Care Home: Hill Ash House

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What the care home does well The home works well to promote the privacy and dignity of residents. A good range of activities are provided both inside and outside of the home catering for the needs of all residents. There is information available if any resident should need to use an advocacy service. A good choice of meals are provided which were generally enjoyed. The environment of the home was well-maintained and clean providing residents with a safe and comfortable environment. Suitable adaptations have been made in the rooms of people with a sensory impairment. Well over half of the care staff working in the home have a National Vocational Qualification at level two or above. What has improved since the last inspection? The documentation used by the home to assess the needs of potential residents is now more comprehensive. There has been an improvement in the standard of care planning with clear and individualised plans being produced. The approach to assessing risks to residents has also improved and both care plans and risk assessments have had frequent reviews. There is good record keeping in relation to any complaints received. Improvements have been made to the laundry. What the care home could do better: The home needs to insist on receiving written information from local authorities about all prospective residents needs before they are admitted to the home. The home needs to improve practices around the storage, administration and recording of residents` medication. Some of the shortfalls with medication practices found at this inspection showed that there had been little improvement since the inspection by a Pharmacy inspector from the Commission in June 2009. The home should provide training in the safeguarding of adults for all staff. The home must improve recruitment practices which must include all the required checks to protect residents. Quality audits for medication need to be more robust and recruitment practices should be subject to quality audits. Key inspection report Care homes for older people Name: Address: Hill Ash House Hill Ash House Ledbury Road Dymock Glos GL18 2DB     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: Adam Parker     Date: 2 7 0 1 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 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) © 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 27 Information about the care home Name of care home: Address: Hill Ash House Hill Ash House Ledbury Road Dymock Glos GL18 2DB 01531892980 01531890767 mpearce@ehguk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): European Healthcare Operations Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category sensory impairment Additional conditions: The maximum number of service users who can be accommodated is 36 The registered person may provide the following category of service only: Care Home only - Code PC, to service users of either gender 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 of 36 places. Sensory Impairment (Code SI) - maximum of 9 places. Date of last inspection Brief description of the care home Hill Ash House is an extended Grade 2 building, set in its own extensive grounds. Following a change in the homes registration it now offers personal care only to older Care Homes for Older People Page 4 of 27 Over 65 36 0 0 9 0 5 0 6 2 0 0 9 Brief description of the care home people. There are ample communal rooms and bedrooms are single with ensuite facilities. A shaft lift offers access to the upper floors. Specialised equipment is provided to meet differing needs and external health care professionals such as the GP, Dentist Chiropodist are contacted as required. There are extensive grounds that can be enjoyed by the residents in the milder weather. The local bus stops in the village of Dymock, which on foot is some distance from the home. Information about current fees was not obtained during this inspection. Copies of the homes Statement of Purpose and Service Users Guide are displayed in the main entrance to the home. 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: 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 judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The visit to the service included a tour of the premises, examination of documentation and medication systems and discussions with residents, staff and management. The inspector was joined on the first day of the inspection visit by an expert by experience. A person who, because of their experience visits a service with an inspector to help them get a picture of what it is like to live in or use the service. With this inspection the expert was selected specifically for their ability to communicate with residents who have a sensory impairment. The expert commented The home must be congratulated in making huge strides in accommodating Deaf residents needs however more could be done to promote the inclusion of all residents Deaf and hearing alike. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 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 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 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process does not always ensure that information from local authorities is received about a residents needs before care in the home is offered, so that residents cannot be sure that they will receive the care they require. Evidence: The assessment documentation for a number of residents recently admitted to the home was looked at. Where residents had been funded by a local authority, information in the form of a care plan had been obtained. Although the home had carried out their assessment prior to the resident moving into the home, the local authority had been slow to supply theirs with one resident. The care plan was dated on the same day that the resident was admitted. The home should insist on receiving the local authority care plan or assessment prior to the resident entering the home to ensure that their needs can be met. It was confirmed with two other residents that the home had received the local authority care plan before the resident had moved in although there was no record of when the care plans had been received. Care Homes for Older People Page 10 of 27 Evidence: The home does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there has been an improvement in care planning, some further work still needs to be done around medication record keeping and storage in the interests of residents