Care Home: Honeymead Care Home

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What the care home does well The home has clear information within it`s Statement of Purpose and the home`s welcome pack in order to inform people about the services and facilities that are able to be provided at Honeymead. People are well supported to access healthcare services as required, specialist services are arranged as needed. Medication is well managed in the home, records are well maintained in this area. The home is commended for achieving a five star food hygiene award from Bristol City Council. People told us they enjoyed meals at the home. Staff are recruited and appointed appropriately in order to ensure suitable people are employed at the home. Staff are provided with good induction training, core training and specialist training as required. What has improved since the last inspection? The Registered Person has ensured that the needs of people are fully assessed, by a suitably trained person, before a placement is offered. People can be assured that their needs will be met and that the home has the appropriate facilities and staff skills to care for them. Following our last inspection the Registered Person arranged for a falls prevention nurse to be contacted for advice in respect of how the individual identified during our last visit could be supported better at the home. Arrangements had also been made by the home for resident`s to be visited by other social care and health professionals as required. People living at Honeymead are supported to ensure they do not look unkempt. Private dietary information about people is not now on public display. However, more should be done to ensure that people are supported by staff to maintain their dignity and to be treated with respect. Detailed risk assessments have been completed in respect of dealing with, and responding to behavior which can challenge. This ensures that appropriate action is taken to support people in a safe manner. The Registered Person has ensured that staff have undertaken core and refresher training in adult protection procedures. This ensures that staff are given the information and knowledge required and to also ensure that they are aware of their role and responsibility in this area. All new members of staff complete the organisations induction-training programme and evidence of how their competence has been achieved is recorded. Staff undertake training in core areas such as manual handling, first aid, health and safety and basic food hygiene. Refresher training as required in these areas has also been arranged.Training has been provided in supporting those with behaviour which can challenge and dementia awareness. Sufficient and appropriate staffing levels are in place at the home. This is so that staff have the time to do their job properly and people`s care needs can be met in a timely manner. The Registered Provider has appointed an individual to manage the care home.This will provide clear, consistent leadership at Honeymead. The manager must submit an application to be registered with us, in order that we can assess their `fitness` to manage a care service. The Registered Person has made arrangements for the staff working in the care home to receive suitable training in fire prevention and to ensure, by means of fire drills and practices, at suitable intervals, so that they are aware of the procedure to be followed in the event of a fire. This ensures that staff can be aware of their role and their responsibility in the event of a fire emergency. The Registered Person has ensured the records required as specified in schedule 3 are kept up to date. This ensures that records required by regulation for the protection of people living in the home and for the effective running of the business are maintained and accurate. All care staff working in the home are now formally supervised. What the care home could do better: Care plans must clearly record how people are to be supported on an individualised basis and provide clear direction and guidance for staff in order that people are fully supported in all aspects of their care. Furthermore, it is also recommended that the home undertakes a full re-assessment/review of care plans in order to ensure that the information contained within them is correct. Staff must consider their use of language and `tone` of reports written within individual`s daily progress notes. This is in order to ensure they are writing about people respectfully. Hoist weighing scales should be provided in order that individual`s with mobility difficulties can be weighed effectively. The identified `spare` bed that is not required in an individual`s room should be removed, this will give the individual more space in their room. Minutes of resident`s meetings should record what action is going to be taken, and by whom as a result of issues raised by those who live at the home, this will evidence that issues are being listened to and acted upon as appropriate. The Registered Person must ensure that any complaint made under the complaints procedure is fully investigated.This is to ensure that people can be confident that issues raised are responded to and fully investigated as required. Staff should be reminded of their `duty of care` to resident`s who live at Honeymead in line with the terms and conditions of their employment. It is recommended that the home review their policies and procedures in respect of staff conduct, training and where required remind staff of their responsibilities as outlined within the homes statement of purpose. When it has been found that staff conduct is not in line with the aims and objectives of the home and staff are not working within the terms of their employment appropriate action should be taken to address staff performance issues. At this visit we spent time with the administrator who is responsible for the safekeeping of money and valuables held at the home on behalf of resident`s. This person confirmed to us that they are the only person who has access to the safe and is the only person who deals with money and property deposited at the home. We found no errors in the recording of money held by the home and these corresponded with money checked by us. We did find that there were occasions when the administrator had not signed for cash brought into the home. We also found that a cheque book was being held for a resident and this had not been recorded. The administrator told us that the area manager checks a sample of resident`s cash against records held, this is good practice and it would be further good practice for this to be recorded. It is required that residents property that is held at the home for safekeeping must be recorded in order that it is accounted for. Furthermore the home must ensure consistent record keeping and signing in respect of financial records for money held on behalf of those who live at the home We saw that the home maintains a record of `actual` fire reports, these were when toast was burnt or faults in the detection system had activated the fire alarm. We found inconsistencies within the recording of these records. These reports were not dated and staff had not recorded what the suspected cause of the fire was, or whether there were any faults and whether or not these had been rectified. We recommend that staff who complete these reports are reminded of their purpose and complete the report fully as required. The home has in place a number of risk assessments relating to the running and management of a care home. We saw that these assessments were well written and contained clear information in order to direct and inform staff practice. We noted that these assessments had recently been reviewed, but did not record by whom. The manager confirmed his awareness of the assessments and his responsibility in signing these to evidence his involvement and knowledge of them. It is recommended that the manager evidences his involvement of these risk assessments. Key inspection report Care homes for older people Name: Address: Honeymead Care Home 183 West Street Bedminster Bristol BS3 3PX     