Care Home: Holywell Bay Care Home

What the care home does well People who use the service, who we could speak to, said they were happy living in the home. They said staff were caring and supportive. Relatives were also positive about the care given. Food provided is to a good standard. The home employs an activities organiser who does an excellent job providing a range of activities four days a week which people using the service enjoy. Other staff members seem highly committed and caring towards the people using the service, and we observed staff working with the client group to a high standard. What has improved since the last inspection? The home now has a walk in shower facility on the first floor. Therefore people in this part of the building now have a usable bathing facility near their rooms, and the home has a suitable bathing facility for wheelchair users. Some decoration has been completed in the main lounges and these look pleasant and accommodating. Pre admission assessment procedures at the home are much improved so we were much more satisfied there are appropriate procedures that the registered persons check to ensure they assess people correctly before admission is arranged. All people we case tracked generally had a satisfactory care plan; although some concerns have been raised, to us, about care planning and recording processes by external professionals. Medication systems are now managed to a satisfactory standard. Pureed food is now separated out so it is more appealing to people who require a soft food diet. The home has a new designated responsible individual, and the person carries out visits, on behalf of the registered provider, on a monthly basis. The lift has been serviced since the last inspection. What the care home could do better: We still have several concerns about the operation of the service. In summary the statutory requirements, which the registered provider must take action include improvement regarding: (1) Care planning, risk assessment and record keeping regarding the care of people in the home (2) There is a need for significant financial investment in the building so it meets satisfactory standards for the people living there. (3) Staffing levels need to be reviewed. There are not appropriate levels of staff on duty to meet people`s needs. (4) Staff training for example in regard to health and safety related issues, which all care staff are required to undertake. Some staff also need to receive training regarding dementia, dealing with aggression/ challenging behaviour. (5) We require the registered provider to investigate concerns raised to us,in regard to the conduct of the registered manager. The registered provider needs to assure the Care Quality Commission that the registered manager is a fit person to manage the home.(6) Quality assurance policies and practice need some improvement. (7) Health and safety precautions, in some areas, require some improvement. These matters must be addressed in the timescales set, and the commission will monitor to ensure appropriate action is taken through our assessment processes. Key inspection report Care homes for older people Name: Address: Holywell Bay Care Home Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT     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: Ian Wright     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 45 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 45 Information about the care home Name of care home: Address: Holywell Bay Care Home Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT 01637830801 01637831119 holywellbay@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Newport Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Service users to include 1 adult under the age of 65 years. The maximum number of service users who can be accommodated is 45. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia aged 65 years and over on admission - Code DE(E) - maximum 45 places Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission - Code MD(E) maximum 45 places Date of last inspection 2 2 0 4 2 0 0 9 0 0 Over 65 45 45 Care Homes for Older People Page 4 of 45 Brief description of the care home Holywell Bay provides care and accommodation for up to 45 older people- all of whom may be diagnosed with dementia and/ or mental disorder. The registered provider is Newport Care Limited. The registered manager is Ms Sherran Thompson. Holywell Bay care home is situated in the village of Holywell Bay, which is on the north coast of Cornwall near the town of Newquay. The home has pleasant views of the sand dunes, golf course and sea. The home is a large two-storey property which has been extended. There is a choice of communal areas for example a large dining area, which also has a seating area, a large lounge, a TV lounge, and a smoking room. There are also other rooms which the registered manager said the provider is planning to redecorate so they can be used. The home also has an enclosed garden which residents can use. At the time of the inspection fees were between £502 and £2421 per week. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the homes management or the CQC website. Care Homes for Older People Page 5 of 45 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: This key inspection took place by one inspector, in sixteen and a half hours over two days. All the key standards were inspected. The methodology used for this inspection was: (1)To case track three people using the service. This included, where possible, meeting and discussing with the people their experiences, and inspecting their records. (2) Discussing care practices with management, staff, relatives and people who use the service. (3) Inspecting records and the care environment. (4) Carrying out a postal survey of the views of people who use the service, staff who work in the service, and the relatives of people who use the service. (5) An Expert by Experience accompanied the inspector. This person works for Age Concern/ Help the Aged and has experience of using care services for elderly people. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report. Care Homes for Older People Page 6 of 45 Care Homes for Older People Page 7 of 45 What the care home does well: What has improved since the last inspection? What they could do better: We still have several concerns about the operation of the service. In summary the statutory requirements, which the registered provider must take action include improvement regarding: (1) Care planning, risk assessment and record keeping regarding the care of people in the home (2) There is a need for significant financial investment in the building so it meets satisfactory standards for the people living there. (3) Staffing levels need to be reviewed. There are not appropriate levels of staff on duty to meet peoples needs. (4) Staff training for example in regard to health and safety related issues, which all care staff are required to undertake. Some staff also need to receive training regarding dementia, dealing with aggression/ challenging behaviour. (5) We require the registered provider to investigate concerns raised to us,in regard to the conduct of the registered manager. The registered provider needs to assure the Care Quality Commission that the registered manager is a fit person to manage the home. Care Homes for Older People Page 8 of 45 (6) Quality assurance policies and practice need some improvement. (7) Health and safety precautions, in some areas, require some improvement. These matters must be addressed in the timescales set, and the commission will monitor to ensure appropriate action is taken through our assessment processes. 