Care Home: Irene House

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What the care home does well Residents have an assessment of need carried out before they move into the home. This ensures staff have the right information to care for individuals. Care plans contain lots of information and help ensure the personal and health care needs of residents are met consistently and safely. Residents say they are happy with the medical care they receive. Residents are treated with respect and their rights to privacy are upheld. Visitors are made welcome and residents are supported to maintain contact with their families. Residents expressed satisfaction with activities on offer. For example one person said `they keep me occupied`. Residents are supported to raise concerns, have access to a robust complaints procedure and are protected from harm. The environment is well maintained and clean and hygienic. Residents are happy with the staff who support them. Comments include `The staff take time to chat to the residents and attend to their needs` and `Always a feeling that the carers are fully committed`. What has improved since the last inspection? The AQAA also informs us that the following improvements have been made with regard to care management `Built good relations with the local surgery, improved the overall quality of care planning and developed the Resident of the Day approach to ensure that Residents, their families and representatives are included in the care planning process`. The range and choice of activities has improved. This now includes using volunteers to assist with group and individual activities, including outings in the mini bus. Also residents have participated in planting flowers and vegetables in the courtyard. Resident Craft morning session produced crafts to sell at summer fayre. Regular extra musical events have been arranged. Lounges have been redecorated, planters have been purchased for the court yard garden area and a handy person is now in place to improve the response time for dealing with minor repairs and the upgrading of communal area decor. Quality monitoring systems are being introduced in order that the home can measure if it is achieving its aims and objectives. What the care home could do better: The manager has been in post since February 2009 and at the time of inspection had not submitted an application to begin this process. This must happen in order to comply with the law. Medication practises must improve to ensure systems are safe and comply with the law. These must include hygiene practises in handling medication, the accurate recording of all medication administered and maintaining a record of all medication entering the home. Recruitment practises must improve to reduce risks to residents. These must include ensuring no new members of staff commence working at the home before the required recruitment documentation is in place. For those staff already working at the home and the required documentation has not been obtained action must be taken to reduce risks to residents including undertaking assessments of risk and and if necessary removing staff from working with residents. Key inspection report Care homes for older people Name: Address: Irene House 1 Parkfield Road Worthing West Sussex BN13 1EN     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: Lesley Webb     Date: 1 3 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 30 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 30 Information about the care home Name of care home: Address: Irene House 1 Parkfield Road Worthing West Sussex BN13 1EN 01903529060 01903529058 srijit.duffadar@guildcare.org www.guildcare.org Guild Care care home 40 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 to be accommodated is 40. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the hoem are within the following categories: Old age, not falling within any other category - (OP) Date of last inspection Brief description of the care home Irene House is a care home registered to accommodate forty residents over the age of sixty-five years, some of who may have nursing needs. The home is situated in a residential area of Worthing. It is a detached, two-storey building with a central courtyard area and private parking facilities at the front entrance. Residents are accommodated in single rooms with a wash hand basin. Two bedrooms have en-suite toilet facilities. There is a passenger lift for access from the ground floor to the first floor. There are three lounge areas and two dining rooms. Irene House is owned by Guild Care, an organisation, which has three other care, homes in the area. Care Homes for Older People Page 4 of 30 Over 65 40 0 Brief description of the care home The current level of fees range from £455.00 to £639.00 per week. Items not covered by the fee include hairdresser, chiropodist, aromatherapy, daily papers and toiletries. Care Homes for Older People Page 5 of 30 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: We visited this home on Tuesday the 13th of October 2009, arriving at 9.30am and staying until 5.30pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The manager was present during our visit and assisted us throughout by providing documentation and answering any questions we raised. During our visit to the home we had conversations with six residents and three staff. We examined the care records of three residents and recruitment records of four permanent staff. We also looked at other documentation maintained in the home such as staff training records, medication and complaints. In addition to this we looked around the home and indirectly observed interactions between residents and staff. Prior to our visit the home supplied us with copy of its Annual Quality Assurance Assessment (AQAA) and nine residents completed questionnaires and returned them to Care Homes for Older People Page 6 of 30 us. Information from all of the above sources was assessed and used to help us form judgements on the quality of service people living at the home receive. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 30 The manager has been in post since February 2009 and at the time of inspection had not submitted an application to begin this process. This must happen in order to comply with the law. Medication practises must improve to ensure systems are safe and comply with the law. These must include hygiene practises in handling medication, the accurate recording of all medication administered and maintaining a record of all medication entering the home. Recruitment practises must improve to reduce risks to residents. These must include ensuring no new members of staff commence working at the home before the required recruitment documentation is in place. For those staff already working at the home and the required documentation has not been obtained action must be taken to reduce risks to residents including undertaking assessments of risk and and if necessary removing staff from working with residents. 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 30 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 30 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. All Residents have an assessment of need carried out prior to admission to ensure staff have the right information to care for individuals. Evidence: Prior to our inspection the home sent us its Annual Quality Assurance Assessment (AQAA). With regard to assessment processes it states Full needs assessment carried out, unless an Emergency, by suitably qualified staff usually Manager. This is completed for all residents, if necessary, in conjunction with the Care Management assessment for Social Services clients and/or Nursing Continuing Care PCT checklist. During our visit to the home we looked at the pre admission documentation for three residents, including the newest person to move into the home and spoke with the nurse in charge and manager. Evidence from these sources supports the contents of the homes AQAA. Care Homes for Older People Page 11 of 30 Evidence: For example evidence of pre admission assessment was seen in all of the residents files sampled. The assessment covers all areas of need including, health, personal and social care. Nine residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. All state they received enough information about the home before they moved in to help decide if it would be the right place for them. Irene House does not offer intermediate care. Care Homes for Older People Page 12 of 30 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 and associated documentation is in place for identified needs in order that the personal and health care needs of residents are met consistently and safely. Medication practises do not safeguard residents. Residents are treated with respect and their rights to privacy are upheld. Evidence: With regard to health and personal care the homes AQAA states Relatives are encouraged to be involved in providing personal care, if they and the resident wishes. Residents are able to see any visiting professional in private, and always within the privacy of their own room. We assist with NHS Domiciliary Dental visits, optician and audiology visits as required. We request referral via GP for Community Physiotherapy, SALT Team, Dietitian, Palliative team, etc, as required by individual residents. A registered Chiropodist visits Irene House regularly if the residents wishes to use. We have good working relations with Primary Care Trust and Social Care Services. We ensure we have the facilities and skills within the staff team to meet the changing needs of the residents. Delivery of a consistently high standard of health and personal care, ensuring privacy and dignity of residents at all times. We have a contract with Care Homes for Older People Page 13 of 30 Evidence: our local Doctors Surgery which ensures that Residents have access to the Doctor at least once fortnightly. All staff attend induction training and have to meet Skills for Care requirements, which incorporates best practise regarding Privacy and Dignity. When visiting the home we sampled three residents care records, spoke with staff and indirectly observed care practises, finding evidence that supports the contents of the AQAA. For example all residents had a plan of care that contained comprehensive information on health, personal and social needs. Each resident also had risk assessments for nutritional needs, mobility, falls and pressure areas. All of the assessments have been reviewed on a monthly basis. In addition to this each resident has a lifestyle summary that includes preferences with regard to personal care and support. As at previous inspection we found evidence that residents have access to specialist health support as required including general practitioners, chiropodists, dentists and outpatient appointments. Nine residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. Eight state the home always makes sure they get the medical care needed and one that they usually. When asked the question what could the home do better a comment was recorded of We would like to see each resident have a nominated carer who could tell relatives or friends any little things the resident requires or could answer small points such as does the resident need anything toiletries, more