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: Odette Coveney     Date: 1 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 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 38 Information about the care home Name of care home: Address: Honeymead Care Home 183 West Street Bedminster Bristol BS3 3PX 01179535829 01179231480 honeymead@mimosahealthcare.com www.mimosahealthcare.com Mimosa Healthcare (No4) Limited care home 68 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accomodated is 68 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 Honeymead Care Home is one of four nursing homes in the Bristol area owned by Mimosa Healthcare Ltd. The three other homes in the Bristol area are in Bishopsworth, Southmead and Shirehampton. Honeymead Care Home is a purpose built care home with accommodation provided over two floors. The home is run as two units. The first floor Ashton Suite, accommodates 37 persons. The ground floor Clifton Suite, has 31 beds. The home has a number of shared rooms that are only used by one person and therefore the number of people that can be accommodated is reduced to 64 in total. Placement is generally Care Homes for Older People Page 4 of 38 Over 65 68 0 2 1 0 4 2 0 0 9 Brief description of the care home for people aged 65 years and over, however providing the home is able to meet the needs of younger people they can live here. Both floors have communal rooms and bathing facilities. The home is located within walking distance from the main Bedminster area where there are local shops, public houses and a post office. There is a regular bus service into the centre of Bristol that passes in front of the home. The front of the property is used for car parking, so visitors can park near to the front entrance and main reception. The gardens to the rear of the home are level, have a pleasant patio area and established shrubbery. The area is secure and fairly secluded. The cost of placement is approximately £370 for residential care and £500 - £641 for nursing support the price is dependent upon individuals assessed need. Additional charges are made for a number of services - these are listed in the homes brochure. Prospective residents can be provided with information about the home and this will detail the services and facilities available at the home. Care Homes for Older People Page 5 of 38 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 unannounced key inspection took place over 16 hours and was completed in two days. One inspector visited the home on the first day, two inspectors came to the home on the second day of the visit. The manager was present during the inspection and participated in the process. Evidence was gained from a whole range of different sources, including: Information provided within the Annual Quality Assurance of the service. Directly speaking with people who live and work at the home. A review of individuals care records. A tour of the home, an examination of some of the homes records and observation of staff practices and interaction with the people who live at the home. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home and to also review Care Homes for Older People Page 6 of 38 the ten requirements and seven recommendations made during our last key visit to the service which was undertaken in April 2009. Since our last key visit to the home we have attended a number of strategy meetings, these have been chaired by Bristol City Council and attending the meetings have also been representatives from Mimosa, from health services and the local authoritys contract compliance department. The purpose of these meetings was to monitor the service being provided to the people living at Honeymead in line with the improvement plan provided by the home after our last inspection. The area manager has kept the Commission informed of events that have occurred at the home and of the progress made with the requirements and recommendations that had been set by us at our last key visit to the home in April 2009. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? The Registered Person has ensured that the needs of people are fully assessed, by a suitably trained person, before a placement is offered. People can be assured that their needs will be met and that the home has the appropriate facilities and staff skills to care for them. Following our last inspection the Registered Person arranged for a falls prevention nurse to be contacted for advice in respect of how the individual identified during our last visit could be supported better at the home. Arrangements had also been made by the home for residents to be visited by other social care and health professionals as required. People living at Honeymead are supported to ensure they do not look unkempt. Private dietary information about people is not now on public display. However, more should be done to ensure that people are supported by staff to maintain their dignity and to be treated with respect. Detailed risk assessments have been completed in respect of dealing with, and responding to behavior which can challenge. This ensures that appropriate action is taken to support people in a safe manner. The Registered Person has ensured that staff have undertaken core and refresher training in adult protection procedures. This ensures that staff are given the information and knowledge required and to also ensure that they are aware of their role and responsibility in this area. All new members of staff complete the organisations induction-training programme and evidence of how their competence has been achieved is recorded. Staff undertake training in core areas such as manual handling, first aid, health and safety and basic food hygiene. Refresher training as required in these areas has also been arranged. Care Homes for Older People Page 8 of 38 Training has been provided in supporting those with behaviour which can challenge and dementia awareness. Sufficient and appropriate staffing levels are in place at the home. This is so that staff have the time to do their job properly and peoples care needs can be met in a timely manner. The Registered Provider has appointed an individual to manage the care home.This will provide clear, consistent leadership at Honeymead. The manager must submit an application to be registered with us, in order that we can assess their fitness to manage a care service. The Registered Person has made arrangements for the staff working in the care home to receive suitable training in fire prevention and to ensure, by means of fire drills and practices, at suitable intervals, so that they are aware of the procedure to be followed in the event of a fire. This ensures that staff can be aware of their role and their responsibility in the event of a fire emergency. The Registered Person has ensured the records required as specified in schedule 3 are kept up to date. This ensures that records required by regulation for the protection of people living in the home and for the effective running of the business are maintained and accurate. All care staff working in the home are now formally supervised. What they could do better: Care plans must clearly record how people are to be supported on an individualised basis and provide clear direction and guidance for staff in order that people are fully supported in all aspects of their care. Furthermore, it is also recommended that the home undertakes a full re-assessment/review of care plans in order to ensure that the information contained within them is correct. Staff must consider their use of language and tone of reports written within individuals daily progress notes. This is in order to ensure they are writing about people respectfully. Hoist weighing scales should be provided in order that individuals with mobility difficulties can be weighed effectively. The identified spare bed that is not required in an individuals room should be removed, this will give the individual more space in their room. Minutes of residents meetings should record what action is going to be taken, and by whom as a result of issues raised by those who live at the home, this will