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 45 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 45 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. Information provided to people who use the service (e.g. regarding services offered) needs improvement. For example people who use the service must receive a statement of terms and conditions of residency or contract, containing the information required in the regulations regarding payment of nursing fees. This will ensure that people using the service receive transparent information about fees payable, and what services are provided-for nursing needs- free of charge for the person. Pre assessment procedures are satisfactory and should ensure the registered persons check they can meet a persons needs before admission is arranged. Evidence: The home has a satisfactory statement of purpose and service user guide. A copy of the service user guide is available in each bedroom. We inspected the pre admission assessments for three people. There is a satisfactory pre admission assessment policy and pre admission assessment format. Completed Care Homes for Older People Page 11 of 45 Evidence: assessments contained satisfactory information regarding the people who moved to the home. One professional, and one service user who responded to our postal survey, wrote that they received enough information about the service and assessment systems are satisfactory. Senior staff told us a full pre admission assessment is completed with the prospective resident before admission is arranged. We viewed the contracts / statement of terms and conditions of residency for some people using the service. As we outlined at our inspection last year, there still needs to be a clear statement of how nursing fees will be paid (i.e. it needs to be clear the State will fund this part of the fee (for nursing), and individuals are only paying for board and personal care). Costs within the contract clearly need to be broken down. The registered persons need to check the records for all people using the service, and ensure information provided is appropriate. Where necessary the person using the service and their representatives need to be provided with this information. Care Homes for Older People Page 12 of 45 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are happy with the personal and health care support they receive. Care staff are viewed as caring and supportive. Some improvement is required regarding record keeping and care planning. There are also some concerns regarding the care of some users as highlighted below, and we are seeking further information regarding these matters. The medication system, is generally managed to a satisfactory standard. Evidence: The home caters for people with dementia and /or mental disorder. Some people also have physical disabilities, and some people are frail due to their age. Some of the people accommodated can be significantly challenge services. The Expert was told that people living in the home are given the choice what they can wear. However, when people are unable to make a choice they receive appropriate support. Everyone looked well cared for, well dressed, and it was clear staff did their best to ensure peoples autonomy is maintained as much as possible so their clothing / appearance reflects individuals personality and culture. Care Homes for Older People Page 13 of 45 Evidence: The inspector was able to talk with several people using the service. Everyone the inspector spoke to said they were happy living at the home. The inspector also was able to speak to several relatives. All said they were happy with their relatives care, although a minority said there were one or two unresolved problems. One matter was referred to the manager to be investigated. Several people said staff were excellent. Other comments from relatives included that staff were caring, very attentive, treat people using the service with love and care and are very dedicated. The inspector spent the majority of his time in the communal areas of the home. It was clear that some of the people using the service could be challenging or disturbed for example shouting, needing high levels of physical supervision to prevent them from falling and harming themselves etc. Staff reacted to the constant demands in a calm and highly professional manner. Staff were always person centred, and did all they could to meet peoples needs. There seemed no unnecessary separation between the resident group and the staff group; staff were only too keen to sit with people using the service, comfort them and talk with them. Levels of interaction were excellent. The inspector asked several relatives if the levels of interaction were always to such a high standard. All confirmed this was the case. One person said they had initially been suspicious that the high levels of positive interaction was put on, but after visiting the home on many occasions, and at different times of the day, were now certain the caring nature of the staff group was genuine. The inspector also believes this is the case, after several visits, and carrying out two formal observation exercises at the two previous key inspections. One person raised a concern with us that they wanted to move from the home, and they believed they were unfairly restricted by care staff. Assessment of the persons records showed that the person does have professional representation. An assessment by a mental health professional in the Autumn of 2009 concluded that restrictions on the person were in their interests, and also the person was placed in an appropriate setting. However, it was concluded that action should be taken to move the person to the area they wished to live. We are seeking clarification from the agency regarding what action has since happened, and whether current restrictions will be reviewed to ascertain if they are still necessary. We will write to the person concerned, as promised, once we have received the required information. An Expert by Experience helped the inspector with this key inspection. She spent her time talking and observing people using the service, staff and management. She said she observed staff being caring, kind and attentive to the residents needs. She said that staff were very focused on peoples needs, and showed affection and friendship, Care Homes for Older People Page 14 of 45 Evidence: which appears to be genuine and not put on for inspectors. All staff were viewed as caring by our expert. The Expert raised concerns to us that there are no visits from physiotherapists or occupational therapists which worried her as most of the residents just sit around all day becoming more stagnant. The Expert was concerned that people did not have more access to zimmer frames or other walking aids which may enable them to be more independent.The inspector has said to the expert that there is inadequate services available for people, in Cornwall. However it is recommended that management of the home ask the health services to assess people individually for these services. However one relative remarked that their partner, who lived in the home, had improved their mobility skills significantly since moving to the home. The Expert was also concerned that one person was being moved by two staff-when it may have been more appropriate for a hoist to be used. Staff assured us that their practice was correct, but such matters do need to be kept under review. The Expert said staff were observed knocking on peoples doors before entering. In regard to bathing our expert was told people could usually have a bath once a week, with