Care Home: Hillcroft Residential Care Home

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What the care home does well People had access to useful information about the services available at Hillcroft; this would help them to decide whether the home was the right place for them to stay. Residents had access to a range of health care support; their health had been monitored and appropriate advice sought as needed. Staff were trained in health care matters which would help them to recognise and respond to any changes in resident`s health. Residents and their relatives were kept up to date and involved in decisions about care; this would help to ensure that residents received the care they both needed and wanted. Residents were happy with the meals they received; comments included `the meals are very good, we always get a choice` and `the food is good and is better now we have our own chef`. There were a range of activities and entertainments that met residents diverse social needs and expectations. Information had been collected about residents hobbies and interest which helped staff to provided suitable activities for individuals. One resident said `there is something going on everyday`. Residents said they were able to make choices about how to spend their day. They said they could do what they wanted and staff listened to them and respected their requests. A range of specialised aids and adaptations were provided to maintain resident`s comfort and safety and to help them maintain their independence wherever possible. Residents knew who to speak to if they were unhappy and were sure their concerns would be taken seriously. One resident said `if I was unhappy I would speak to Margaret (the registered manager) as I know she would sort everything out` and another said `Margaret is always here and always asks if everything is alright`. Staff responded to residents and visitors to the home in a friendly but respectful manner. It was clear that residents and staff were very fond of each other and this helped to create a homely feel to the home; one resident said `staff love us and respect us and thats how it should be`. Residents said `I think there is not a lot they can do better` and `staff are caring and friendly`. Staff were given the appropriate training and support to help them to look after people properly. Staff said `the induction was very interesting and I found out a lot of things that were new to me` and `the training is very good and always available`. What has improved since the last inspection? There was a registered manager in post who was responsible for the day to day running of the home. Staff made positive comments regarding the management of the home including `the manager is always there when I need and is very supportive`, `the home is well run and the management team are always at hand`, `the home is run very well` and `the atmosphere is homely and happy`. From a tour of the home it was clear that the registered persons had worked hard to respond to previous concerns and had made a number of improvements to ensure residents lived in a a pleasant place. There was a plan to support further improvements which had been discussed with residents at meetings; this supported that residents were involved in the day to running of the home. One staff said `we have worked hard to improve the home` and one resident said `I like the improvements, the home is lovely`.The way in which resident`s medicines were managed had improved; records and practices showed that medicines were managed safely and residents received the correct treatment. New staff were recruited safely and checks were in place prior to them starting work; this ensured residents were protected from unsuitable people. What the care home could do better: The information collected about residents before they were admitted to the home could be improved; this would ensure all aspects of residents needs were considered. The care plans had improved although there was still a lot of duplication of information resulting in some residents needs not being recorded clearly. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hillcroft Residential Care Home 16-18 Long Lane Aughton Ormskirk L39 5AT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Matthews     Date: 0 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Hillcroft Residential Care Home 16-18 Long Lane Aughton Ormskirk L39 5AT 01695422407 01695420866 sv22susan@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Raycare Limited care home 29 Number of places (if applicable): Under 65 Over 65 29 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home only - Code PC 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 The maximum number of service users who can be accommodated is: 29 Date of last inspection Brief description of the care home Hillcroft is a converted three-story building set within is own grounds and is registered to provide personal care for up to 29 older people. There is car parking space at the front and side of the building. The home is situated in the village of Aughton on the outskirts of Ormskirk where there is a range of community and leisure facilities. Accommodation is provided on three floors which can be accessed either by stairs or passenger lift. There are shared and single occupancy bedrooms, most of which have en suite facilities and there are bathroom and toilet facilities on each floor. Care Homes for Older People Page 4 of 28 Brief description of the care home Communal space consists of two lounges, of which one has a conservatory extension; there is a separate dining room. The gardens are attractive and easily accessible with a small courtyard and patio area at the back of the building. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £385.50 to £435.00. There were additional charges for newspapers, hairdressing, dry cleaning, private chiropody and personal toiletries. Care Homes for Older People Page 5 of 28 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: The key unannounced inspection, including a visit to the home, took place on 6th July 2009. The last inspection on this service was completed on 26th June 2008. The inspection process included looking at records, a tour of the home, discussions with the registered manager and two senior care staff and four residents. The inspection also looked at things that should have been done since the last visit and a number of areas that affect peoples lives. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? There was a registered manager in post who was responsible for the day to day running of the home. Staff made positive comments regarding the management of the home including the manager is always there when I need and is very supportive, the home is well run and the management team are always at hand, the home is run very well and the atmosphere is homely and happy. From a tour of the home it was clear that the registered persons had worked hard to respond to previous concerns and had made a number of improvements to ensure residents lived in a a pleasant place. There was a plan to support further improvements which had been discussed with residents at meetings; this supported that residents were involved in the day to running of the home. One staff said we have worked hard to improve the home and one resident said I like the improvements, the home is lovely. Care Homes for Older People Page 7 of 28 The way in which residents medicines were managed had improved; records and practices showed that medicines were managed safely and residents received the correct treatment. New staff were recruited safely and checks were in place prior to them starting work; this ensured residents were protected from unsuitable people. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 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 28 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 were given clear information about available services to help them decide whether Hillcroft was a suitable place for them to live. Residents were only admitted to the home following a detailed assessment of their needs; this ensured they could be looked after properly. Evidence: The information about the home had been updated and made available to new and existing residents and their families; this would help people to decide whether Hillcroft was the right place for the to stay. The service user guide needed to include a summary of last inspection, comments from people using the service and a copy of terms and conditions; it was not yet available in other formats but the registered manager said this could be considered if needed. Residents said they had been given sufficient information about Hillcroft before they were admitted. Care Homes for Older People Page 10 of 28 Evidence: The records of three residents were looked at in detail. Each resident had been issued with a copy of their contract or statement of terms and conditions although the room to be occupied was not recorded; residents need this information to ensure they were aware of their rights and obligations during their stay at Hillcroft. Information was collected about residents before they were admitted to help staff to determine whether they could be looked after properly. The resident and significant other people such as relatives and social workers had been involved in the assessment process; this would help to ensure residents received the care they both needed and wanted. The pre assessment form had been reviewed although it did not reflect all aspects as listed in standard 3.3 and could lead to some needs not being considered. The registered manager said people would be invited to visit the home and view the facilities and meet staff and other residents before they decided to live at the home. A member of staff or key worker would be allocated to them and would be available to help them to settle in and to answer any questions they might have. Training records showed that staff had the skills and competencies to meet current residents needs. Staff surveys indicated they were given the training they needed. Care Homes for Older People Page 11 of 28 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. Residents health and personal care needs were met although the detail in the care plans did not always reflect the care and attention being given. Medicine practices had improved and showed that medicines were managed safely. Evidence: Three residents records were looked at in detail. The care plans had improved although there was still a lot of duplication of information resulting in some residents needs not being recorded clearly. Examples included lack of information to advise staff to recognise and respond to a residents change in blood glucose levels, how to support a resident who suffered from low mood and to recognise any side effects from her medication and how to support a resident who suffered from arthritic pain. From discussion with staff it was clear they were aware of residents needs but that the care plans did not always reflect the care that was being given; this could place residents at risk of not receiving the care they needed. There was some good information about residents likes, dislikes and preferences and Care Homes for Older People Page 12 of 28 Evidence: the daily report recorded how residents had spent their day and whether their condition had improved or not. Residents and their relatives had been involved in decisions about care and any changes to the care plans; this would ensure they would receive the care they both needed and wanted. Any risks to residents had been assessed but action to be taken by staff to remove or reduce the risks were not always recorded in a plan of care. The risk assessments need to be kept under regular review to identify any changes in condition. The use of bed rails had been risk assessed, discussed with the resident and their relatives and kept under review; this would ensure that this method of restraint was appropriate for the resident. Residents