Care Home: Holywell Nursing Home

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What the care home does well Holywell provides a homely and comfortable environment for people and people using the service told us that they were very happy at the home. The home ensures that people are appropriately assessed before a placement is offered so that all parties can be sure that the home can meet an individuals` assessed needs and aspirations. People are provided with information about the home and services offered and can `test drive` the home before making a decision to move there on a permanent basis. The home`s care planing procedures ensure that peoples` needs and preferences are clearly set out so that staff can deliver care in a consistent and person centred manner. People are encouraged to be involved in the care planning process. People spoken with during this inspection were positive about the care they received and they commented on the kindness of staff. We were able to observe staff interacting with people in a very kind and professional manner. We were able to see evidence that people have access to a range of health care professionals. We were also able to see evidence that the home appropriately monitors and reviews peoples` health care needs. People have the opportunity for social stimulation in line with their needs and preferences. Activities coordinators are employed covering a five day period and a programme of events is clearly displayed for people. The home ensure that peoples needs are met by appropriate numbers of staff who have the skills and training needed. No concerns were raised regarding staffing levels and staff were very positive about the training and support they received. The home follows robust procedures for staff recruitment which reduce the risk of harm or abuse to people using the service. Safe procedures are followed for the management and administration of peoples` medication. Up to date procedures ensure the health and safety of persons at the home. What has improved since the last inspection? At the last inspection three statutory requirements were raised. These related to introducing systems for staff supervision, quality assurance and for ensuring the cleanliness of a designated area. At this inspection, we were able to see evidence that the registered person had taken appropriate action to address these requirements. What the care home could do better: At this inspection we made one requirement and some good practice recommendations. The requirement raised related to the storage of medicines requiring refrigeration. We found that the temperatures of the fridge storing medicines exceeded the safe limits of between 2-8c. We made good practice recommendations relating to moving and handling assessments in that they should also identify the type and size of sling required by each individual with an assessed need. We have recommended that the home reviews its` application for employment so that it prompts applicants to provide a minimum 10 year employment history. This will allow the home to fully explore the reasons for any gaps in employment. We have also recommended that the reference request form, especially for registered nurses, requests information on the applicants clinical/nursing skills. The home also need to develop a staff training matrix which will assist them to clearly identify staff training achievements and requirements. Staff supervision records could be further improved if records contained information about the individuals` training needs or requests. Records should also be signed by the home and staff member. Appropriate procedures are followed for the management of peoples` monies but the home should ensure that all transactions are confirmed with two staff signatures. This will offer better protection for staff and for people using the service. Key inspection report Care homes for older people Name: Address: Holywell Nursing Home Brent Street Brent Knoll Somerset TA9 4BB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: kathy McCluskey     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Holywell Nursing Home Brent Street Brent Knoll Somerset TA9 4BB 01278760601 01278760912 holywellnursinghome@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sarah Elizabeth Joyce care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 25 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 category: Old age, not falling within any other category (code OP) Date of last inspection Brief description of the care home Holywell Nursing Home is a large detached property situated in the village of Brent Knoll. The home benefits from ample parking, a pleasant garden and views of the surrounding countryside. Accommodation is provided over two floors with a passenger lift giving access to the first floor. Holywell is registered with the Quality Commission to provide general nursing care for up to 25 residents over the age of 60 years (see also conditions). The registered provider/manager is Sarah Joyce who is a dual registered nurse (RGN/RMN). Registered nurses provide 24hr cover at the home. The home has 17 single bedrooms and 4 double bedrooms. Eleven bedrooms have en-suite toilet facilities, some of which are screened by curtains. All bedrooms are fitted with a wash Care Homes for Older People Page 4 of 28 Over 65 25 0 Brief description of the care home hand basin as a minimum. Some shared rooms have limited space. The fees range from: £575 & 675 per week and will be varied in line with the level of Free Nursing Care or Continuing Care Contributions from the Primary Health Care Trusts. People using the service meet the cost of personal items/toiletries, hairdressing, chiropody, newspapers and some staff escorts. 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: This unannounced inspection was conducted over one day (6hrs) by CQC regulation inspector Kathy McCluskey. The registered provider/manager was available throughout this inspection and all records required for this inspection were made available to us. We were given unrestricted access to the home and were able to speak with a number of staff and people using the service. We also met with a visitor. We would like to thank all those involved for their time and cooperation with the inspection process. The term we used throughout this report refers to we the Commission. The following is a summary of the inspection findings and should be read in conjunction Care Homes for Older People Page 6 of 28 with the whole of this report. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: At this inspection we made one requirement and some good practice recommendations. The requirement raised related to the storage of medicines requiring refrigeration. We found that the temperatures of the fridge storing medicines exceeded the safe limits of between 2-8c. We made good practice recommendations relating to moving and handling assessments in that they should also identify the type Care Homes for Older People Page 8 of 28 and size of sling required by each individual with an assessed need. We have recommended that the home reviews its application for employment so that it prompts applicants to provide a minimum 10 year employment history. This will allow the home to fully explore the reasons for any gaps in employment. We have also recommended that the reference request form, especially for registered nurses, requests information on the applicants clinical/nursing skills. The home also need to develop a staff training matrix which will assist them to clearly identify staff training achievements and requirements. Staff supervision records could be further improved if records contained information about the individuals training needs or requests. Records should also be signed by the home and staff member. Appropriate procedures are followed for the management of peoples monies but the home should ensure that all transactions are confirmed with two staff signatures. This will offer better protection for staff and for people using the service. 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 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 10 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 are provided with information about the home which enables them to make an informed decision about using the service. The home has procedures in place which ensure that placements are only offered once people have been appropriately assessed. People are able to test drive the home. Evidence: The home have produced a Statement of Purpose and Service User Guide which provides people with information about the home and services offered. These documents are available at the home and are made available to people who are thinking about using the service. We were able to see that the home has appropriate procedures in place which ensure Care Homes for Older People Page 11 of 28 Evidence: that people are appropriately assessed before a placement at the home is offered. Evidence of pre-admission assessments were available in the care plans examined at this inspection. Assessments from health care professionals were also seen to be in place as appropriate. The homes completed AQAA stated; Our recently updated pre-admission questionnaires address all aspects of daily life, equality and diversity and we enlist prospective service users and relatives to be involved in its completion. It addresses the mental capacity and restrictions of liberty and we encourage the prospective resident to discuss fears and beliefs about his/her future care and how we can address this. We will address practicalities of equipment in use and specialist care provided to ensure our staff are able to address all needs with their skills. During a tour of the premises we were able to see evidence that people are provided with a range of specialised equipment to meet their needs. Staff spoken with confirmed that they had the skills and training needed to enable them to meet peoples needs. People are able to test drive the home before making a decision to move there on a permanent basis. The homes completed AQAA states; We often ensure that all prospective service users are aware that their admission is on a trial basis for them and does not have to be permanent and that we welcome discussion and involvement in meetings. We encourage enquirers to make an unannounced visit to Holywell when planning to look round. Care Homes for Older People Page 12 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. The homes care planning procedures ensure that staff are able to deliver a consistent and person centred approach to care. Appropriate procedures are in place to ensure that peoples health care needs are met. The home ensure that people are treated with respect. Safe procedures are followed for the management and administration of peoples medication. Evidence: We examined three care plans at this inspection and found them to be up to date. We were able to see that care plans had been developed from a range of assessments which included moving and handling, reducing the risk of pressure sores and nutrition. Care plans contained clear information for staff as to how peoples needs should be met. We were able to see that people had been consulted about their preferences. This helps staff to deliver a person centred approach to care. Care Homes for Older People Page 13 of 28 Evidence: We were able to see evidence that people have access to a range of health care professionals and that the home had sought the input/advice from health care professionals where required. Records are maintained within each persons plan of care. The home ensures that peoples weights are monitored each month. We were able to see that care plans had been raised where concerns had been identified. We were able to see that peoples diet and fluid intake were being recorded where appropriate. We found that appropriate pressure relieving equipment was in place for people with an assessed need. We observed staff using hoists to transfer people. It was very evident that staff were very familiar with the equipment they were using. It was positive to note that staff offered reassurance and an explanation to the individuals throughout the process. Staff told us that they had received up to date training in moving and handling procedures. We found moving and handling assessments to be up to date. Assessments identified the equipment to be used and the number of staff required to assist the individual. We have recommended that the assessment includes the type/size of sling required by individuals. During this inspection we spoke with a number of people using the service and observed staff interactions with them. People were positive about the care they received. They told us that the staff were very kind and always there to help. We found staff interactions with people to be very kind and respectful. We examined the homes procedures for the management and administration of peoples medication. The home uses the monitored dosage system (MDS) with preprinted medication administration records (MAR). We found all medicines to be securely stored with no excess stocks. All available MAR charts were examined and these were found to be well maintained. Appropriate procedures were being followed for the management and administration of controlled drugs. We found appropriate procedures to be in place for the receipt and disposal of medicines. The home need to take action to ensure that the temperature of the fridge storing medicines remains within safe limits (2c-8c) as records indicated that on occasions, temperatures far exceeded safe upper limits. Medicines are only administered by the registered nurse on duty. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity for social stimulation and the home are aware of peoples preferences and abilities. Visitors are welcome at the home in line with the wishes of people using the service. Meals are freshly cooked at the home. People are offered choices and special diets are catered for. Evidence: The home employs three activities coordinators who cover four hours a day, five days a week. A programme of activities was seen to be clearly displayed for people. Some of the activities planned for December included a visiting artist, coffee morning, armchair travel, eat and meet, visiting choir and visits from a pat dog. People told us that there was always something going on if you wanted to join in. The home maintains records relating to each persons involvement in an activity and people can enjoy looking at the photographs of recent events. Care plans contain information about individuals social history/hobbies so that staff can ensure that people are offered activities in line with their preferences. Care Homes for Older People Page 15 of 28 Evidence: During this inspection many people and some relatives attended a regular meeting chaired by the provider/manager. Activity and catering staff were also present and many topics were discussed. It was clear that people were encouraged to express their views and ideas. The home welcomes visitors at any reasonable time in line with peoples wishes. We met with a visitor during this inspection who told us that they were always made to feel welcome and were kept very well informed about their relative. The homes completed AQAA told us that; visitors are made to feel welcome and are offered refreshments, they are encouraged to be involved in daily life and activities if they wish. All meals are prepared and cooked at the home by designated catering staff. Details about peoples preferences are detailed in each persons plan of care and information is also displayed in the kitchen for catering staff. The days menu is clearly displayed in the home for people using the service. We were able to observe lunch being served during this inspection. The meal looked plentiful and appetising and it was clear that people were offered choices. People were very positive about the meals at the home. They told us that there was always plenty to eat and drink. They also told us that snacks were available in between meals. We observed the lunch time experience to be relaxed. Staff were observed assisting people as required in an unhurried manner. Care Homes for Older People Page 16 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. The home ensures that people feel confident in raising concerns. Systems are in place to reduce the risk of harm or abuse to people using the service. Evidence: The home has an appropriate complaints procedure which is clearly displayed in the reception area of the home. Copies of the complaints procedure are also available for each person in their bedroom. We spoke with a number of people during this inspection and they told us that they would not hesitate in raising concerns if they had any. No concerns were raised with us during this inspection. The homes completed AQAA told us that the home had investigated one complaint in the last twelve months which was not upheld. Complaints are investigated in line with the homes procedures. The registered provider/manager, in the completed AQAA states; We have a volunteer who spends time with the residents at Holywell and she is available to read the complaints policy and any other policy to those who have difficulty reading or understanding it. We have an approach of welcoming and addressing complaints openly. I see this as an opportunity to evaluate what is happening at Holywell. The home displays information for people about local advocacy services. Information is also available regarding peoples rights. Care Homes for Older People Page 17 of 28 Evidence: We spoke with four members of staff during this inspection and all confirmed that they had received training in the prevention of abuse. They also confirmed that they knew how to raise concerns about safeguarding adults. We have recommended that the home obtain an up to date copy of Somersets policy on safeguarding adults as this is not only a useful training tool but contains clear information on the local policy and contacts. Care Homes for Older People Page 18 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. The home although not purpose built and with some limited space in areas, provides people with a very homely, comfortable and well maintained environment. People can personalise their bedrooms and screening is available in shared bedrooms to ensure peoples privacy. Procedures are in place to reduce the risk of the spread of infection. Evidence: Holywell is an older property which has been adapted and extended over the years. It provides a homely feel and is situated in a quiet village with views of the countryside. During this inspection we viewed a number of bedrooms and all communal areas. The home has one main communal area consisting of a lounge/dining room. The dining room and lounge are separated with a curtain. Currently the dining room is only able to seat eight people. Given that the home is not purpose built, storage space is limited and some corridors are quite narrow and not all corridors are fitted with grab rails. Staff told us that they did not experience any concerns in being able to meet peoples needs. People using the service did not express any concerns and told us that they liked the homely and comfortable feel. This was also confirmed by a visitor. Care Homes for Older People Page 19 of 28 Evidence: Not all bedrooms are fitted with en-suite facilities and the home have some shared bedrooms. Screening is available in shared bedrooms to ensure peoples privacy. Not all bedrooms are fitted with a lock. People are provided with an adjustable bed and we were able to see a good supply of pressure relieving equipment in place. A nurse call system is in place. The homes completed AQAA told us that there are plans to further improve the environment for people. It told us that the home have a rolling programme of refurbishment and redecoration in place. It told us that people are encouraged to personalise their bedrooms. This was apparent when we looked at bedrooms. The AQAA told us that the home have