staff working at the home had been trained in safe moving and handling. The local authority have offered additional training in the use of new equipment once this has been purchased. Care Homes for Older People Page 22 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is generally well managed and the management approach is open and positive. Although checks on health and safety are made, there are a number of practices which put peoples health and safety at risk. Evidence: The manager is an experienced nurse who has worked at the home for many years. She knows the people who live and work there well and showed genuine fondness for them. She showed us that she has a good relationship with the people who live at the home, and while she showed us around, she spoke to each individual in a kind and caring way, clearly knowing their personality, likes and needs. The staff told us that they found her caring and supportive and felt that she created a good atmosphere to work in. People told us that they found the manager open and approachable. The manager has set up well organised systems and records at the home. And she demonstrated a good knowledge about all aspects of the day to day operations, including care, staffing, resources and health and safety. Her knowledge of the service Care Homes for Older People Page 23 of 31 Evidence: and the needs of individual people living and working there is commendable. And she is clearly committed to providing a very caring and homely environment where people feel safe and comfortable. However, she manages and organises everything herself, including all health and safety, medication, stock and record checks and writing, reviewing and updating all the care plans and staff supervisions. Because the manager does not delegate any of these duties it means that she is constantly very busy and it means that if she was not able to work for a while, others may not know the systems and procedures to make sure the home runs smoothly. The manager should consider delegating some responsibilities and duties. There is no formal recorded plan of what action staff need to take in an emergency situation. The home is privately owned and therefore there is no larger organisational structure offering support. There needs to be a clear plan which shows what the staff should do if the manager or owner were unavailable and an emergency arose. There is a record of monthly quality visits by the owner. People who live at the home need to make their own private arrangements for managing their finances as support with this is not provided at the home. Throughout the day of our inspection we saw two places where cleaning products, white spirit and paint had been left unattended and accessible to anyone. The majority of people who live at the home are frail and unable to move around independently. However, cleaning products and paint, which may be harmful to people, should not be left unattended and should be stored securely to make sure no one is at risk from these. The majority of radiators are covered to reduce the risk of people being scalded. However, some of these covers are open at the sides and people are at risk of scalding themselves against exposed hot water pipes. We found that we could easily reach hot surfaces and that these surfaces were hot enough to scald if they were touched for long enough. Two radiators, in bathrooms on the first and second floors, were not covered. The radiators were on and were hot during our visit. This puts people at risk of being scalded. Two electronic devices which hold fire doors open safely were broken at the time of our inspection and these doors were wedged open in a way which would prevent them from automatically closing if the fire alarm system was activated. We saw that some people were unable to leave their beds and were cared for in their rooms. The staff need to be able to make visual and physical checks on their wellbeing throughout the Care Homes for Older People Page 24 of 31 Evidence: day. Their bedroom doors were wedged open so that staff could do this. However, these doors would not automatically close when the fire alarm is activated. This puts people at risk because fire and smoke may not be appropriately contained. All doors which need to be held open must be equipped with devices that do this safely and allow the door to close automatically in event of a fire. We looked at first aid supplies at the home. We saw that some of the first aid equipment had passed its expiry date and needed to be replaced. A duvet was draped over the stair lift on one stair well for the duration of our visit. This stair well is not usually used by people who live at the home. But staff could be at risk of tripping over this and this could be a risk as materials which could be combustible should not be stored on or under stair wells. The manager conducts checks on health and safety, including fire safety. We saw that these were recorded and identified any areas of concern. We saw that there had been recent checks on electrical, water and gas safety. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 The registered person must make sure the correct moving and handling equipment is purchased so that everybody who lives there is safe when they are supported to move. Because people who live at the home and the staff who support them may be at risk if the wrong or inappropriate equipment is used. 09/04/2010 2 38 13 The registered person must make sure all hot water pipes and radiators are appropriately covered. Because people may be at risk of scalding if hot surfaces are exposed. 31/03/2010 Care Homes for Older People Page 26 of 31 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 7 15 The registered person must make sure care plans are clear and give full details of each condition and the care and support needed. Because people may not get the right support or care if information is not clearly recorded or is confusing. 30/07/2010 2 8 13 The registered person must arrange for people who live at the home to have the equipment they have been assessed to need. Because people who live at the home and the staff supporting them may be at risk of injury if incorrect moving and handling equipment is used. 30/07/2010 3 9 13 The registered person must make sure medication administration and storage is correctly recorded and that it has not expired. 30/06/2010 Care Homes for Older People Page 27 of 31 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 Because people may be at risk if medication is not managed according to the procedure. 4 10 12 The registered person must make sure records and the staff always refer to people by their preferred name. The registered person must make sure the practice of keeping bedroom doors open is agreed by the person or their representative and makes sure their rights to privacy are respected at all times, Because people may feel that they do not have privacy and dignity if their doors are left open while they are in bed. 6 12 16 The registered person must 30/06/2010 make sure peoples individual interests are recorded within their care plans and that the staff offer support for them to pursue these. The registered person must 30/06/2010 make sure all damaged equipment, including call bells and the toilet frame are 30/06/2010 5 10 12 30/06/2010 7 19 23 Care Homes for Older People Page 28 of 31 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 repaired appropriately or replaced. 8 19 23 The registered person must complete the work to replair damaged ceilings and walls. The registered person must have a written plan to demonstrate how all repairs an redecoration within the home will be completed. The registered person must create and record a plan for staff to follow in event of an emergency, including what to do if the manager and owner are not available. The registered person must take precautions for containing and preventing fire. The registered person must make sure first aid supplies have not passed the expiry date. 30/07/2010 9 19 23 30/06/2010 10 32 13 30/06/2010 11 38 23 30/06/2010 12 38 13 30/06/2010 13 38 13 The registered person must 18/06/2010 make sure substances which are potentially hazardous to health are stored securely and in accordance with COSHH regulations. Care Homes for Older People Page 29 of 31 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 14 38 13 The registered person must make sure all radiators and hot water pipes are appropriately covered to prevent the risk of people scalding themselves. 30/06/2010 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 12 The manager should consider organising a more structured programme of group activities which allows people to decide whether they wish to participate in advance. The manager should make sure records of staff training are clearer and easier to audit. The manager should consider delegating some of the duties and responsibilities to other staff to help the smooth running of the home. 2 3 30 31 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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