had access to a range of health care support; their health had been monitored and appropriate advice sought as needed. Staff were trained in health care matters which would help them to recognise and respond to any changes in residents health. Residents said they received the care and support they needed. Residents who required nursing input were supported by the district nursing service; staff said the nurses are very good and come when needed. The medication procedures had been reviewed but needed minor review to support staff with ordering, medicines taken away from the home, handwritten entries, PRN or as needed medicines and verbal changes. Records had improved and supported safe management of residents medicines. Medicines were stored securely and at safe temperatures. Details on medication records (MARs) had improved and would reduce the risk of error. Only senior staff managed medicines and they had received appropriate training to help them to do this safely. Staff responded to residents and visitors to the home in a friendly but respectful manner. It was clear that residents and staff were very fond of each other and this helped to create a homely feel to the home; one resident said staff love us and respect us and thats how it should be. There were policies and procedures to support staff with dying and death. Care plans included residents last wishes and choices which would be followed by staff. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents social and recreational needs and expectations were met. Residents enjoyed healthy, varied and nutritious meals that suited their dietary needs and preferences. Evidence: Residents said they were able to make choices about how to spend their day. They said they could do what they wanted and staff listened to them and respected their requests. The provision of activities, entertainments and outings had improved. Staff had collected information about residents routines, hobbies and interests; this would help to plan more suitable activities. From looking at records and discussion with residents it was clear that a range of suitable activities were being provided; one said there is something going on everyday. It was recommended that the names of the residents who participated in the activities were recorded to help to identify whether every residents social needs were being met. On the day of the inspection residents were enjoying a sing a long and one resident said it makes us feel happy another resident said when I was a hundred, the party they did for me was lovely. Residents were involved in planning future activities and entertainments; this showed they were Care Homes for Older People Page 14 of 28 Evidence: supported to make decisions about their lives. Residents were able to maintain links with the local community and friends and family. One resident said she enjoyed meeting her friends at the local luncheon club and church. Another resident said Ive made some good friends here, there is always someone to talk to. Residents said their visitors were always made to feel welcome. Staff were observed responding to residents and visitors to the home in a friendly but respectful manner. The menus offered residents a choice of nutritious and healthy meals. Residents made positive comments about the meals including the meals are very good, we always get a choice and the food is good and is better now we have our own chef. Residents had been consulted about any changes to the menu and the kitchen staff were aware of their food preferences; this would ensure that residents received meals they enjoyed. Dining areas had been improved and were bright and clean; tables were pleasantly set with menus, appropriate condiments, cutlery and crockery. Staff were patient and helpful and gave support and assistance where needed and the meal time was unhurried and enjoyed by residents. Care Homes for Older People Page 15 of 28 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 were able to express their concerns and complaints and were confident they would be listened to. Procedures to protect residents from harm were clear although lack of staff could place residents at risk. Evidence: People had access to a clear complaints procedure and records showed complaints were responded to properly. Residents knew who to speak to if they were unhappy; one resident said if I was unhappy I would speak to Margaret (the registered manager) as I know she would sort everything out and another said Margaret is always here and always asks if everything is alright. Staff said they knew how to respond if anyone had any concerns; this would ensure peoples concerns and complaints would be listened to. The safeguarding procedures had been reviewed to provide staff with clear guidance; this would help them to contact the appropriate agencies if abuse or neglect were suspected. Not all staff had been provided with up to date safeguarding training but further sessions were planned; staff need regular training to help them to identify and respond appropriately to any abuse or neglect. Records showed that safeguarding adults had been discussed at staff meetings and all staff had read the procedures. There were procedures to support staff with reporting any poor practice in the home, Care Homes for Older People Page 16 of 28 Evidence: dealing with residents finances and dealing with verbal and physical aggression; these procedures would help to guide staff to protect residents. The use of bed rails had been risk assessed, discussed and agreed with residents and their relatives and kept under review; this would ensure this form of restraint was appropriate. Care Homes for Older People Page 17 of 28 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 lived in a pleasant, safe and comfortable home with records to support ongoing improvements. Evidence: A tour of all areas was undertaken. There had been a number of concerns regarding some areas of the home at previous inspection visits however it was clear that