medication needs. However general health needs are being met and privacy and dignity is being upheld. Evidence: The care documentation for a number of residents was looked at. Care plans were detailed and individualised with clearly identified needs and objectives. Part of the care plan is an action plan and this described exactly what actions staff would need to take to meet a residents needs as well as highlighting areas where the resident was independent and staff should allow this. Care plans also reflected actions in line with health care needs where these had been identified. Risk assessments had also been completed for falls and care plans produced where a need was identified. Residents had assessments completed for pressure area care with regular reviews. There was recorded evidence of residents receiving input for health needs from visiting professionals such as chiropodists and General Practitioners (GP)s. Care Homes for Older People Page 12 of 27 Evidence: Arrangements for medication administration and storage were looked at. Since the previous key inspection a random inspection of medication systems in the home had been undertaken by one of our pharmacy inspectors in June 2009. One of the cupboards containing medication could not be locked and the key could not be located during the inspection visit. This situation existed despite a similar issue being raised at the random pharmacy inspection. The storage for controlled drugs was looked at. The inner medication storage cupboard as well as containing controlled drugs also contained a number of other items such as medication that was not classed as a controlled drug, Paracetamol tablets of unknown origin, an item of jewellery and some wall fixings that had been removed from inside the cupboard. A similar situation had also been found at the random pharmacy inspection. The controlled drugs cupboard should only be used to store controlled drugs and not other items. Access to these items may compromise the security of the controlled drugs which must be maintained. The home must also check that the correct wall fixings are in place. There was varied practice in relation to dating bottles of liquid medication as an indication of the expiry date with some bottles dated and some not. In addition a bottle of simple linctus was in use that was clearly past the expiry date printed on the bottle. Staff were advised to dispose of this. All eye drops were kept in the fridge but this is only necessary for a very few items where the manufacturer will specifically state this. Generally eye drops are best stored at room temperature as this is more comfortable when the drops are instilled. Storage temperatures were being monitored and records showed that these were within correct levels both for the storage room and the refrigerator. As at the previous key inspection it was found that some handwritten directions on the Medication Administration Records (MAR) had not been signed or dated by the person writing the directions and there was no indication such as a signature to indicate that the entry had been checked by another member of staff. Some protocols were in place to guide staff in giving medication prescribed on an as required basis. Some gaps in the recording of medication administration were found on the medication charts. This was despite a regular audit being in place. Medication audits clearly need to be more robust to pick up such issues. Staff were observed maintaining the privacy and dignity of residents with such actions as knocking on doors before entering. Residents with a sensory impairment have flashing lights to alert them if anyone wishes to enter their room. One resident described staff as polite, courteous and respectful. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a varied and appropriate activities programme, good social contact and a choice of meals served in attractive surroundings. Evidence: Activities in the home had included pottery, music and movement, knitting and sewing and a film club. A musical entertainer also visits the home and there are monthly visits from a mobile library. As well as an annual fete there are also some trips out of the home to visit such places as a local garden centre. There was also a trip to the seaside in the summer. A number of residents had care plans for social activities. It was noted that there were no gardening activities available and this should be considered if there is an interest from residents. The activities coordinator works in the home for five days per a week from Monday to Friday. The home had until the recent past produced a newsletter, however the member of staff with responsibility for this had retired. One resident spoke to the expert about how they had enjoyed contributing to this. This was discussed with the manager who reported that there were plans to reintroduce the newsletter. For people with sensory impairment flash bingo sessions are held which all residents can take part in. Despite information told to the expert, the home were able to Care Homes for Older People Page 14 of 27 Evidence: demonstrate that a carol concert held at Christmas had included signing for residents with a sensory impairment. In addition monthly visits were made to the deaf association community centre in Gloucester as well as Saturday Night Bingo sessions. One resident also went swimming on a regular basis. The expert found that some residents were not aware of how to use subtitles on the television and would benefit from this. Holy Communion is held in the home once a month for all Christian denominations. The home also has the details of a local Roman Catholic Priest if any visits should be requested by residents. At Christmas children from the local village school had visited to sing carols. The homes AQAA document stated All service users are able to receive visitors in privacy and they are able to see whom they choose, there is no restriction on visits or on times of visits. Despite the rural location of the home, residents are able to access to transport through the use of dial a ride and the home has the use of a minibus and a wheelchair car. Information about advocacy services is widely available in the home with posters displayed on notice boards. Residents are able to personalise their individual rooms with a number of items including furniture. The home has a six weekly menu which makes use of seasonal vegetables. At lunch there is a choice of main dish including a vegetarian option. There is also a diabetic option for dessert on the menu. A record is kept