additional bed baths. We inspected the files of four people who use the service. A care plan was available on all files inspected. Care plans are stored in the nurses station-which is situated off the dining room. Staff had helped some of the people using the service to create life stories, which included photos of people and their families. It was disappointing these documents had not been incorporated into the peoples main files-as this information would be highly beneficial-particularly for new staff- to get to know the person. From the postal survey we can conclude that the perception of many stakeholders is that people using the service are well cared for. Many of the staff replying to our survey said the care people received was a positive of the service provided. One external professional responded to our survey. They said in regard to the provision of health and social care this was usually well provided., and peoples privacy and dignity was usually respected. The person said the diverse needs (in relation to age, ethnic background, sexuality, disability etc.) is always respected. Staff were viewed as caring and empathic. In regards to relatives, carers and advocates; the majority of this group said the service always (5) meet the needs of people using the service, with a minority(1) saying this was usually the case. Most people (4) said staff always give the correct support, with the rest(2) saying this was usually the case. This group generally felt the Care Homes for Older People Page 15 of 45 Evidence: staff group responded well to the diverse needs (in relation to age, ethnic background, sexuality, disability etc.) The one person who uses the service, who responded to our survey said they were happy with the care they received. The majority of relatives said staff do their best to assist people living in the home to keep in touch with them, and always ensure relatives are informed of important issues regarding their loved one. In regard to health records kept, these still require some improvement. Records of when someone sees a GP and / or a district nurse are satisfactory. We could determine for two of the four people that we case tracked when they last saw a dentist and a chiropodist, but it was not possible to ascertain when any of the people last saw an optician. This may be a recording problem, but it needs to be clear when someone sees a medical professional, so staff keyworkers can ensure people receive this medical support if it is required. It is also vital, at the pre admission stage, staff who complete the assessment, check what medical support has been received, so this can be arranged if this is necessary. A concern has been raised by a health care professional regarding the care of one person at the home. We have referred the matter to Cornwall Council who fund the persons care. The matter is currently being investigated under the authorities safeguarding procedure. We raised a concern about one person who had a hearing impairment. The persons partner said they had raised the issue with their spouse but the person refused to recognise the problem. The relative said it may be helpful for a third party to raise the issue. The issue was not highlighted in the care plan, and it was not clear from the persons file if any action had been taken to discuss the issue, or if it had whether the person had declined assistance. The registered provider needs to address this issue with the person in a sensitive manner. If the person does not wish assistance with, for example, an appointment to the audiologist this should be recorded in their care plan. We inspected the medication system. Medication is stored in a dedicated clinical room. Medication is supplied in a monitored dosage system supplied from a local pharmacist.The medicines room needs complete renovation. The room smelt of damp, and the wall paper had become detached, and was stained due to this problem. However, the room was kept clean by the staff group, and was tidy. Improvement of the room needs to be addressed in the buildings development plan. Storage of general prescribed medication is satisfactory. Some controlled drugs are kept in the home, and administration and recording of these are satisfactory. Care Homes for Older People Page 16 of 45 Evidence: The operation of the system is generally well managed. We did note that a couple of dosages of medication were not signed for, although these seemed to be administered. Similarly there was a minority of types of medication which were over stocked, and greater care of ordering needs to occur so to minimise the cost to the NHS and also to avoid waste through medication having to be returned for disposal. Nurses administer the medication and they have received formal training in March 2009 regarding administration of medication. Care Homes for Older People Page 17 of 45 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. Routines,food and opportunities generally meet the needs of the people living in the home. We have made some suggestions-in the text of this section which should be given serious consideration- to further develop this area of home life. Evidence: People using the service, who the inspector and Expert by Experience spoke to, said they could get up and go to bed when they wished. We observed throughout the inspection a relaxed and friendly atmosphere in the home. As outlined in the previous section, the inspector observed staff being constantly engaged with people in the home to provide good care, and encourage positive interaction. One member of staff said they regularly give the ladies in the home a manicure, and also hand and face massages to all people in the home; which they love. The registered provider has employed an activities worker for three hours in the afternoon for four days a week. The member of staff has made a positive contribution to the home, and assists people to engage in a variety of activities. When we were at home the person had organised a music afternoon and was also showing some DVDs Care Homes for Older People Page 18 of 45 Evidence: of music relating to the era when the people in the home were younger. Many people were thoroughly engaged, and enjoyed these activities. Church volunteers also were visiting one man. He thoroughly enjoyed this, and seemed to find their presence very comforting. The volunteers said the vicar will visit the home approximately monthly, and provide a short service. The Expert by Experience thought there should be more time allocated for activities workers in the home, particularly as the numbers of people living in the home increased (It is currently just over half full). She has also suggested more work is completed with individuals to make personal folders made up of photographs and activities they would have been involved in during their earlier lives. This may help people to keep their memories intact. Some work has already been completed, with some people on life story work but there is room to expand this. Both the Inspector and Expert thought choices available to people could be expanded. For example the majority of people spent their time in the main lounge, although there is a quieter lounge area in the dining room where some people spend their time, and also a smoking lounge. The large TV lounge could be better utilised for peoples daily activities. We were disappointed that although the weather was pleasant, the door to the garden was locked, and people could not access the garden. Exploring the possibility of utilising these areas of the home would provide people with more choice of where to spend their time. We were told a hairdresser visits the home