Care Home: Herrington Grange Nursing Home

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What the care home does well The staff collects information from the person and other professionals before anyone is admitted into the home to make sure they can meet their needs. People are helped to access all health care and Advocacy services. Care plans are easy to understand, follow best practice and Department of Health Guidance. Information about people`s past lifestyles and current aspirations are being written down so that staff can support them and help them access help from others. Visitors are always welcomed and there are links with the local community. Clear information is available should anyone have a concern or complaint about the care or service they are receiving. Staff are respectful and sensitive with people when helping them or when speaking to them. Staff receive ongoing training so that they can care for the different needs of people living in the home.They have completed safeguarding training and would be confident that they can recognise signs of abuse and would be able to raise an "alert" to protect anyone at risk. Staff are being directed and supervised formally and in everyday practice which is improving people`s quality of life. The Registered Manager makes sure that quality assurance systems are followed so that people receive consistent quality of care and their views are taken into account. The Registered Manager makes sure that all checks and clearances are completed before staff are employed. She makes sure that people`s records and personal monies are kept safe. All maintenance checks are being completed on a weekly and monthly basis with records kept. The home is a clean and pleasant place to live. Comments from surveys included: "The home provides a homely caring environment.Visitors always receive a warm welcome and relatives are kept informed of any developments relating to residents care.There is good all round communication and residents are involved in any decision making where possible." "I am very happy in Herrington Grange.The staff are kind and helpful and I am looked after very well". Other professionals said: "The home has been committed to pilot Supportive Palliative Care in Sunderland.There has been a real dedication from key staff with this work." "The strong leadership of the manager and skilled , enthusiastic staff are the reasons behind the delivery of palliative and end of life care". "The staff make sure people`s dignity and privacy are respected and they manage wound care well". What has improved since the last inspection? The Registered Manager and the staff have continued to improve the care and services provided for those living in the home. There was one requirement from the last visit which was to improve the sluicing and disposal facilities which has been done. What the care home could do better: Staff need to make sure that all handwritten directions on medication records have witness signatures. The mealtime experience needs to be reviewed so that people can have choices of portion size and the food reflects seasonal changes.The menus need to show what all of the food choices are which includes snacks,suppers and alternatives.Menus should be available in different styles that people can understand. The staffing levels at peak times need to be reviewed. The refurbishment and redecoration programme needs to continue. All rooms which are being used as storage should be kept locked. A risk assessment is needed for the glass cabinets and the cabinets secured to the wall. Comments included: "There seems to be fewer activities compared with the twelve months ago.Other visitors have remarked on under staffing in the last few months." "Could have better staffing levels." Key inspection report Care homes for older people Name: Address: Herrington Grange Nursing Home Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Irene Bowater     Date: 2 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Herrington Grange Nursing Home Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW 01915845854 01915120958 herrington.grange@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd care home 50 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 50 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, maximum number of places: 50 Physical Disability, over 65 years of age - Code PD(E), maximum number of places: 30 Physical Disability - Code PD, maximum number of places: 10 Date of last inspection Brief description of the care home Herrington Grange is a privately owned care home, which is located in a village in a semi-rural area. It is reasonably close to a range of local facilities including shops and a Church, and is also near to a bus stop. The home may provide permanent accommodation with personal care support and nursing for up to fifty older people, some of whom may have a physical disability. A limited number of physically disabled Care Homes for Older People Page 4 of 27 Over 65 50 30 0 10 Brief description of the care home adults under the age of sixty-five may also be accommodated within this total number. The homes entrance is level,and a shaft lift provides access between floors. Accommodation is laid out over both the ground and first floors. Each has selfcontained lounges and adequately equipped bathrooms. All bedrooms have en-suite toilet facilities. The building shares it grounds with another care home owned by the same company. The grounds are well kept, there are accessible paved areas for service users, and car parking is available. Information about the home is available in the Statement of Purpose and Service User Guide.These are both available in the reception area of the home. The fee rates are 407 pounds with the nursing element of 106:30 pounds on top.Newspapers,toiletries and clothing and some outings are not included in the fee rate. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit we looked at information we have received since the last visit on the 16 October 2007. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service,their relatives,staff and other professionals. We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. In future,if a requirement is repeated,it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 27 The Visit. An unannounced visit was made on the 15 October 2009.A further announced visit was made on the 22 October to complete the inspection and give feedback to the registered manager.This visit was carried out by one inspector and took seven hours to complete. During the visit we: Talked with people who use the service,staff,relatives and the manager. Looked at information about the people who use the service and how well their needs are met. Looked at other records,which must be kept. Checked that staff have the knowledge,skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean,safe and comfortable. We told the manager what we found. Care Homes for Older People Page 7 of 27 What the care home does well: The staff collects information from the person and other professionals before anyone is admitted into the home to make sure they can meet their needs. People are helped to access all health care and Advocacy services. Care plans are easy to understand, follow best practice and Department of Health Guidance. Information about peoples past lifestyles and current aspirations are being written down so that staff can support them and help them access help from others. Visitors are always welcomed and there are links with the local community. Clear information is available should anyone have a concern or complaint about the care or service they are receiving. Staff are respectful and sensitive with people when helping them or when speaking to them. Staff receive ongoing training so that they can care for the different needs of people living in the home.They have completed safeguarding training and would be confident that they can recognise signs of abuse and would be able to raise an alert to protect anyone at risk. Staff are being directed and supervised formally and in everyday practice which is improving peoples quality of life. The Registered Manager makes sure that quality assurance systems are followed so that people receive consistent quality of care and their views are taken into account. The Registered Manager makes sure that all checks and clearances are completed before staff are employed. She makes sure that peoples records and personal monies are kept safe. All maintenance checks are being completed on a weekly and monthly basis with records kept. The home is a clean and pleasant place to live. Comments from surveys included: The home provides a homely caring environment.Visitors always receive a warm welcome and relatives are kept informed of any developments relating to residents care.There is good all round communication and residents are involved in any decision making where possible. I am very happy in Herrington Grange.The staff are kind and helpful and I am looked after very well. Other professionals said: Care Homes for Older People Page 8 of 27 The home has been committed to pilot Supportive Palliative Care in Sunderland.There has been a real dedication from key staff with this work. The strong leadership of the manager and skilled , enthusiastic staff are the reasons behind the delivery of palliative and end of life care. The staff make sure peoples dignity and privacy are respected and they manage wound care 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 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive clear information about the service and good assessment of need before admission.This helps them make the right decision about using the service. Evidence: The Statement of Purpose and Service User Guide are readily available in the reception area of the home.These would benefit from being made available in easy read, large print and audio style so that people with disabilities can easily understand what the home has to offer. There is also a wealth of information available to help people access other services including Advocacy and other health services. Clear complaints information is available and there is a box where people can put their suggestions of how to improve the service,identify concerns and any compliments. People,and,or their relatives are able to visit the home before moving in and spent Care Homes for Older People Page 11 of 27 Evidence: time looking at what the service can offer and where possible choose a bedroom. The Company has a very detailed assessment tool, Care and Heath Assessment (CHAP) which is completed by the manager or qualified nurse.This along with the care plan from the care manager, and ,where necessary a nurse assessor is used to formulate a care plan for that person. Each person has a contract which sets out the rights and obligations of both parties and the manager writes to individuals to confirm that the home can meet their needs. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is being planned and delivered in a respectful and more person centred way.This enables people to fully access health care and other services and ensures their needs are being met. Evidence: Each person has a plan of care based on the admission information which was carried out by care managers,senior nursing staff and where needed the nurse assessor. Staff complete a Care and Health Assessment(CHAP)which is very detailed and covers all aspects of peoples heath and social care needs. Risk tools include pressure ulcer prevention using the Waterlow scoring system,dependency,moving and handling,nutritional assessments,using the Malnutrition Universal Screening Tool(MUST),continence and fall risk assessments. This information help the staff understand the level of risk and help them complete care plans based on individual need. Qualified nurses should be aware that details of moving and handling equipment Care Homes for Older People Page 13 of 27 Evidence: needs to be recorded along with the name and code of the hoist and sling. There is evidence that the staff are working with the person and their representatives to find out about previous lifestyles and histories.This information is now showing how they are starting to promote peoples independence and choice although further work is needed. The care plans looked at were easy to follow and were up to date.Information from other professionals is sought and their advice followed.For example contact with GP services,Palliative Care Specialists,Tissue Viability Nurses,Speech and Language Specialists,Consultants,and other NHS services. Several people have food and fluid charts to record their daily nutritional intake.These were being completed properly and could be cross referenced to the