evidence that issues are being listened to and acted upon as appropriate. The Registered Person must ensure that any complaint made under the complaints procedure is fully investigated.This is to ensure that people can be confident that issues raised are responded to and fully investigated as required. Staff should be reminded of their duty of care to residents who live at Honeymead in Care Homes for Older People Page 9 of 38 line with the terms and conditions of their employment. It is recommended that the home review their policies and procedures in respect of staff conduct, training and where required remind staff of their responsibilities as outlined within the homes statement of purpose. When it has been found that staff conduct is not in line with the aims and objectives of the home and staff are not working within the terms of their employment appropriate action should be taken to address staff performance issues. At this visit we spent time with the administrator who is responsible for the safekeeping of money and valuables held at the home on behalf of residents. This person confirmed to us that they are the only person who has access to the safe and is the only person who deals with money and property deposited at the home. We found no errors in the recording of money held by the home and these corresponded with money checked by us. We did find that there were occasions when the administrator had not signed for cash brought into the home. We also found that a cheque book was being held for a resident and this had not been recorded. The administrator told us that the area manager checks a sample of residents cash against records held, this is good practice and it would be further good practice for this to be recorded. It is required that residents property that is held at the home for safekeeping must be recorded in order that it is accounted for. Furthermore the home must ensure consistent record keeping and signing in respect of financial records for money held on behalf of those who live at the home We saw that the home maintains a record of actual fire reports, these were when toast was burnt or faults in the detection system had activated the fire alarm. We found inconsistencies within the recording of these records. These reports were not dated and staff had not recorded what the suspected cause of the fire was, or whether there were any faults and whether or not these had been rectified. We recommend that staff who complete these reports are reminded of their purpose and complete the report fully as required. The home has in place a number of risk assessments relating to the running and management of a care home. We saw that these assessments were well written and contained clear information in order to direct and inform staff practice. We noted that these assessments had recently been reviewed, but did not record by whom. The manager confirmed his awareness of the assessments and his responsibility in signing these to evidence his involvement and knowledge of them. It is recommended that the manager evidences his involvement of these risk assessments. 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 10 of 38 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 11 of 38 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. The home provides people with clear information about the services and facilities that are able to be offered at Honeymead. People moving into Honeymead can be assured that their needs will be fully assessed before moving into the home. Evidence: The home has a detailed Statement of Purpose. This provides those living at the home, and those thinking of moving into Honeymead, information about the aims and objectives of the home as well as giving information about the facilities and services of the home. Information is also provided about the staffing and the management arrangements for the home. Also included within the document is information about the pre-admission assessment that is completed prior to people moving into the home and people can see what the assessment entails. Within the homes Statement of Care Homes for Older People Page 12 of 38 Evidence: Purpose information is given about emergency procedures and how people will be supported in these situations. Information is also given on how people can raise issues of concern and how these will be responded to. When we undertook our last key visit to the home in April 2009 we found that the pre -assessment for people being admitted into the home covered a comprehensive range of needs to be supported. However, we found that the assessment for one person had been poorly completed, with many areas left uncompleted. We saw that there had been no recognition that this persons needs were outside the homes conditions of their registration for placement at the home. At our last key visit we also found that for another person the home had not fully checked that the service that they could offer matched what was needed. Therefore as a result of these issues a requirement was made by us that the Registered Person must ensure that the needs of people are fully assessed, by a suitably trained person, before placement is offered. This is so that people can be assured that their needs will be met and that the home has the appropriate facilities and staff skills to care for them. Within our last report we said that upon admission the Registered Person must ensure that care plans must fully reflect the complex and diverse needs of people and must clearly record how people are to be supported on an individualised basis and provide clear direction and guidance for staff in order that people are fully supported in all aspects of their care. We found that, for people recently admitted into the home, care plans were well written and sufficiently detailed, outlining all areas of support required. At this visit we looked at the pre-admission procedures followed for the most recent admission. Since the person had moved to the home from a distance, they had attended the home for a days assessment prior to then moving in. A full and detailed assessment of the persons individual care needs were recorded that included diagnosis, current medication regime, communication needs, breathing, sleeping, and personal care needs, mobility, elimination, and skin integrity. Any equipment needs are identified, and we saw that those referred to were in place. By completing this assessment the home has concluded that they are able to meet the persons care needs. We could see that the persons family had previously visited the home, had a look around, been shown the vacant room and been told what the home had to offer. We spoke with this person, who confirmed these arrangements and said I am well looked after, they are looking after me fine. Within the completed Annual Quality Assurance Assessment (AQAA), which had been completed by the home and returned to us prior to our visit, the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; We fully intend to build on our improvements and widen the areas Care Homes for Older People Page 13 of 38 Evidence: of improvement. This includes the compilation of a photographic representation of the home, to include rooms, communal areas, staff etc , in order to convey to potential service users who are unable to visit the home, the facilities and general layout of the home and introduce the staff prior to an admission. The Manager will continually monitor admissions. We plan to continue with robust assessments, and ensure we build our reputation within the local community and with service providers. Within the AQAA completed by the home they also said that their plans for the forthcoming twelve months are to make the statement of purpose and welcome packs available when necessary in Braille or large print. We look forward to reviewing progress in this area when we complete our next key visit to the home. Care Homes for Older People Page 14 of 38 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. Care plans do not always fully reflect the actual support that is given to individuals and information contained within these plans of care must