once a fortnight. There is a dedicated hair salon area. However both the Inspector and Expert felt this was dirty and did not look as if it had been used for some considerable time. The Expert looked at what level of involvement there was for people to do small tasks such as laying tables or clearing up. The Expert felt it would take a lot of work and interaction to enable people to participate in such everyday activities. However it is a good idea that people are offered the opportunity so they can feel useful-if that is the wish of individuals living in the home. We understand no external entertainers are employed by the registered persons.Our Expert commented the home does not have any transport so people are dependent on relatives to take them out, and many have no opportunities to go outside or on social trips. The one person using the service, who answered our survey said there was enough activities available. Relatives who answered our survey said either people always (3) Care Homes for Older People Page 19 of 45 Evidence: could live the life they chose or usually (2) could choose the lifestyle they wanted to live. We saw many people come to visit the people living in the home. Many relatives stayed for several hours. Although people tended to receive their visitors in the main lounge, there are numerous other rooms for people to receive visitors in private. People are positive about the food provided. A cooked breakfast-such as egg on toast can be provided. The main meal is served at lunch time. There is a choice of cooked tea or sandwiches at tea time. Regular drinks were served to people throughout the days of the inspection. The main meal on the day of the inspection was served in the dining room, and the majority of people were assisted through to that area. Some people remained in the lounge to have their meal. Staff assisted them in eating where this was necessary. Assistance was to a good standard, staff fed people at the individuals pace, and talked with the person when the person wanted this. However some people using the service were either disruptive or some people had to be encouraged to sit down every so often (so they would eat enough, and also so they did not fall). Staffing over the meal time seemed very stretched, due to the amount of personal assistance people require. Concerns about staffing levels are referred to, in more detail, in the staffing section of the report. The inspector had a meal with people living in the home. The food served was prepared to a good standard, and the majority of people said they enjoyed the meal. Pureed meals are served appropriately i.e. meat, and different vegetables are all pureed separately so the food looks presentable and appetising. The kitchen was inspected. It is clean and well equipped. There was generally a satisfactory supply of stock. However staff complained that there was not enough meat provided for them to cook some meals and they subsequently had to bulk meals out such as stews with vegetables. This is not appropriate; particularly as food is so important to this group of people for whom meal times are an important part of the day. The matter was discussed with the representative of the responsible individual, who assured us after the inspection that higher quantities of meat would be provided for the cooks. Although we do understand the need to avoid waste, it is essential that staff are empowered to provide satisfactory quantities of food for people living in the home. The commission will be very concerned should we have further evidence of unreasonable economising. Care Homes for Older People Page 20 of 45 Evidence: Suitable records of meals are kept. The Food Standards Agency Better Food, Better Guidelines hygiene system is in place. The cooks also said they needed better equipment e.g. to peel vegetables (currently due to lack of time they were often purchasing unnecessarily expensive frozen food stuffs) and to puree food (the cooks were only able to purchase domestic style food processors-which are unsuitable in a commercial kitchen.) One member of staff told us that the home had gone through several food processors in the last 18 months-as the equipment provided was unsuitable-it would therefore be more cost effective for a commercial piece of equipment to be purchased. The inspector spoke to the representative of the responsible individual-who agreed with this analysis- and said she would liaise with the registered persons to convince them to ensure more appropriate equipment is purchased. Care Homes for Older People Page 21 of 45 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding procedures are satisfactory, and people who we contacted did not have any concerns about the service. People said they know what to do if they wish to express a concern or make a complaint. Some improvement regarding training in safeguarding, mental capacity and deprivation of liberty is necessary, although this appears to be underway. Evidence: The registered persons have a satisfactory complaints procedure. A summary of this is contained in the homes statement of purpose and service user guide. The registered persons have not received any complaints regarding the home. The Care Quality Commission have also not received any complaints about the home. When our Expert by Experience spoke to people in the home she reported that nobody reported any concerns, and people said to her that people had not experienced any swearing, bullying or mistreatment in any way. All staff answering our survey said they knew what to do if they had concerns about the home. The relative answering the survey also knew what to do if they had a complaint. The registered persons have a satisfactory adult safeguarding procedure. Most staff Care Homes for Older People Page 22 of 45 Evidence: have attended adult safeguarding training, although there some staff that need to attend this. Some staff also need to attend training regarding Deprivation of Liberty and the Mental Capacity Act. We have received some concerns from an external professional and this matter has been referred to Cornwall Council, and is being investigated as a safeguarding issue. Policies need to be updated with current contact details regarding the Care Quality Commission. Care Homes for Older People Page 23 of 45 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Holywell Bay is clean and offers acceptable, but basic facilities, for the people living there. Although there has been some improvement in facilities in the last year, the building requires considerable, ongoing investment to bring it up to a satisfactory standard. Evidence: The building was inspected. Holywell Bay is a large building, with lots of space for the people accommodated. There are several communal rooms: a large lounge, a large dining room with a lounge area, a TV lounge, a smoking room, a Chapel room and a hairdressing salon. The garden is accessible to people living in the home if the door is not locked. Bedrooms are primarily situated along two long corridors. There is a large kitchen, and laundry areas. The home has a sluice facility. There is a shaft lift which connects the first floor with the ground floor. The lounges, dining room/ TV area, and another larger TV room are all reasonably decorated and have suitable furnishings. Since the last inspection the main lounge has been decorated, and there are plans to decorate the dining room / TV area. During the inspection, the majority of people using the service were gathered in the large lounge and also the TV area of the dining room. We saw one man using the large TV lounge during the inspection , but otherwise this was not