care plan.People who have low body weight or poor appetite have their weight regularly checked and should there be any concern the dietician is contacted for further advice. Details about wound care was very clear with staff being able to demonstrate how they are following the advice of the Tissue Viability Nurse (TVN). This included photographs of the wounds with recording of consent,body maps to show improvements or other wise and clear information about dressing changes. There is plenty of pressure relieving equipment and specialist beds. Personal care is also detailed and show preferences for male or female carer,choices of clothing,bathing or showering and choices about joining in with events or not. Currently medicines stored are being in two areas. One treatment room is being designated for medication storage as previously it was also used as an office. Medication policies and procedures are in place and staff have received up to date training. There were clear recording of all medicines received,administered and disposed of and Medicine Administration Records and Controlled Drug check showed no discrepancies. Not all hand written directions had two signatures. All of the staff were kind and knew each person well.All care interventions were delivered in private and in respectful sensitive manner. Staff have had training in Palliative Care and comments from professionals regarding their commitment to providing good end of life care were very positive. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in meaningful activities is satisfactory however there is a limited menu which means people are not able to exercise choice and control over their diet and prevents them from leading full and active lives. Evidence: The home has an activities person who arranges events in and out of the home. Information about planned events are displayed and include, knitting, gentle exercises, reminiscence, regular communion, card making and floor games. There is a planned visit visit to the pantomime in December and in house entertainment over the Christmas period.On the day of the visit staff were planning a 100th birthday party. There is an activity room upstairs with vast range of equipment including videos, books, CDs and games. Records of activities taken part in or not, are recorded.Several people do not want to take part in social events and this is respected. Staff are currently trying to complete life histories but again some people do not want to discuss their previous lives. Care Homes for Older People Page 15 of 27 Evidence: Visitors welcome at any time and Advocacy information is available. People have been encouraged to bring small items with them making their rooms homely and reflective of their previous lifestyles,religious beliefs and cultural backgrounds. Dining rooms are pleasantly decorated and furnished.Menus were on tables along with dried flower arrangements, appropriate condiments ,table linen and cutlery. The lunch time menu was displayed and consisted of beef stew with dumplings,potatoes,carrots and peas or oxtail soup followed by rhubarb crumble and custard. The tea time choices were sausage sandwiches or sandwiches. Drinks were available throughout the day,although no juices,biscuits,home bakes or fresh fruit were made available. Menus showed limited choices for main meals or alternatives should the main meal not be appetising.Also there is no recording or evidence of snack meals including suppers. The meal served at lunch time was nicely cooked and of ample portion size.Staff gave assistance in a discreet sensitive manner. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good complaints and protection procedures are in place and effectively followed to ensure people and their relatives are listened to and protected from harm. Evidence: The Company has a comprehensive complaints procedure,which is displayed in the home.It is also available in the Service User Guide which is readily accessible in reception. The complaints records show that two complaints have been received and both have been properly investigated with outcomes recorded. The manager has an open doorpolicy where people can come and voice any concerns they may have. Should anyone wish is put forward any issue anonymously there is a suggestion box in the reception area of the home. There are clear Safeguarding policies and procedures.Training is initially completed during induction and by completing the Companys training workbooks.Staff also complete training with Sunderland Local Authority so that they can be sure they take the right action should there be any suspicion or allegation of abuse. There have been no safeguarding alerts received. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well maintained and is a clean and pleasant place for people to live. Evidence: The home is a purpose built two storey building and shares the site with another home belonging to the same company.There are pleasant gardens and level access to the home.Car parking is available to the front of the home. The lounges and dining rooms are pleasant ,suitably furnished and have lots of ornaments,pictures and audio equipment.Following some recent redecoration the glass cabinets have not been secured to the wall to prevent toppling incidents. Some of the corridor and bedroom carpets have been down for some years and would benefit from changing. All of the bedrooms have an en-suite toilet and hand wash basin. Some of the flooring in these areas are also becoming worn and should be replaced as part of the refurbishment programme. There are sufficient usable bathrooms and shower facilities.There are adapted baths and there is level access to showers. Handrails are available throughout the home to assist those with reduced mobility and hoists are available on both floors. Care Homes for Older People Page 18 of 27 Evidence: There are a number of profiling beds with integrated safety rails which are used for those needing nursing care. In general the bedrooms are suitably furnished and decorated.People have brought small items with them which makes the rooms homely and individualised. One bedroom is being used to store mattresses,wheelchairs,broken bed bases,profiling mattresses,chairs and tables. This should be kept locked until cleared. On the day of the visit work had started to replace some lighting and extractor fans in the home. There are sluice facilities on both floors although there is only one disinfector which is located on the ground floor. Staff were observed to follow infection control procedures and confirmed they had completed training. On the day of the visit the home was clean,tidy and odour free. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems around recruitment.training and selection of staff are good however staffing levels at peak times only adequately meet the complex range of needs of the people using the service. This means peoples lifestyles are restricted and overall affects their quality of life. Evidence: On the day of the site visit thirty four people were living in the home,several had high complex nursing care needs. Staffing levels consist of two qualified nurses and five care staff during the day, this includes a senior carer. Overnight there is one qualified nurse and two care staff. The day shift hours vary from 8am until 8pm and the overnight shift starts at 8pm until 8am. The registered manager is supernumerary and ancillary staff include an administrator, domestic, laundry, cook, kitchen assistants, maintenance and an activities person. During the morning of the visit it was difficult to locate staff. The reason for this is that most people need two staff to assist them prepare for the day and this routine was not completed until lunchtime. Staff said that morning and night times were very busy and the main focus was either helping people get up or help them go the bed.Given there Care Homes for Older People Page 20 of 27 Evidence: are only three people on duty overnight little activity occurs at this time and people usually have to wait for the day staff to come on duty so they can be helped prepare for the day. Recruitment procedures are followed to to minimise any risk to those living in the home.There was evidence of completed application forms,job description,two written references,Criminal Records Bureau (CRB) checks and proof of identity.Personal Identification Numbers(PIN) of qualified nurses are checked with the Nursing and Midwifery Council to make sure nurses are registered and able to practice. Training includes dealing with emergency procedures, health and safety, moving and handling,CPR,anaphylaxis,infection control,safeguarding,catheter care,leg ulcer management, wound care,palliative care and safe handling of medication. All staff have regular supervision and appraisal. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by an an experienced and competent manager who makes sure good quality assurance and safety systems are in place. This makes sure people receive a good quality of care and they are protected as far as possible from harm. Evidence: The manager has been registered with the Commission.She is a first level registered nurse,holds the Registered Managers Award and she has to complete regular training to maintain her nursing registration. Audits of all care and other services are carried out with actions and outcomes recorded.The regional manager visits on a monthly basis and completes a separate report.These audits and reports make sure that the quality of the home is continually monitored and improved. Regular staff meetings are held and agendas include health and safety,clinical governance,training,care planning ,daily routines and the key worker system. Care Homes for Older People Page 22 of 27 Evidence: The home produces a newsletter so that everyone has information about current events and developments.There are also regular relative and resident meetings so that people can express their views and be informed about any changes that may be happening. The AQQA was completed and returned when and for and the information showed what improvements are planned for the coming year. Should anyone wish the home to keep their money clear systems are in place.The details are kept of all deposits and expenditure on the computer system and paper records,including receipts are signed for.Monthly reconciliation checks are carried out of balances and cash. All mandatory training is up to date and health and safety risk assessments are kept. A risk assessment for the glass cabinets is needed and they need to be secured to the wall to prevent any toppling incident.And any bedroom or bathroom which is used for storage should be kept locked. Internal maintenance checks are up to date and external service certificates are available and up to date. Accident are recorded and best practice guidance is used to track trends,which prevents,as far as possible the same incident or accident occurring. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 15 12 The registered persons must 04/01/2010 ensure that people living in the home receive a varied balanced diet . This will make sure people can choose from a varied wholesome menu which suits individual need. 2 27 18 The registered persons must 01/03/2010 ensure that there are sufficient staff on duty at all times. This is to make sure peoples individual needs are met and and they are afforded choices about daily routines. 3 38 13 The registered persons must 30/11/2009 ensure that a risk assessment is available for the glass cabinets and they must be secured to the wall. Care Homes for Older People Page 25 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure as far as possible any accident occurring. 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 2 3 4 1 7 7 9 It is recommended that the Statement of Purpose and Service User Guide are made available in alternative styles. It is highly recommended that the person centred approach to care planning and delivery continues. It is highly recommended that the moving and handling directions include details of hoists and slings used. It is highly recommended that staff sign and date handwritten entries they make on the MAR charts.Each entry should be checked and countersigned by a second person to reduce the risk of error when copying information. Menus should offer choices for all meals and snacks and these should be available in a style understood by the people living in the home. It is recommended that the refurbishment and redecoration plans continues. It is recommended that bedrooms that are used for storage be kept locked until the room can be cleared. 5 15 6 7 19 24 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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