be more person centred and show that individuals have been involved in their development People are well supported with their health and professionals are contacted when a need has been identified. Medication administration is well managed in the home. Evidence: At our last visit to the home we were not satisfied with the information provided within individuals care plans, these did not provide full and detailed information about individuals needs in order to direct and guide staff practice. A requirement was made by us that the Registered Person shall prepare a written plan which will record how the service users needs, in respect of their health and welfare are to be met. At this visit we looked at five care files and sampled files of others living at the home as part of the case tracking process. This means that we spent time reading the records of the people that we selected, and decided by meeting them, and talking with the staff caring for them, whether the care plans give the complete picture of how to meet a Care Homes for Older People Page 15 of 38 Evidence: persons needs. We did not find this to be the case in all instances in respect of how people were supported with their personal care and aids to assist them. Whilst all areas were covered in each of the plans, some of the information recorded was not relevant or was not consistent with other recordings. Examples include wrong information about a persons walking aid, a personss preference to having a shower but the plan talked about helping them to have a bath, and reference to a pressure relieving cushion in the armchair, for a person who is totally nursed in bed. This evidences that those staff who are preparing care plans are recording in the actions to be taken, those tasks that they feel should be taken, or are expected. The plans are not person centred and do not evidence that the person, or their representative was involved in drawing up the plan. Some people had two sets of plans about the same issue, and staff were reviewing both on a regular basis. We saw that a number of risk assessments are completed in respect of the likelihood of falls, nutrition, moving and handling, and pressure area risk assessment. As a result of one persons pressure area risk assessment, their tissue viability care plan said they should have a pressure relieving cushion in their armchair. This person told us they did not have a cushion but were comfortable. This is another example of individual plans being prepared in a token manner. It is recommended that the home undertakes a full re-assessment/review of care plans in order to ensure that the information contained within them is correct. Where falls risk assessment indicates a medium or high risk a falls log is maintained and any falls and the circumstances will be recorded. Moving and handling risk assessments result in a safe system of work being devised that sets out what equipment and number of carers are required for any tasks. During our last key visit to the home we were not satisfied with the level of information recorded within some peoples risk assessments. A requirement was made by us that detailed risk assessments must be completed in respect of dealing with, and responding to behavior which can challenge. This was to ensure that appropriate action is taken to support people in a safe manner. Upon review of these records we found that the home had worked hard to improve record keeping in this area. We saw that the assessments in place recorded potential triggers for behavior, recorded the resulting behavior and how this was dealt with and furthermore recorded the end result. The requirement was found to have been met. During our last visit to the service we were concerned that an individual had experienced a high number of falls and specialist advice had not be sought by the home, a requirement was made by us that the Registered Person must arrange for the Care Homes for Older People Page 16 of 38 Evidence: falls prevention nurse to be contacted for advice. We reviewed this same persons records and found that following our last visit the falls prevention nurse had been contacted by the home and had visited the individual identified, advice had been given and we found that this person has had a significant reduction of the falls experienced. Upon examination of training records we found that in June this year six staff attended a talk given by the falls prevention nurse, demonstrating a commitment from the home in raising awareness in this area. Where the home needs to monitor a persons body weight, this is not always done when a person cannot sit on the weighing scales. No other means of measuring are undertaken (for example of the girth). The manager told us that hoist scales are in the process of being purchased. We looked at wound care planning documentation for one person. The tissue viability plan indicated how often the dressings needed attention and what medical products are to be used. We saw that the Tissue Viability Specialist Nurse had been consulted, as was required during our last visit to the service. Progress is monitored with regular photography and an evaluation is recorded each time the wound is attended to. During this visit we looked at medication procedures. We observed medications being given out safely. Photographs of each person are kept with their medication administration sheet (MAR chart), as required or prn medication protocols are in place and when people want to retain responsibility for some or all of their medications, a self-administration assessment form is completed and GP approval recorded. There are safe procedures for the ordering and storage of medications. Improvements have been made with the records kept in respect of medications return to the pharmacy for disposal - a returns log is kept. Where oxygen cylinders are stored or in use, appropriate hazard warning signs are in place. We saw in healthcare records maintained by the home that people were accessing services as needed. We saw that people are also accessing specialist services as required. We saw in records that people had been seen by the speech and language therapist and had been provided with equipment to aid their communication, someone is also supported by the blind association and advice is provided in order that this person is supported in this area. During our visit a general practitioner was reviewing the medication for some of people who live in the home ensuring that what is prescribed is effective for residents medical conditions. Care Homes for Older People Page 17 of 38 Evidence: At our last visit to the home we made a requirement that people living at Honeymead should be supported fully to ensure they do not look unkempt and also that private dietary information about people should not be on public display and furthermore that people should be supported to maintain their dignity and be treated with respect. Whilst we found some improvements in this area the requirement has not been fully met. During our two days at the home we did not see people looking unkempt, people we saw were supported in this area well and no concerns were noted by us, we also found that the home had removed private dietary information from the notice board. However, during our visit we were walking, talking to a male resident and passed an open bedroom door where a female resident was facing the door, she was in a state of undress, with her dignity fully compromised. This is not acceptable. Also during this visit and through our examination of care records we found that staff do not always refer to people they are looking after in a manner that respects that persons dignity. When we read the minutes of residents meetings held in July, August and September we saw that residents had reported Staff never pull the curtains or close the door when they are seeing to you another resident reported I dont like the windows open, the night staff dont draw the curtains. There were comments in one persons daily notes about an event that had occurred where the nurse had written he is capable of pressing the call bell. This shows a total lack of understanding for this person who is in extremely poor health. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home and returned to us prior to our visit, the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; Care plan audits continue and improve through quality management system, for the home to be aware and refer under Deprivation of Liberty safeguards if necessary. The home are in the process of introducing Dignity champions, to make care more individualised, person centered and to challenge practices that need improvement. Nurses are to continue attending care plan training, in addition further training such as catheter care, wound management and challenging behaviours will be sought and delivered. The AQAA completed by the provider also informed us that the home plans to closely monitor delivery of care, that reviews of care are to continue and the manager to immediately notify other health professionals of concerns to ensure the resident has swift and effective support to meet changing needs. Care Homes for Older People Page 18 of 38 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 living at the home are encouraged and supported to participate in activities and events organised by the home. Meals provided at the home are of a good standard, varied and able to meet individuals special dietary requirements. Evidence: There is one designated activities organiser who arranges activities for people. An outside entertainer is booked each month and there was a slide show in September, and music events planned for October and November. A Christmas party is planned for December. A hairdresser visits twice a week, shopping trips out in to Bedminster are arranged on occasions. Arts and crafts sessions and ball games are arranged weekly at other times they do whatever people want to do. Photographs of previous events are located throughout the home. A working and playing care plan is prepared for each person with the aim of looking at how the home will meet that persons social needs but those seen were meaningless and generic. One person told us that they are very keen to be involved in, and organise regular singing events - they are waiting to see the activities organiser. Care Homes for Older People Page 19 of 38 Evidence: During this visit we spent some time talking with the chef and reviewing menus. We found that the home operates a four week rolling rota and for each meal there are two main choices with alternatives available should these not be wanted. The menu viewed demonstrated to us that a variety of food is available including meat, fish and vegetarian options. The chef was able to tell us about how individuals likes and choices as well as special dietary needs are Incorporated within the menu, examples were given to us. We saw within individual care records that diet requisition and special needs are well recorded, the chef had signed and dated these demonstrating their involvement in this area. The chef told us of the plans to attend residents meetings in order to answer any queries in respect of meals provided, this is good practice. We also read the report of the recent inspection undertaken at the home of Bristol City Councils environmental health officer, the home was awarded the maximum five stars for food hygiene and standards within the kitchen, the home is to be commended for this. We saw from the visitors book that people receive visitors at the home. staff confirmed to us that people are welcome at any time. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home and returned to us prior to our visit, the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; We intend that all residents will have a Memory diary that will describe all stages of their lives, significant events and fondest memories etc. This will be used to develop the social and recreational care plans, provide appropriate topical discussion and help staff and residents develop a trusting relationship and friendship. The chef will serve meals in the dining room and gather feedback about the standards of the food at the time it is served. Care Homes for Older People Page 20 of 38 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. Staff have completed training in order that they can be aware of their responsibilities to protect vulnerable adults. However, when concerns are raised more must be done to ensure that appropriate action is taken to protect and support the people in their care. Evidence: At our last key visit to the home a requirement was made by us that the Registered Person must ensure that staff undertake core and refresher training in adult protection procedures in order to ensure that staff are given the information and knowledge required and to ensure that they are aware of their role and responsibility in this area. Through discussion with some staff and a review of training records we found this requirement to have been met, since our last visit thirty one staff have completed training in this area, the remaining eleven staff are also booked to attend within the next four weeks. Whilst this is significant we were extremely concerned to find that two staff members had been alerted by two residents, of two differing incidents pertaining to concerns over staff practices yet had not done anything with this information and had not reported it to the manager. When we spoke with the manager about this he was unaware of the issues and no action had been taken. During our last visit to the home we were not satisfied that complaints were being handled effectively and a requirement was made by us that the Registered Person must ensure that any complaint made under the complaints procedure is fully Care Homes for Older People Page 21 of 38 Evidence: investigated.This is to ensure that people can be confident that issues raised are responded to and fully investigated as required. During this visit to the home a relative told us about a formal complaint they had raised to the home in respect of staff manner and approach. We tracked this complaint and found that it had been recorded within the homes complaints logbook and that the home had written to the complainant with their response. In respect of the issue about staff manner this was upheld by the home. We found out who was on duty at the time of the incident and identified which member of staff the complaint was about, although the home had upheld the complaint they had not discussed the allegations with the staff member, nor had they received any formal supervision, no action was taken to address the issue. Within the homes complaints logbook we saw another complaint about staff approach that was made by a relative in May this year. The relative was extremely upset and wrote to the home about their concerns, the complaint was that a staff member told their relative that they can do more for themselves, this resident has a number of disabilities and is dependent on staff for their personal care support. The home upheld the complaint yet there is no evidence of any investigation undertaken by the home about the concerns raised, the staff members on duty at the time of the incident were not spoken with, nor were they supervised. The home must act when concerns are raised to them, they must evidence that a full investigation has taken place and what actions will be taken. Within the management section of this report we have written about residents meetings where issues raised by people who live at the home have not been dealt with, also within minutes of these meetings residents had said that they didnt know who to speak with should they have any concerns. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, two references and satisfactory Criminal Records Bureau disclosures. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of residents had been reported to the Care Quality Commission, the home had responded to incidents as required. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home and returned to us prior to our visit, the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; To continue to provide good care and a safe and happy environment for our clients to live in, cared for by dedicated and well trained staff. the home also reported that they are introducing the dignity in care values for residents at Care Homes for Older People Page 22 of 38 Evidence: the home, to include protected mealtimes, blue tray / placemat system for residents who are at high nutritional risk and who need additional support from staff, picture menus and care in progress signs on doors where residents are receiving care. This includes the appointment of a champion for dignity in care and who will challenge staff who do not at all times treat residents with the utmost dignity and respect. The home also reported that it intends to continue the training of staff in N.V.Q. Levels 2 and above, increasing the amount of staff with a good value base. The home also said that the Manager will attend adult protection training with the local authority organised by the safeguarding team. The home also said that the staff who attend training courses are to share knowledge gained and experience of that course with other members in small staff meetings. In addition the home said that it intends to carry out an audit of the performance of the home in regard to dealing with complaints successfully and to the satisfaction of the complainant. Care Homes for Older People Page 23 of 38 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. Honeymead is suitably furnished and maintained to provide a good environment in which to live. Evidence: Honeymead Care home is a purpose built double storey home located in West Street, Bedminster, Bristol. The home is close to a local shopping centre and amenities such as banks, coffee shops a supermarket and public houses. The home is also near good bus routes into Bristol City Centre and is near to Temple Meads train station. The home is staffed by nursing and care staff who are on duty 24 hours a day, 7 days per week. There is parking to the front of the home and a well maintained garden for residents use at the rear of the home. Upon arrival at the home there is a reception area with seating, information is on display here about the services and facilities provided by the home. This area is next door to the managers office and the ground floor nurses station. On both floors of the home there are lounge and dining areas, these were seen to be comfortable and were areas that are well used by the people who live at the home. Care Homes for Older People Page 24 of 38 Evidence: At this visit we viewed some bedrooms all were well furnished and had been personalised with photographs, pictures, plants and flowers with soft furnishings to reflect individuals taste and choices. People in their rooms appeared to be comfortable, staff were seen to be monitoring people in their rooms and checking on their wellbeing. We spoke to one person who had a room usually used for two people for themselves, we noted a spare bed that is not required in an individuals room, limiting the space for the resident, it is recommended that it should be removed as it is not required. Toilets are situated in readily accessible parts of the home near to communal areas. Bedrooms all have en suite facilities for individuals use. Toilets and bathroom areas seen by us were found to be clean, tidy and odour free. There are adaptations in place throughout the home and specialist equipment including mobility aids, bathing aids and handrails are in place. There is a passenger lift, this was seen to be in good working order at the home. We found the emergency call bells to be working as required, at the time of our visit staff were seen to respond promptly to requests for assistance. Within the Annual Quality Assurance Assessment (AQAA),which had been completed by the home and returned to us prior to our visit, the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; To improve the garden area and encourage more residents to access it in finer weather. The home also reported that they want to improve signage, as previously mentioned, for doors where residents are receiving personal care. The home has also stated that it will put up a dignity in care display in the reception so residents and visitors are made aware of what it wants to achieve and to share in the drive to improve how people are cared for in the home. Care Homes for Older People Page 25 of 38 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. Those living at Honeymead are supported by staff who are recruited and trained appropriately in order to support the people in their care. However, the home must respond when concerns are raised about practice (see management section). Evidence: There have been no significant changes in the numbers of the staff team since our last visit to the service and there remains a stable staff team at the home. Information contained within individual staff files were all of a consistent standard. The files for three staff were reviewed: including a recently recruited staff member. All of the required documentation was in place in respect of robust recruitment and selection practices. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with, including two references being taken up, a Criminal Records Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults had been checked before the staff started working at the home. At our last key visit to the service completed by us in April staff were unable to find copies of induction training that had occurred at the home, records of this training that were found were incomplete. A requirement was made by us that all new members of staff must complete the organisations induction-training programme with evidence of how their competence has been achieved to be recorded. At this visit we found that Care Homes for Older People Page 26 of 38 Evidence: this requirement had been met. We reviewed the training and induction of those staff most recently appointed to the home and saw that they had completed a Skills for Care induction programme that covered: understanding the role of a care worker, policies and procedures of the home and workers relationships with others. We also saw that bank staff complete an induction, this covers fire safety at the home, how the emergency call system is activated and how it must be responded to. The importance of confidentiality is also covered within this training. During our last visit to the home a requirement was made by us that sufficient and appropriate staffing levels must be in place at the home. This is so that staff have the time to do their job properly and peoples care needs can be met in a timely manner. At this visit the manager confirmed to us that at the time of our inspection there was one registered general nurse and four care staff on each floor, these staff were further supported by ancillary staff. Duty rotas seen by us and staff we spoke with confirmed to us these staffing levels. The manager is aware that staffing numbers must also be based and allocated depending on the needs and assistance required by those living at the home and that should increased staffing be required at times that this must be provided. The home has in place a clear audit of core training that has been undertaken by staff at the home, this, and individual training records and certificates seen showed us that staff have undertaken training in areas such as first aid, food hygiene and protection of vulnerable adults. A requirement set by us at our last visit to the service was that staff must undertake training in core areas such as manual handling, first aid, health and safety and basic food hygiene, furthermore that refresher training as required in these areas must also be arranged. We found this requirement to have been met. At our last visit to the home in April 2009 a requirement was made by us that staff must have the skills, knowledge and understanding to support those people living at the home with special needs. That training must be provided in supporting those with behavior which can challenge and also training must be provided in dementia awareness. We spoke with staff who confirmed to us that they had completed training in these key areas, that they had found the training useful and it had provided them with skills in order to support people who live at the home. A training matrix seen by us confirmed that there are twenty three staff who have completed dementia awareness training and six staff who have undergone training in dealing with behaviours that can be challenging. We also saw within the homes completed AQAA that prior to our visit that the mental health in reach team have provided two very informative training sessions at the home to help the staff plan care and to undertake safe practices whilst meeting the needs of residents who have some behaviours that Care Homes for Older People Page 27 of 38 Evidence: challenge. The manager told us that there is a commitment from the in reach team to provide further training in this area. A number of staff meetings have taken place at the home since our last visit, as recommended by us, these meetings have provided an opportunity to discus the needs of residents and to provide a forum to discuss staff roles and responsibilities, as well as expectations for themselves as staff and the service provider. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home and returned to us prior to our visit, the home had recorded that: The manager has commenced a project about the workers of the week and this will motivate staff to achieve greater standards of care. The home believes that this will result in an annual presentation. The home said that they are undertaking a full review of the training of staff, and that they are in contractual negotiation with the training department and contractor in order to release the budget to managers, thus allowing the manager to source local training specific to the needs of the staff group; this will include train the trainer for such areas as moving and handling so all new staff will receive such training during their induction days. The training programme will be developed to ensure all mandatory training is received in-house and covers all mandatory courses and service specific requirements. Within the homes AQAA they also stated that: We want to focus efforts on improving staff attendance and whilst supporting staff we will effectively manage problem sickness absence. The home will review and provide flexible staffing levels to meet the dependency levels of residents including when the suspension is lifted. The home also said We will endeavor to have all care staff with an N.V.Q. 2 or above in care. Due to concerns over staff manner and approach as outlined within the complaints and management sections of this report our judgement is that further work is needed to ensure that all staff are aware of their duty of care to residents who live at Honeymead in line with the terms and conditions of their employment and it is recommended that the home review their policies and procedures in respect of staff conduct, training and where required remind staff of their responsibilities as outlined within the terms and conditions of their employment. Care Homes for Older People Page 28 of 38 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. There is a manager in post at the home, in order that The Commission can determine their fitness they should register with us. Staff are now better supervised than previously, however, the home must ensure that issues of poor performance are dealt with appropriately in order to ensure that those who live at the home are supported and protected as required. Records of financial transactions must be improved to ensure a consistent approach. Evidence: A requirement was made by us in April 2009 that The Registered Provider shall appoint an individual to manage the care home. This was in order to provide clear, consistent leadership at Honeymead. Prior to our visiting Honeymead we had been contacted by the newly appointed manager Mr Peter Joshua-Turberville. Mr Joshua-Turberville is a qualified RMN with many years experience in managing care Care Homes for Older People Page 29 of 38 Evidence: services for older people. Mr Joshua-Turberville commenced work at the home on 3rd August 2009. We discussed with the manager the registration process in order that we can determine his fitness to manage the care home. The manager assured us that he was in the process of completing his application for the Registered Managers post and that this would be submitted to us promptly in order that the process can commence. At our last visit to the home in April 2009 we recommended that residents meetings are held at the home. This is in order that people who live at the home can have an opportunity to have their say on how the home is run and to raise any ideas, suggestions, concerns they may have. We saw that since our last visit three meetings have been held and a variety of subjects have been discussed including menus, issues of poor staff practice and complaints. These minutes did not give any other information about what the home was going to do with the information give. Minutes of residents meetings should record what action is going to be taken, and by whom as a result of issues raised by those who live at the home, this will evidence that issues are being listened to and acted upon as appropriate. At our last visit to the home in April 2009 we were not satisfied that staff were receiving sufficient amounts of fire safety training and a requirement was made by us that the registered person must make arrangements for persons working in the care home to receive suitable training in fire prevention and to ensure by means of fire drills and practices, at suitable intervals, that they are aware of the procedure to be followed in the event of a fire. This to ensure that staff can be aware of their role and their responsibility in the event of a fire emergency. A review of fire records and staff training audits, as well as confirmation from staff evidenced to us that since our last visit to Honeymead twenty eight staff have completed corporate fire safety training, staff have also attended fire drills as required. The requirement had been met. When reviewing the homes fire logbook we saw that the home was completing the daily, weekly and monthly checks as needed. Fire drills and training were also well recorded. We saw that the home maintains a record of actual fire reports, these were when toast had been burnt or faults in the detection system had activated the fire alarm. We found inconsistencies within the recording of these records. We found that reports were not dated and staff had not recorded what the suspected cause of the fire was, or whether there were any faults and whether or not these had been rectified. We recommend that staff who complete these reports are reminded of their purpose and complete the report fully as required. We saw that the home had been visited by the fire service in August 2009, within the fire officers report we saw that some failures had been noted, these included escape Care Homes for Older People Page 30 of 38 Evidence: routes were found to be obstructed, making escape routes not able to be used as quickly and safely as possible. We saw that the home acted promptly to rectify the failures and had forwarded to the fire service within a week an action plan to address the shortfalls. No concerns over fire safety were found by us during this visit. The home has in place a number of risk assessments relating to the running and management of a care home. We saw that these assessments were well written and contained clear information in order to direct and inform staff practice. We noted that these assessments had recently been reviewed, but did not record by whom. The manager confirmed his awareness of the assessments and his responsibility in signing these to evidence his involvement and knowledge of them. It is recommended that the manager evidences his involvement in these risk assessments. At this visit we spent time with the administrator who is responsible for the safekeeping of money and valuables held at the home on behalf of residents. This person confirmed to us that they are the only person who has access to the safe and is the only person who deals with money and property