clothing etc we had this over 2 years ago but staffing doesnt allow this now. We discussed the above comment with the manager who informed us this would be looked into. The AQAA also informs us that the following improvements have been made with regard to care management Built good relations with the local surgery, improved the overall quality of care planning and developed the Resident of the Day approach to ensure that Residents, their families and representatives are included in the care planning process. We examined the medication and records of nine residents. For three of the residents records were not in place for all of their prescribed medications entering the home or the quantity received. Also four of the residents are prescribed medicated creams. No records of these being administered are in place. The nurse in charge informed us this is because the creams are stored in residents bedrooms and administered when Care Homes for Older People Page 14 of 30 Evidence: personal care is undertaken. The omissions in recordings mean that we are not able to tell if people always get the medicines that have been prescribed for them. Records for one resident detail them being prescribed midazolam and morphine sulphate (strong pain relief medication) to manage pain. These were recorded on the previous months medication administration records but not on the current months. The nurse in charge informed us its supposed to be. We asked the nurse in charge to rectify this mistake immediately in order that any nurse responsible for administering medication are aware this medication is available to the resident should they require it for management of pain. The home maintains a stock of some medication such as pain relief. The nurse in charge said that a stock record is not maintained and agreed this should be implemented to aid monitoring and safety. During lunch time we observed a nurse give a resident their medication. When doing this the nurse took the residents medication from its container placed in her hands and broke the medication into pieces before placing on the table where she observed the resident take the medication. We discussed this practise with the manager and operations director for the service, who agreed to speak to the nurse responsible immediately regarding the poor practise observed. We examined the records and storage facilities for controlled drugs. All were in good order and up to date. All residents that we spoke with during the inspection they confirmed that they are treated with respect at all times and that their privacy and dignity are protected. Throughout the inspection it was observed that residents are spoken to with respect. Staff knocked on doors and greeted residents prior to entering rooms. Care Homes for Older People Page 15 of 30 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. The lifestyle choices offered in the home meets residents needs and preferences. Visitors are welcome and residents in the main enjoy a varied diet. Evidence: With regard to lifestyle choices the homes AQAA states We have very proactive Activity Coordinators, both from a care background. Regular social activities arranged, inviting relatives and friends.i.e weekend and bank holiday events. Regular weekly outings, 1 to 1 and as a group. Daily or twice daily we offer a range of group and 1 to 1 activities for residents. Open visiting, and encourage relatives and friends to take an active part in any social or other activities in the home. Food tasting events are made into special occasions i.e. Evening out at Irene and Grand Irene Tea. When visiting the home we looked at a variety of records, spoke with staff and indirectly observed care practises, finding evidence that supports the contents of the AQAA. For example records confirm a choice of activities are available six days per week, and these include in-house and external activities. Whilst at the home residents were observed participating in a quiz game. All those involved appeared to enjoy this event. During the afternoon residents were observed Care Homes for Older People Page 16 of 30 Evidence: leaving the home to go on an outing in the community using the homes mini bus. Nine residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. Five state the home always arranges activities they can participate in, one that they usually and one that they sometimes. Two people stated that this question was not applicable to them. When asked the question what does the home do well two additional comments were recorded of Communication between home, residents, relatives, involvement of residents in activities and Keeps me occupied. Since our last inspection the homes AQAA informs us that We have recruited volunteers to assist with group and individual activities. This includes help with bus trips. Residents have participated in planting flowers vegetables in courtyard. Resident Craft morning session produced crafts to sell at summer fayre. Regular extra musical events have been arranged, with volunteers assisting. We have increased the contact with the local community, i.e local church at easter and Christmas, Brownie pack visiting at events and other occasions. Examination of records and discussions with the manager confirm that the above improvements have been made. With regard to meals the homes AQAA states We provide a well balanced nutritional 6 week rotating menu with resident involvement through meetings and menu surveys which is changed twice a year. We hold regular food taster sessions attended by residents and their families to help with menu planning. Relatives are invited to join residents for meals. At least 90 percent of