the registered persons had worked hard to respond to the concerns and had made a number of improvements to ensure residents lived in a a pleasant place. There was a plan to support further improvements which had been discussed with residents at meetings; this supported that residents were involved in the day to running of the home. One staff said we have worked hard to improve the home and one resident said I like the improvements, the home is lovely. There was a maintenance book where staff recorded any requests for repairs; it was recommended that a date was recorded on completion of the work to help to identify whether requests were responded to promptly. Residents had access to a safe and secluded garden and patio areas although the enclosed patio area was in need of attention as the uneven paving slabs could place people at risk of trips and falls. One resident said he enjoyed sitting in the gardens in the warmer weather. Care Homes for Older People Page 18 of 28 Evidence: There were various communal areas all of which were pleasantly decorated, bright and comfortable. Most bedrooms had en suite facilities and some were supplied with commodes; there were clearly marked toilet and bathroom areas located near to bedrooms and communal areas. Residents were provided with a range of specialised aids and equipment to maintain their comfort and safety and to help them to maintain their independence wherever possible. All rooms were equipped with a nurse call system and enabled residents to call for assistance from staff. Wheelchairs were safely stored either in residents rooms or in designated storage areas. All bedrooms had suitable door locks and a lockable storage space to help maintain residents rights to privacy. New carpets, bedding and furnishings had been purchased to ensure residents rooms were pleasant and comfortable; residents were happy with their rooms and many had brought in personal treasures to enhance the homely feel of the home. Shared rooms had privacy screen to ensure residents privacy and dignity were respected. Radiators were covered to protect residents from heat and scalds. Window restrictors were in place to reduce any risk to residents and also to improve security, one restrictor was damaged in the pink bathroom and this was reported to the registered manager. The laundry was situated in the basement and was accessed by using a key code. The laundry was suitably equipped and had been cleared of debris to make it safe for staff. All areas of the home were clean and residents said it was always fresh and clean. One resident said her clothes were well looked after and always came back cleaned and ironed. Care Homes for Older People Page 19 of 28 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. Staff were suitable, competent and provided in sufficient numbers to meet residents needs. Evidence: Rotas showed the home was staffed with sufficient numbers of staff to meet the needs of the residents. Residents said there were enough staff to give them the support they needed. Residents made comments about the recent changes to staff and said staffing levels have improved, there have been changes to staff but everyone is very nice and we miss staff when they leave as they get used to what we want. The registered manager said there had been changes to the staff team but it was now stable with a low turnover ensuring residents received care from staff who were familiar with their needs. Staff comments included there is good teamwork and we all work well as a team. Other comments from residents included I think there is not a lot they can do better and staff are caring and friendly. Three staff files were looked at in detail and showed that a safe and fair recruitment procedure had been followed that would protect residents from unsuitable people; staff confirmed that all checks had been completed before they were employed. However Care Homes for Older People Page 20 of 28 Evidence: the application form needed to include clear dates of employment to ensure there were no unexplained gaps in employment and the reference request form should clearly indicate the referees details; the registered manager said all the procedures, handbooks and records were to be reviewed over the next few weeks. It was recommended that a recent photograph as a means of identification should be included as part of the application process, the validity of references should be checked by a telephone call and the employment contract should indicate a start date. (see recommendations made under records - standard 37). There was a training matrix that clearly identified staff training needs and showed the competencies of current staff. Records showed that new and existing staff were given appropriate training to help them to understand the needs of the residents in their care and that more than half of care staff had achieved a recognised qualification in care; this showed that the home was committed to improving standards of care through the provision of training. Staff confirmed they were given the training they needed to meet residents needs; comments included the induction was very interesting and I found out a lot of things that were new to me and the training is very good and always available. All staff were given regular individual support which would help to identify any further training needs. New staff were given extra support and monitoring until they were confident to work independently as part of the team. Staff were able to air their views and opinions at meetings although one staff commented that meetings should be held on a more regular basis. Staff said they were kept up to date and were happy working at the home; one staff said I enjoy my job and the people around me. Care Homes for Older People Page 21 of 28 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 was safe and well managed and people were involved in decisions about how the home was run. Evidence: Mrs Margaret Sutcliffe is the registered manager. Mrs Sutcliffe has