sufficient assisted bathing facilities to meet the current needs of people using the service. We found all areas of the home seen during this inspection to be clean and free from malodours. Domestic and laundry staff are employed. We were able to see that staff have access to appropriate hand washing facilities and sanitising gel and that they have access to a good supply of protective equipment. Care Homes for Older People Page 20 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. Peoples needs are met by sufficient numbers of staff who have been appropriately trained. The homes staff recruitment procedures ensure that people are protected from the risk of harm or abuse. Evidence: During this inspection we noted a good staff presence. People using the service told us that staff were always available when they needed them. We spoke with care staff and registered nurses during this inspection and no concerns were raised regarding staffing levels. A registered nurse is on duty 24 hours a day. The home also employs catering, domestic, maintenance and administrative staff. Staff were positive about training opportunities available to them. They confirmed that they had the skills and training to enable them to meet the needs of people using the service. The homes completed AQAA told us that of the 26 permanent care staff employed, 14 have achieved a minimum of an NVQ level 2 in care. This equates to 54 which exceeds the recommended 50 of the National Minimum Standards. Care Homes for Older People Page 21 of 28 Evidence: We examined the homes procedures for staff recruitment. We looked at recruitment files for two most recently employed staff. These were found to contain all required information. There was evidence that appropriate references, criminal record and adult protection checks had been obtained prior to employment commencing. We have recommended that the home reviews its current application for employment form to request at least 10 years employment history. We have also recommended that the reference form is updated, especially for registered nurses, so that information is requested about applicants clinical/nursing skills. We were able to see that on commencement of employment, staff complete a basic in-house induction followed by an induction programme which follows the skills for care common induction standards. We were shown an overall training plan of training undertaken and planned though it was difficult to evidence what training each staff member had completed. It has been recommended that the home develop a training matrix which clearly identifies training completed and training due. Care Homes for Older People Page 22 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. Effective management procedures are in place and people benefit from an open and inclusive style of management. The homes quality assurance procedures seek the views on the quality of the service provided, from people using the service and other stakeholders. Procedures are in place to ensure the safe management of peoples finances. Staff are appropriately supervised. Up to date procedures ensure the health and safety of persons at the home. Evidence: The registered provider/manager, Sarah Joyce is a registered general and registered mental health nurse with over twenty three years experience of managing her own home. She promotes an open and inclusive style of management. Care Homes for Older People Page 23 of 28 Evidence: Regular meetings are held for all staff and for people using the service and their representatives. We were able to see a meeting being held for the latter during this inspection. People appeared very relaxed and keen to express their views and ideas on a range of topics. Minutes are maintained for all meetings. The registered provider/manager is very hands-on and it was apparent at this inspection that she had a very good knowledge about peoples needs and preferences. Both staff and people using the service appeared very relaxed in her presence. Staff told us that they found the provider/manager very approachable and that they felt well supported. The home has quality assurance procedures in place which seek the views of people using the service, their representatives and health care professionals. We were able to see an analysis of the most recent survey conducted in January and March 2009. Results were positive and, where required, actions had been identified to address any comment raised. As required/requested, the home assists people to manage small amounts of pocket money. Records are maintained for all transactions for each individual and receipts are maintained for all purchases. Monies are securely stored. To reduce the risk of abuse. we have recommended that all transactions are confirmed with two staff signatures. As required at the last inspection, a formal system of staff supervision has been introduced. Records were seen to be in place but these could be further improved if they included details about any training needs or requests identified at the supervision meeting. Records should be signed by the employer and the staff member. We examined records and toured the premises and found that the home was taking appropriate steps to ensure the health and safety of persons at the home. All servicing records and mandatory training for staff were found to be up to date. No concerns were identified during a tour of the premises. 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 9 13 (2) The registered person 12/01/2010 must make arrangements to ensure that the temperature of the fridge storing medicines remains within the safe limits of 2-8c. This is to ensure the safe storage of medicines requiring refrigeration. 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 home should ensure that moving and handling assessments identify the type and size of sling to be used for each individual with an assessed need. The home should obtain an up to date copy of Somersets policy on safeguarding adults. The home should review its current reference request form so that it requests information about the applicants clinical/nursing skills. The home should update the application for employment form to prompt applicants to provide a minimum 10 year Page 26 of 28 2 3 18 29 4 29 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations employment history. 5 30 The home should develop a staff training matrix which clearly identifies staff training achievements and due dates for mandatory training updates. To ensure more robust procedures, two staff signature should be obtained to confirm financial transactions on behalf of people using the service. 6 35 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!