used. The Chapel area was used for an activity session during the inspection. Care Homes for Older People Page 24 of 45 Evidence: People who we spoke to said they were happy with their accommodation. Our postal survey raised no significant concerns regarding the accommodation, although one person commented that bedrooms should be improved and the surroundings upgraded. The Expert by Experience did not think the property was satisfactory. In summary she concluded it was not very homely, and work needed to be completed to make rooms brighter and lighter. She said there should be more pictures and decorations. We agree with this, if it is possible, although we recognise the challenging behaviour of some people in the home may mean that the environment has to be functional to minimise harm to people using the service. The Expert said The home is basic with no attention to making the surroundings a place to want to live in. Action should be taken to improve the environment where this is necessary. Both the Expert and Inspector thought some areas of the home looked very neglected and unused, for example the hairdressing salon. We stated at the last key inspection in April 2009 that the smoking lounge and hairdressing area needed significant improvement. This has not occurred. Both rooms were dated, and particularly the decorations and furnishings in the smoking room are very poor. There are two downstairs toilets. These are both in need of redecoration, were not particularly clean or inviting. The door from the dining room to the hallway is locked and people need to know a code to either enter or leave the main living space. This prevents some people, who are possibly able to, from going to their bedrooms or leaving the main living area with out asking staff. There may be good reason for this in order to protect people from danger, however the registered persons need to actively consider whether they are depriving people of their liberty by the measure that has been taken. The matter needs to be risk assessed, recorded and this assessment regularly reviewed in line with Deprivation of Liberty / health and safety / fire guidelines. We noted that one of the rear doors, by the toilets, was bolted, although it is marked Fire Exit. It is essential the registered persons liaise with the fire brigade to ensure there are a satisfactory number of fire exits. If this door is required as a fire exit, it must not be bolted. If it is not required as a fire exit, the sign must be removed, and there must be a satisfactory number of fire exits for people if they need to leave the home in an emergency. There has been some improvement to the bathroom facilities. At the last inspection Care Homes for Older People Page 25 of 45 Evidence: we noted one area of the building had no communal bathroom facilities. A wet room type facility is now provided, which is fully wheelchair accessible. This ensures that people living in this part of the home have a suitable facility near their bedrooms. Although many of the bedrooms have bathroom facilities, these are in many cases inappropriate for the needs of the group of people accommodated and people using the service cannot use these facilities. There are two other communal bathroom facilities which although satisfactory do require improved decorations to ensure they are attractive and inviting. Some of the bedrooms were inspected. Where resources have been provided staff have ensured some bedrooms have been redecorated and new furniture has been purchased. However some of the bedrooms are still very basic and below the standard of accommodation we would expect; and major investment is still required in this area of the home. Some bedrooms for example require new curtains, and we received a number of comments that bedding is inadequate and needs replacing.The Expert by Experience said bedrooms were basic, outdated and not very cosy. She said Corridors leading to the rooms were very dark and need more lighting.The Expert also commented that although there are two toilets near the main lounge, only one is accessible for people who use wheelchairs, and one person using the service commented that this could cause people having to wait for a long while if people were toileted together. Many of the bedroom doors do not have a lock. It should be a default position that all bedrooms have a lockable bedroom door, and people are issued with a key unless they lack capacity to do so. All people should have a lockable space for valuables in their bedrooms, although we do note that some of the new furniture purchased does have a lockable drawer. One person said they had made a formal complaint to the provider regarding availability of television reception in bedrooms following digital switchover. This was after repeated requests to the registered manager to provide this service which had not been dealt with. The person was assured this matter was rectified for all bedrooms. However we were told that the upgrade was only in regard to four bedrooms. If this is the case, the registered provider needs to ensure that all bedrooms have this facility available to people using the service, as part of the upgrade of the facilities. The outside of the building has been repainted a couple of years ago, although some aspects of the home are beginning to look worn and in need of redecoration again. Care Homes for Older People Page 26 of 45 Evidence: The home was however very clean on during the inspection and there were no unpleasant odours in the home. Care Homes for Older People Page 27 of 45 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. Staff are viewed positively by people who use the service. However staffing levels need to be reviewed to meet the needs of people using the service. Personnel and recruitment records are satisfactory. Training provision needs some improvement so staff have sufficient knowledge and skills to carry out their jobs and meets legal standards. Improvement in these areas will ensure there are sufficient numbers of staff who are trained appropriately work with the people in the home. Evidence: On the day of the inspection there were four care staff on duty from 07:00 to 19:00. There was one registered mental health nurse on duty from 07:00 to 19:00. There is an activities co-ordinator on duty four afternoons a week. There were ancillary staff on duty such as kitchen, laundry and administration staff. At night there were three care staff on duty from 19:00 to 07:00, including one registered nurse on duty from 19:00 to 07:00. We received a number of concerns from staff, and also from some relatives; through our postal survey and through face to face interviews about staffing levels. In our postal survey two people said there were usually enough staff, three people said sometimes and two people said there were never enough staff. Several of the respondents stated there usually was only enough staff to provide personal care and feed people. We interviewed several staff and concerns were raised by a number of Care Homes for Older People Page 28 of 45 Evidence: these staff about staffing levels. People using the service, who the inspector spoke to, all said they were positive about care staff. Our Expert by Experience spoke to several staff members about their experiences regarding working in the home. She was positive about the input staff provided for example staff appear to be focused on the residents. They are showing affection and friendship which appears to be genuine. She said all staff seemed caring, and had no concerns about how staff interacted with the people in the home. She described the staff as having an understanding of