the required care and management qualification that would support her in her role and there was evidence that she had updated her skills and knowledge. Staff made positive comments regarding the management of the home including the manager is always there when I need and is very supportive, the home is well run and the management team are always at hand, the home is run very well and the atmosphere is homely and happy. There had been a number of concerns highlighted at the last key inspection; it was clear, from the evidence gathered at this inspection visit, that management and staff had worked very hard to improve all aspects of the home. One staff said we have Care Homes for Older People Page 22 of 28 Evidence: worked hard to improve the home. The home had achieved the Investors In People award (IIP), which is a recognised quality assurance system that monitors various aspects of the management of the home and the training and development of staff; the results were used to improve the service for people. They home had also achieved a five star rating from an external monitoring company who had visited the home and had sought peoples views and opinions. The registered manager was advised that the star rating from the monitoring company could be confused with the star rating from the Care Quality Commission (CQC) and it was suggested that an explanation be included in the service user guide to avoid misleading anyone. The views and opinions of residents and relatives had been obtained either at meetings or as part of an annual survey and used to improve the home; this showed they had been kept up to date and had been involved in decisions about the day to day running of the home. Policies and procedures had been reviewed since the last key inspection and provided staff with clear and safe guidance. Staff were also issued with a handbook that provided them with useful information. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a reasonable picture of what had improved over the last twelve months and where further improvements were needed. There was a business plan for the next twelve months which showed how the service was to be developed. The registered provider (owner of the home) regularly visited the home to make sure people were happy with the service they received and that the home was being managed properly. Systems to check whether staff were following policies and procedures and meeting peoples needs were being developed. Records were stored securely. Any concerns with records had been referred to under individual standards. Recommendations relating to recruitment practices are included under standard 37. Records showed that residents finances were safeguarded although it was recommended that two signatures were obtained for the records. A random check of records showed that equipment and systems were safe, serviced Care Homes for Older People Page 23 of 28 Evidence: and maintained and staff had received training that would help to keep them and others safe. Care Homes for Older People Page 24 of 28 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 25 of 28 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 care plans must clearly detail residents needs and any action to be taken by staff to meet those needs. This will ensure residents needs will be met. 17/08/2009 2 8 15 Any risks to residents must 17/08/2009 be kept under regular review and action to be taken by staff to reduce the risk to be included in a plan of care. This will ensure residents needs will be met. 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 1 The service user guide needs to include a summary of the last inspection, residents views of the service and a copy of the statement of terms and conditions; this would ensure people were fully aware of their rights and obligations during their stay. The room number needs to be included as part of the Page 26 of 28 2 2 Care Homes for Older People agreed contract/terms and conditions; this re-assures residents that they will stay in the room of their choice. 3 3 The pre assessment form should include all aspects as listed in standard 3.3; this would ensure all aspects of residents needs are considered. The care plan format should be reviewed to reduce duplication of information. There should be medication procedures to support staff with ordering, medicines taken away from the home, handwritten entries, PRN or as needed medicines and verbal changes. The activity record should include the names of residents who have participated in the activity; this will help to ensure all residents social needs are being met. All staff should receive regular safeguarding training to ensure they recognise and respond to any abuse or neglect. The enclosed patio area was in need of attention as the uneven paving slabs could place people at risk of trips and falls. A date should be recorded in the maintenance book on completion of the work; this would help to identify whether requests were responded to promptly. The window restrictor in the pink bathroom should be repaired or replaced to ensure residents safety. There should be systems to check whether staff were following policies and procedures and meeting peoples needs Two signatures should be recorded for any financial transactions undertaken on behalf of the residents; this would ensure residents finances were safeguarded. The employment contract should indicate a start date. A recent photograph as a means of identification should be included as part of the application process. The application form should include a clear record of the dates of employment to ensure there were no unexplained gaps in employment. The reference request form should clearly indicate the referees details and should be checked by a telephone call; this would help to check whether it was from an appropriate person. 4 5 7 9 6 12 7 18 8 19 9 19 10 11 25 33 12 35 13 14 15 37 37 37 16 37 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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