of any alternative meals provided to residents that are not part of the menu. Menus are displayed in the home although some residents commented that the print was too small to read. There is also an illustrated poster showing snacks that are available. Supper consists of a choice of a cooked snack or soup as well as cakes or a dessert. The expert took lunch with some of the residents. They confirmed that choices were always available, and that they could have snacks if they requested them outside of the usual meal times. They were generally positive about the meals provided. One resident described how the cook would meet with them to discuss meal preferences. Care Homes for Older People Page 15 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. The home acts on complaints in the interests of residents and care staff are given training to ensure that residents are protected from abuse. Evidence: Information on how to make a complaint is available in the home. The expert confirmed with a number of residents that they all felt confident about raising a complaint if they needed to. The Homes AQAA document stated that four complaints had been received in the twelve months prior to November 2009. Details of the complaints and the responses to them had all been fully documented in the homes complaints folder. In respect of residents legal rights the home has information relating to the Mental Capacity Act 2005. Staff had attended training on this as well as the associated deprivation of liberty safeguards. The home has a policy for protecting residents from abuse that was on display as well as a whistle blowing policy. Records showed that the majority of care staff had received training in safeguarding adults. However apart from the administrator none of the ancillary staff had received this training. Consideration should be given to providing safeguarding training to other staff such as to increase awareness of such issues within the staff team as a whole. A safeguarding incident in 2009 had been reported to the relevant authorities. Care Homes for Older People Page 16 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. Residents have the benefit of living in a well-maintained and clean, environment with personalised individual rooms and suitable adaptations made for the needs of the residents. Evidence: A tour of the premises was undertaken. The home was noted to be warm with all areas looked at, clean and well maintained. Since the previous key inspection there had been some changes to the use of communal areas with the dining room at the front of the home now in use as a lounge and the lounge at the rear now used as a dining room. A number of bedrooms on the top floor which had been extensively refurbished were occupied by residents with a sensory impairment. Suitable adaptations had been made for the specific needs of these residents. However the expert felt that it would be useful if a deaf organisation could visit the home to carry out an audit in relation to meeting the communication needs of people with a sensory impairment. The entrance hall contained information about the home and about planned activities. There are well kept gardens around the home with car parking at the front of the home. A small courtyard provided with seating is available for use by residents when the weather allows. One resident was using this area when smoking although there was no shelter provided for them for wet weather. Residents rooms were comfortable and contained various degrees of personalisation with some enjoying views of the countryside surrounding the rear of the home. Some rooms on Care Homes for Older People Page 17 of 27 Evidence: the ground floor at the rear of the home had their own individual access to the garden. New furniture had been introduced to some rooms which had been designed without sharp corners so as to minimise the potential for any resident injuring themselves. The laundry had washable floor surfaces and work had been carried out since the previous key inspection to repaint the walls and remedy a leak behind one of the machines. Arrangements for hand washing were in place. It was noted that hand cleaning gel dispensers had been located at various points around the home as an aid to infection control. Care Homes for Older People Page 18 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. Sufficient staff are deployed and training is provided in a number of areas to meet residents needs. However there has been no improvement in recruitment practices which have potentially put residents at risk. Evidence: In addition to the manager the home is staffed with five carers in the morning and four in the afternoon and three waking staff at night. This was an increase on the numbers at the previous key inspection and reflects the increased occupancy of the home. In addition to care staff there are a number of ancillary staff and an administrator. Based on information supplied on the AQAA document the home had well over 50 of staff trained to NVQ level 2 or above. Records for recently recruited members of staff were examined. Two members of staff had started working in the home before the second of their two written references had been received. With a third member of staff a second reference had not been received at all. Although the home had unsuccessfully pursued a second written reference from a previous employer this had not been forthcoming. However no attempt had been made to seek another reference from a different source. Two other members of staff had started work before their PoVA first or ISA adult first check had been completed. Care Homes for Older People Page 19 of 27 Evidence: A third member of staff had been employed without a risk assessment being carried out regarding information on their Criminal Records Bureau Disclosure. This information had also not been included on their application form. Such risk assessments must form part of the recruitment procedure in the interests of protecting residents. The home has a document for induction training that covers the common induction standards for social care in England. Evidence was given of training carried out by staff in relation to the needs of residents with a sensory impairment. This included deaf/deaf blind awareness, sensory deprivation awareness and introduction to British Sign Language (BSL). Some staff had completed BSL at level one as well as a level one course in deaf/blind awareness and communication. Residents reported that some staff were better than others at signing. A review should take place of the skills and knowledge of staff in relation to communication with residents with sensory impairment. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite good quality assurance work in a number of areas, there is still improvement needed and quality monitoring of recruitment and medication practices to ensure the safety and well being of the residents. Evidence: At the time of the inspection visit the registered manager of the home had recently resigned. The home was being managed by an acting manager who had relevant qualifications and previous experience of managing a care home. Quality assurance is approached through the use of various satisfaction surveys. These had been sent out to residents, visitors and staff as well as outside care professionals such as GPs and chiropodists. It was reported that staff use sign language to gain the views of residents with a sensory impairment. Reports of responses received are produced that include comments made as well as responses to questions about aspects of the service. Visits and reports by a representative of the registered provider made under the care homes regulations had been carried out on a Care Homes for Older People Page 21 of 27 Evidence: monthly basis. Visits included speaking to residents, their representatives and staff working in the home to gain their views of the service provided. Action plans are produced following these visits. There are also regular residents and relatives meetings. Some residents were aware of these meetings but did not attend them, although relatives did attend on their behalf. A number of quality monitoring audits were in place, however these need to be extended to include recruitment practices following the findings at the inspection. In addition a more robust approach to quality monitoring should be applied to medication practices. The arrangements for looking after residents money was looked at and satisfactory arrangements were in place with records kept. Secure storage is available in the home and in addition residents can make use of lockable drawers in their bedrooms or be supplied with lockable money boxes. Staff had received training in first aid, health and safety, fire awareness, moving and handling and infection control. Some, although not all staff had received food hygiene training. Portable electrical appliances had been tested as well as electrical wiring. Central heating systems had been serviced in February 2009. A risk assessment had been completed for Legionella with checks in place in relation to this. Regular monthly checks were also made on hot water temperatures with records kept. The home had a fire risk assessment that had been completed in December 2008. Checks had also been made on window restrictors. Care Homes for Older People Page 22 of 27 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 9 13 Make arrangements to improve the storage arrangements for medicines so as to reflect current legislation and best practice guidance. This is to make sure the shortfalls about medicine storage identified at this inspection are corrected so that all medicines are always stored safely and do not present a risk to anyone in the home. 05/07/2009 2 29 19 Before a person starts work 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 residents are protected through robust recruitment procedures. Not inspected at random inspection on 4th June 2009 but will be checked as properly actioned at a future inspection. 30/04/2009 Care Homes for Older People Page 23 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 9 13 Make arrangements to improve the storage arrangements for medicines so as to reflect current legislation and best practice guidance. This is to make sure the shortfalls about medicine storage identified at this inspection are corrected so that all medicines are always stored safely and do not present a risk to anyone in the home. 31/05/2010 2 29 12 A risk assessment must be 30/04/2010 completed regarding any information on an applicants Criminal Records Bureau disclosure in relation to suitability for employment. This is to protect residents. 3 29 19 Before a person starts work in the home, all the information and documentation specified in 30/04/2010 Care Homes for Older People Page 24 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 Schedule 2 of the Care homes Regulations 2001 must be obtained. This is to ensure that residents are protected through robust recruitment procedures. 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 3 The home should insist on receiving written information from local authorities about all prospective residents needs before they are admitted to the home. A record should be made of the date of receipt of any care plan received from a residents funding authority. Review the storage of eye drops in the fridge and change this in accordance with information provided by the manufacturers. Medication audits should be more robust with particular attention to gaps in the recording of medication administration and the standard of any hand written directions made by staff in the home. Consideration should be given to the development of a room to be used primarily for storing medication. Make arrangements so that all staff write the date on any containers of medicines when they are first opened to use. This helps with good stock rotation in accordance with the manufacturers or good practice directions and with audit checks that the right amount of medicines are in stock. Check that all residents who would benefit from subtitles on the television are aware of how to use these. Introduce gardening activities if these are in line with residents interests. Page 25 of 27 2 3 3 9 4 9 5 6 9 9 7 8 12 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 9 10 11 18 19 22 Give consideration to providing safeguarding training to all staff. Give consideration to providing some shelter for any resident using outdoor space for smoking. Give consideration to organising an audit from a suitable outside organisation in relation to the communication needs of people with a sensory impairment. Review the training and skills of staff in communicating with residents with a sensory impairment. With a view to providing further training to increase and update skills and knowledge. Quality assurance checks should be made of recruitment practices. Check that all staff involved in food preparation have received suitable training. 12 30 13 14 33 38 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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