the needs of the residents...and appeared to be genuinely caring people who are doing the job for the love and not the money. The rota generally shows there is at least one member of staff less than when we carried out a key inspection in April 2009. There is also one less nursing member of staff during the day. The reason given to us was that there are now only 24 people living in the home (compared with 28 people in April 2009). The home can accommodate up to 45 people. Staff however raised concerns that the people who have been admitted to the home recently are however more dependent (in terms of their need for feeding, personal care, challenging behaviour). Some staff raised concerns regarding the arrangements in place to obtain agency staff. It was alleged that the responsible individual was the only person who could authorise agency staff, and on occasion the person had not been contactable. This had resulted in staffing on occasion, it is alleged, being only three members of staff. If this is the case, it puts staff in a dangerous situation considering the significant needs of the people living in the home. It is essential, that the person in charge of the home, at any time, is enabled to have responsibility for ensuring agreed minimum staffing. It may be appropriate for the registered provider to draw up clear guidelines-perhaps in liaison with CQC- regarding minimum levels of staffing, what routes should be followed if staff are sick (e.g. overtime authorisation, use of bank, agency etc.), but then the manager or nurse in charge should be able to arrange additional staffing in emergencies. We therefore trust this situation, if it is the case, is rectified. It is essential there are always a satisfactory number of staff available at all times to assist people using the service. The inspector spent over half of the time on the inspection in the main lounge. As outlined above staff worked really hard to meet peoples needs, worked in a professional manner and spent their time engaged with people to entertain and care for them. We did note that particularly at lunch time staff were very stretched to feed people, ensure there was appropriate supervision and meet peoples other care needs. Care Homes for Older People Page 29 of 45 Evidence: The Expert also said there was insufficient staff to give residents the type of care they deserve. We note that people spend the majority of their time in one of two rooms. Although on the days of the inspection, the weather was pleasant, the door to the garden was locked so people were unable to go outside. Other rooms such as the large television room were not used. Higher levels of staffing subsequently could have ensured people had more options where to spend their time. We were very concerned that one person, who is paid for at least one to one support (line of sight) was not receiving this, and there were many occasions when there was not a member of staff in the same room. Although it is debatable whether the person now needs such a high level of support, this is what the home is paid to provide. We have also received another concern about the care of another person, where the registered persons were offered additional funding to provide one to one night support for them, but this offer was not taken up. It is clear to us, based upon the needs this of person , that the current night time staffing is not satisfactory. We have reported our concerns to Cornwall Council Adult Social Care Department. We require the registered persons to carry out a thorough review of staffing levels at the home. This needs to take into consideration peoples personal care needs, challenging behaviour, continence needs, assessed levels of supervision, size of the building, staff and other stakeholders views. Personnel records were inspected for seven staff (i.e. nursing and care staff on duty during the 24 hour period on the day of the inspection). Personnel records inspected were to a good standard, and generally contained suitable information required by regulation. For example staff employed since the last inspection had two references. Staff had a Protection of Vulnerable Adults First/ Independent Safeguarding Authority check (POVA First/ ISA First) and a Criminal Records Bureau check (CRB). These checks ensure people employed are not on a list which states they are deemed not fit to work with vulnerable people (POVA/ISA), or have a criminal record (CRB) which may deem them unsuitable to work in an environment with vulnerable people. Staff had an application form, containing work history, evidence of their identity and a self declaration of medical fitness, as required by the regulations. Files for nurses registration were satisfactory (i.e.with the Nursing and Midwifery Council (NMC) ). Six of the seven staff responding to our survey stated they thought suitable checks had been completed regarding them prior to them commencing employment. Care Homes for Older People Page 30 of 45 Evidence: In regard to staff induction two people said this was very good, two said it was mostly good, and three said it was partly good. Records of induction were satisfactory. We looked at whether staff had a National Vocational Qualification in care. According to the Annual Quality Assurance Assessment-AQAA (an annual return provided to the commission on an annual basis) 50 of care staff employed (6 out of 12) have an NVQ 2 or above in care. We checked records of training received by eight of the staff employed. By law staff require the following training: (1) Regular fire training in accordance with the requirements of the fire authority. (2) There must always be at least one first aider on duty (at appointed person level). (3) All staff must have manual handling training and regular updates of this (e.g. annually). (4) All staff must have basic training in infection control. (5) Staff who handle food receive food hygiene training. (6) All staff must have an induction and there needs to be a record of this. Staff also need to have suitable training to meet the needs of people who use the service such as dementia, challenging behaviour. The eight records assessed demonstrated that all staff have received training to an adequate standard. Clinical staff have received some training to ensure their professional skills are updated. For example regarding venapuncture, catheter care. This needs to continue to develop so nursing staff all receive regular updates regarding current practice. In regard to care staff; those who have been employed for some time have received generally satisfactory training, although there is a need to update some training for some for example manual handling and food hygiene. We were concerned that some of the newer staff need training regarding dealing with aggressive behaviour and dementia-particularly as the people using the service exhibit many challenges. These staff also needed other training required by law (food handling, first aid, infection control, medication etc.) Several staff also need to receive training regarding deprivation of liberty, mental capacity act and safeguarding. Again it is essential staff receive this training. However the majority of people staff responding to our anonymous questionnaire said training was not satisfactory or helpful. However, when we spoke to people the majority were happy with the training they received, but we did receive some Care Homes for Older People Page 31 of 45 Evidence: comments that internal manual handling was not satisfactory. For example we were told incorrect manoeuvres were taught, and equipment featured in the training was no longer used in care homes. The registered