deposited at the home. We found no errors in the recording of money held by the home and these corresponded with money checked by us. We did find that there were occasions when the administrator had not signed for cash brought into the home. We also found that a cheque book was being held for a resident and this had not been recorded. The administrator told us that the area manager checks a sample of residents cash against records held, this is good practice and it would be further good practice for this to be recorded. It is required that residents property that is held at the home for safekeeping must be recorded in order that it is accounted for. Furthermore the home must ensure consistent record keeping in respect of financial records for money held on behalf of those who live at the home At our last visit to the home a requirement was made by us that the Registered Person must ensure the records required as specified in schedule 3 are kept up to date. This is to ensure that records required by regulation for the protection of people living in the home and for the effective running of the business are maintained and accurate. These related to care records. As recorded within this report we have found improvements in this area and this requirement has been met. A requirement was made by us during our last key visit to the home that all care staff working in the home must be formally supervised and that at least one session for each member of care staff be recorded within this timescale. At this visit we viewed a supervision matrix which recorded supervision sessions that had taken place and those that had been arranged for the forthcoming months. Staff files also contained Care Homes for Older People Page 31 of 38 Evidence: evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good and staff had received the required sessions. Areas of discussion included guidelines and policies of the home, individuals expectations and an evaluation of their performance and how this can be developed. Within the minutes of residents meetings that were conducted in July, August and September this year we were concerned to note that issues of concern raised by residents had not been dealt with. The manager was unaware of the issues and had not been present at the meetings. One resident reported in July that they was told that they had no manners by a carer and if you dont say please and thank you they go for you, this person didnt know the carers name and nothing is recorded about what the home did to investigate this issue. At the meeting held in August a different resident said that when a staff member brought them a cup of tea with sugar in and they told them they dont take sugar the member of staff pulled a face and was a bit rude, the resident had disclosed this member of staffs name. When we looked in this staff members file we could find no reference to the alleged incident. Issues in respect of staff conduct must be addressed by the home and appropriate action taken as required, to ensure that staff are working within the aims and objectives of the home as outlined within the homes Statement of Purpose and in line with the terms and conditions of their employment. Policies and procedures are in place at the home and all are of the standard expected for a care home, we saw that staff are familiarised with these as part of their induction programme with a more in depth approach to such policies as the whistle blowing procedure and adult protection. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home and returned to us prior to our visit, the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; To hold annual reviews with the families of those clients who are privately funded and do not get reviews with a care Manager. The home also reported that We will ensure all staff have a completed Annual Appraisal by the end of the year 2009. The home also said that the manager will continue monitoring by walking the home with a focus on residents health and safety, presentation and dignity. That the home will continue to regularly check on the standard of record keeping and provide support and take action where it is needed. The home also said that all all staff will be reminded in their meetings to always check equipment is safe before it is used and notify CQC of any reportable incidents. Care Homes for Older People Page 32 of 38 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 7 15 The registered person shall 28/06/2009 prepare a written plan which will record how the service users needs, in respect of their health and welfare are to be met. The registered person must ensure that care plans must fully reflect the complex and diverse needs of people and must clearly record how people are to be supported on an individualised basis and provide clear direction and guidance for staff in order that people are fully supported in all aspects of their care. 2 10 12 The registered person shall 30/04/2009 ensure that the home is conducted in a manner which respects the privacy and dignity of service users. People living at Honeymead should be supported to maintain their dignity and be treated with respect. 3 16 22 The registered person must ensure that any complaint made under the complaints procedure is fully investigated. This is to ensure that people 29/05/2009 Care Homes for Older People Page 33 of 38 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 can be confident that issues raised are responded to and fully investifgaed as required. Care Homes for Older People Page 34 of 38 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 32 12 The Registered Person must, 29/11/2009 in relation to the conduct of the care home encourage and assist staff to maintain professional relationships with service users. Minutes of residents meetings should record what action is going to be taken, and by whom as a result of issues raised by those who live at the home, this will evidence that issues are being listened to and acted upon as appropriate. The Registered Person must ensure that records are maintained as required within Schedule 4. Residents property that is held at the home for safekeeping must be recorded in order that it is accounted for. Furthermore the home must ensure 28/11/2009 2 35 17 Care Homes for Older People Page 35 of 38 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 consistent record keeping in respect of financial records for money held on behalf of those who live at the home. 3 36 12 The Registered Person must, 29/11/2009 in relation to the conduct of the care home encourage and assist staff to maintain professional relationships with service users. Staff should be aware of their duty of care to residents who live at Honeymead in line with the terms and conditions of their employment. Issues of poor conduct must be dealt with. 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 7 It is recommended that the home undertake a full re assessment/review of care plans in order to ensure that the information contained within them is correct. Hoist weighing scales should be provided in order that individuals with mobility difficulties can be weighed effectively. The identified spare bed that is not required in an individuals room should be removed. Staff should be aware of their duty of care to residents who live at Honeymead in line with the terms and conditions of their employment. Page 36 of 38 2 8 3 4 24 30 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 It is recommended that the home review their policies and procedures in respect of staff conduct, training and where required remind staff of their responsibilities as outlined within the terms and conditions of their employment 5 38 Records of actual fire incidents must be dated and should also record what the suspected cause of the fire was, whether there were any faults and whether or not these had been rectified. The manager should evidence his involvement of risk assessments in place for the management of a care home.. 6 38 Care Homes for Older People Page 37 of 38 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. 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