provider needs to investigate this matter. It is therefore essential staff are provided with the training they need to do their jobs, and which meets legal standards. Care Homes for Older People Page 32 of 45 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. Significant concerns have been expressed regarding day to day management of the home, and we have asked the registered provider to investigate the concerns raised to us. Some improvement is required regarding quality assurance and health and safety arrangements at the home. Improvement in these areas will ensure people who use the service that the home is managed safely and effectively. Evidence: The registered provider is Newport Care Limited. The responsible individual is Jason Sykes. Mr Sykes is a paid consultant working on behalf of Newport Care. The registered manager is Ms Sherran Thompson. Ms Thompson is currently off on long term sick leave. The Head of Care is currently acting up in the registered managers absence. At the inspection we met an associate of Mr Sykes- Cath Carroll. Ms Carroll was spending two weeks acting as duty manager for the home, as the head of care was on annual leave. If the registered manager is absent after 6 months, the registered persons will need to Care Homes for Older People Page 33 of 45 Evidence: write to us again regarding management arrangements. A new application for another person to be registered to manage the home will be required, if the registered manager remains off on long term sick. In the interim, a copy of a CV (and CRB check) needs to be submitted to CQC so we can be assured the current manager, and management arrangements are satisfactory. In our surveys, and subsequent interviews with staff, we received significant concerns regarding the conduct of the registered manager. We have outlined these concerns in a letter to the registered provider Mr Johal, and to Mr Sykes the responsible individual. We have said that the matters of concern must be investigated, and the registered provider must be satisfied the registered manager is a fit person before she is to manage the home without supervision in future. In general staff said they did not feel supported by the management of the home. Our Expert by Experience discussed management arrangements with staff. The Expert reported staff had no confidence in the manager, who (leaves) staff to their own devices....The manager would not listen to the suggestions of the staff and did not interact with the residents. These and many other comments are disappointing and concerning. When the registered manager first began to work at the home, staff had significant confidence in her, and the hard work she carried out in making a number of significant improvements to the home. Similarly when we spoke to staff last year,everyone we spoke to said they felt supported by management. Two staff also raised concerns about how personal grievances had been dealt with (1) In regard to lack of adjustments to someones working practice, as required under law, when someone is pregnant (2) Following a grievance regarding sexual harassment-no response or investigation was carried out regarding the concerns raised. On inspection of both peoples files, there was no documentation to evidence receipt of the concerns, or in regard to any action taken. Such information should be kept on file, as is required by the Care Homes Regulations 2001. It is therefore essential the matters of concern are fully investigated, and action taken as a matter of urgency to ensure staff have confidence in how the home is managed. The report notes some ongoing concerns regarding some aspects of care practice, staffing levels, staff training and management arrangements. We are concerned that although there have been some cosmetic improvements to some aspects of the homes decor, there is still a need for significant investment to improve the fabric of the building. It is essential, that the registered provider develops a costed development plan, with clear timescales, how the improvements which are outlined as Care Homes for Older People Page 34 of 45 Evidence: required in this report are to be completed. We inspected the registered providers Quality Management Policy. This appears to be an off the shelf policy and does not necessarily reflect practices in the home. When we inspected the home last year, we were assured by the registered manager the policy would be re-written based on current practices in the home. This has not been completed. However we do note the improvements in the decor of some of the communal areas of the home and a new walk in shower facility has been developed. A survey of stakeholder views e.g. people using the service and their relatives, was completed in 2009. The results of this were positive. A representative from the registered provider has visited the home on a monthly basis, and reports were present at the home. The reports are comprehensive and look at various aspects of practice and the management of the home. Mr Sykes had a meeting with relatives of people living in the home in March 2010. This is an excellent initiative, and was welcomed by some of the relatives we spoke to. A further meeting is planned in June 2010, and it is a good idea these occur on such a regular basis. The AQAA supplied by the home was completed to a satisfactory standard, was accurate and contained information requested. We assessed arrangements regarding the management of the finances of people who use the service. Records kept for the management of individual monies were satisfactory, and monies kept tallied with the records maintained. The homes policies need to be updated with current contact details (where applicable) of the Care Quality Commission. The registered provider has a health and safety policy. There is also a fire risk assessment. We were told the maintenance worker completes checks on the fire system. The form which is completed however states the member of staff is only checking the fire doors. The person responsible for the checks said that the checks completed are for the fire system-the form therefore needs to be amended to reflect the task being completed so records are clear. Testing of fire extinguishers and the fire system appears to have been completed appropriately by external contractors. Staff records demonstrate they have received suitable training regarding fire prevention. The fire officer visited in November 2008 and stated precautions at the time were satisfactory. However we have raised a Care Homes for Older People Page 35 of 45 Evidence: concern regarding a fire door which was padlocked. Staff had done this as people living in the home have absconded via the exit. We have said the registered persons must seek urgent advice from the fire authority regarding this matter. Portable electrical appliances were last tested in June 2009. There is a certificate to state the electrical circuit has been tested and is deemed safe (2/8/2006). A gas safety certificate was obtained in February 2009. The oil tank was inspected in May 2009. However, a safety notice states the tank urgently needs replacing- and the registered persons need to take action to carry out this work to ensure people using the service are kept safe. There is a record that the lift was serviced in 4/3/2010. Hoists and hospital type beds have been checked and serviced by an external contractor in March 2010. There is a policy regarding the prevention of legionella. However this is incorrect in regard to what temperature water should be stored at. Subsequently it needs to be rewritten in line with Health and Safety Executive (HSE) guidance. An risk assessment has been completed by an external contractor in June 2009. However it is not clear if satisfactory action has been taken regarding this.Subsequently the registered persons need to check whether current current precautions are satisfactory and do not put people at risk. There is no record the Health and Safety Executive (HSE) has visited the home under the current ownership. The environmental health officer inspected the food premises, and deemed arrangements to be satisfactory. The registered manager has commissioned a plumber to fit thermostatic valves to baths, showers and wash hand basins. Work is outstanding regarding baths and therefore we have renotified this requirement. As stated in the staffing section, training regarding health and safety issues needs some improvement. There is an excellent system to monitor accidents and ensure remedial action takes place as necessary. A current certificate of insurance was displayed in the home. Care Homes for Older People Page 36 of 45 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 6 5 Information issued to people 01/09/2009 who use the service (i.e. statement of terms and conditions of residency / contract) must provide detailed information regarding how nursing costs are met as outlined in the regulations. This will ensure people have clear information about how their costs of care will be paid. 2 19 23 Improve facilities identified, as outlined in the text of the report. This will ensure Holywell Bay provides a suitable facility for the people living and working there. 11/11/2009 3 33 24 Further develop the quality 01/09/2009 assurance system to monitor standards in the home for example regarding care planning, environmental standards, health and safety etc. The quality assurance policy needs to accurately reflect systems in place. An improvement plan has been requested regarding requirements made in the report Care Homes for Older People Page 37 of 45 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 This will help improve service quality and help minimise risks to staff and people who use the service 4 38 13, 23 The registered persons must 01/10/2008 improve health and safety standards in the following areas: (1)Ensure a risk assessment is completed regarding the prevention of legionella, and any necessary preventative measures are taken to prevent Legionnaires disease. (2) Thermostatic valves must be fitted, where appropriate, to wash hand basins and baths- in line with HSE guidelines. Care Homes for Older People Page 38 of 45 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 2 5 Information issued to people 01/09/2010 who use the service (i.e. statement of terms and conditions of residency / contract) must provide detailed information regarding how nursing costs are met as outlined in the regulations. This will ensure people have clear information about how their costs of care will be paid. (Previous deadline of 01/09/09 not met. Second Notification) 2 7 12 Care plans and care records must be maintained, with sufficient detail (e.g. regarding use of as required (PRN) medication and satisfactory care and medical interventions. This will enable care staff to provide and demonstrate that satisfactory care is 01/09/2010 Care Homes for Older People Page 39 of 45 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 given to people living in the home. 3 8 12 The registered persons need 01/07/2010 to clarify the issues of concern raised regarding two people living in the home. This will give us reassurance that care for these people is appropriate, and people are satisfactorily safeguarded. 4 18 12 The registered provider 01/08/2010 must take satisfactory action regarding the outcome of the safeguarding investigation that is currently being undertaken This will provide us with assurance that people using the service are receiving satisfactory care and are safeguarded by the registered persons. 5 19 23 The registered provider must continue to invest in the building, to ensure Holywell Bay provides satisfactory facilities for the people living there. For example the issues outlined in the Evidence section of the report need to be addressed. Proposed improvements need to be evidenced by a costed 01/08/2010 Care Homes for Older People Page 40 of 45 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 environmental development plan which is available for inspection This will ensure Holywell Bay provides a pleasant and homely environment for the people living there. 6 27 18 Staffing levels must be 01/08/2010 reviewed, and a copy of the staff review forwarded to the commission within the timescale set. The registered persons must ensure there are satisfactory arrangements in place, at all times, to ensure there are always satisfactory numbers of staff on duty. This will help to ensure there are sufficient numbers of staff, to meet the needs of the people living in the home, so they are well and safely cared for. 7 30 18 The registered persons must 01/09/2010 ensure staff have satisfactory training, delivered to a satisfactory standard, as required by the law and according to the needs of the people living in the home (i.e. as outlined in the evidence section of the report). Care Homes for Older People Page 41 of 45 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 help people who use the service to be more confident that staff receive training to meet their needs, and according to the law. 8 31 9 The registered provider 01/07/2010 must investigate concerns raised by the Care Quality Commission regarding the conduct of the registered manager. The registered provider is subsequently required to submit a report to the commission regarding its findings. This will help to ensure all stakeholders are satisfied the home is managed to a satisfactory standard, and the registered manager is deemed fit to do so. Ensure there is a 01/08/2010 satisfactory quality assurance policy, and there are satisfactory measures to ensuring there are appropriate compliance of the regulations and ongoing improvement of the building and service. (Previous timescale of 01/09/2009 not met 2nd Notification) This will ensure all 9 33 24 Care Homes for Older People Page 42 of 45 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 stakeholders are assured there are satisfactory management systems at the home to ensure compliance with the regulations and the service continues to improve 10 38 13 Ensure there are satisfactory 01/09/2010 health and safety precautions in the home: (a) Satisfactory precautions are in place to ensure people can exit the building in the case of a fire. (b) Accurate records are kept of checks on the fire system. (c) The oil tank is replaced in accordance with the safety notice issued (d) There are satisfactory precautions in place to minimise the risk of legionella. (e) All baths / showers in the home are fitted with a thermostatic control valve to minimise the risk of scalding. This will give people using the service assurance they are living in a safe environment Care Homes for Older People Page 43 of 45 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 8 The registered persons ascertain if physiotherapy and occupational therapy services can be obtained for people living in the home. Expand the current provision of activities, and address the issues outlined in the report regarding this matter 2 15 Care Homes for Older People Page 44 of 45 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. © 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. Care Homes for Older People Page 45 of 45 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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