all our main courses and supper menus are home cooked. Head chef visits all residents as part of Guild Cares Residents Charter. Residents meetings always provide an opportunity for residents to express view points which can then be actioned feed back to chefs. Again, through our inspection process we were able to confirm the contents of the AQAA. For example records confirm residents are offered at least two choices of meal every day and residents confirmed that the majority of cakes are home made. We joined residents at lunch time, having one of the two main choices of meal on the menu that day. We were offered a choice between chicken in barbecue sauce or toad in the hole. We were not offered a choice of items to accompany this despite a variety of options being available. We also noted that three of the residents at the table we were sitting at who had chosen the chicken option were also not given a choice of accompanying items. All left some element of their meal. Two residents who were also Care Homes for Older People Page 17 of 30 Evidence: at the same table as us had chosen a third option to that on the main menu. They informed us this is available everyday if you do not want what is on offer. Both expressed satisfaction with their meals. Everyone at the table choose homemade lemon me range and cream for dessert and appeared to thoroughly enjoy this. Nine residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. Four state they usually, two they always and two they sometimes like the meals provided. We discussed the provision of meals with the manager and operations director for the home. They informed us of recent changes to the management of catering and that they were looking to make further improvements in this area with regards to actively seeking the views of people who are less able. Care Homes for Older People Page 18 of 30 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. Residents are supported to raise concerns, have access to a robust complaints procedure and are protected from harm. Evidence: Nine residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. All state they know of someone they can speak to informally if not happy. With regard to complaints management the homes AQAA states Clear systems in place for all staff to follow, and residents and visitors to know what to do if unhappy about something. Residents, relatives and staff are aware that the senior team are available on a daily basis. Residents and relatives can express concerns anonymously, using a Complaints Concerns form or relevant Comment Card. Use of Talk back form, where someone can contact the CEO directly. Evidence gained through our inspection process supports this statement. For example records confirm that the home has followed its own complaints procedure when needed and staff confirmed they encourage residents to talk about anything they are not happy with. As one member of staff explained, we talk to residents on daily basis, ask if OK, make them feel happy that they can approach us. The home also maintains a compliments folder. This contains an abundance of cards Care Homes for Older People Page 19 of 30 Evidence: and letters expressing satisfaction with the service provided. As at our previous inspection there are policies and procedures in place regarding safeguarding adults and whistle blowing. Staff spoken to were very clear about their responsibilities towards the people living in the home. Staff receive safeguarding adults training in their induction and they have updates. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe and well maintained environment that is clean and hygienic. Evidence: With regard to the environment the homes AQAA states We provide a very high quality, safe, homely environment. Full range of adaptations, such as grab rails, toilet surrounds, etc. available, which can be adapted to meet individual needs. We have a nil odour policy, through careful assessment and care planning, and liaison with Domestic team. Use of a range of equipment and other adaptations, to meet individual resident needs, with support of other professionals where necessary. We carry out regular room audits and complete the risk assessments required. Large HD ready TV available in the Rectory lounge. Encouragement given to personalise own bedrooms and add homely touches. Outside floral arrangements that makes the home look attractive and welcoming. Range of fully assisted bathing facilities are available throughout the home. Comprehensive call bell system, with choice of equipment to meet individual needs and hard wire call button neck pendants. A courtyard is located for residents use, with large patio area and canopy in the centre of the home with attractive planters at the entrance to the home. Evidence gained through our inspection process supports this statement. For example when we looked around the home we saw that people living in the home have personalised their rooms. Communal areas were well decorated and homely, with Care Homes for Older People Page 21 of 30 Evidence: furniture of a good standard. We did note that some of the door frames within the home were damaged. The manager agreed to contact the fire service for advice in case this affects the efficiency of fire doors. The homes AQAA informs us that the Rectory and Glebe lounges have been redecorated, planters have been purchased for the court yard garden area and that an in house handy person is now in place to improve the response time for dealing with minor repairs and the upgrading of communal area decor. All areas of the home, which we saw during our visit, were clean and hygienic. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are available in sufficient number and are suitably qualified to care for residents. Recruitment practises do not safeguard residents. Evidence: The manager informed us that the staffing levels at the home consists of seven care staff and two nurses of a morning and six care and one nurse of an afternoon. There is also a period of the day when three nurses are on duty when the morning and afternoon shift cross over. At night we were informed there are three care and one nurse. In addition to this separate kitchen and domestic staff are allocated each day. Nine residents surveys were completed and returned to us prior to our inspection. Two state there are always staff available when needed, one that there are sometimes and 5 usually. When asked the question what does the home do well comments were recorded including Caring staff on a whole The staff take time to chat to the residents and attend to their needs and Always a feeling that the carers are fully committed. We examined the recruitment records for the three newest care staff and registered nurse who have commenced working at the home. The first did not include a completed application form or two references. The second did not include two references. The third included only one reference and the nurses did not include Care Homes for Older People Page 23 of 30 Evidence: evidence of her nursing qualification. The manager and other staff at the home including the operations director looked for the missing recruitment records but were unable to locate these in the home. They also telephoned Guild Cares head office who were also unable to find copies of the missing items. As a result we issued an immediate requirement. We have since received written confirmation from the responsible individual of appropriate action taken to meet the immediate requirement. We looked at four staff files and found they all contained evidence that staff have attended training in areas including health and safety, communication, dementia awareness and moving and handling. Care Homes for Older People Page 24 of 30 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. Management of this home is not meeting the needs of residents safely with regard to some medication and recruitment practises. Quality monitoring systems are being introduced in order that the home can measure if it is achieving its aims and objectives. Residents financial interests are safeguarded. Evidence: The manager is not yet registered and at the time of inspection had not submitted an application to begin this process. The manager has been in post since February 2009. She is a registered nurse and holds a National Vocational Qualification at level 4 in management. We instructed the manager that an application for registration must be submitted as a matter of priority. She agreed to do this. During our visit to the home we were shown a new quality assurance system that is being implemented at the home. The new system includes monthly audits that will be undertaken by a compliance team, actions plans as a result of visits and annual user surveys. At the time of our visit one monthly audit had taken place. This had identified Care Homes for Older People Page 25 of 30 Evidence: shortfalls in staff supervision as detailed below but not in medication and recruitment practises as detailed in this report. Records that we looked at demonstrate that staff receive one to one supervising but that this does not occur on a regular basis for all staff. The manager had already identified this as an area that requires improvement before our visit. Although staff have not been receiving regular one to one support staff meetings have been taking place where various aspects of the service and staff roles are discussed. There are systems in place to support residents to manage their finances. Computer records are maintained for each resident that detail income and expenditure and residents and/or their representatives are invoiced on a monthly basis. The AQAA informs us that services including the premises electrical circuits, lifts, hoists and fire equipment have been serviced within agreed timescales. Care Homes for Older People Page 26 of 30 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 27 of 30 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 1 29 19 In line with Regulation 19 13/10/2009 and schedule 2 the registered person must ensure no new members of staff commence working at the home before the required recruitment documentation is in place. This must happen to ensure residents are protected from harm. 2 29 19 In line with Regulation 19 14/10/2009 and Schedule 2 the registered person must ensure for the staff members where the required recruitment documentation is missing they do not work unsupervised and that a risk assessment is completed with remedial action taken, that includes if necessary removing staff from working at the home until the required documentation is obtained. This must happen to reduce any potential risk to residents. Care Homes for Older People Page 28 of 30 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 In line with Regulation 13(2) 13/11/2009 the registered person must review the homes medication practises to ensure that people in the home receive their medication as prescribed. Particular attention must be paid to - * Hygiene practises in handling medication * Accurate recording of all medication administered * Maintaining a record of all medication entering the home This must happen to ensure medication systems and practises are safe and comply with the law. 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 Care Homes for Older People Page 29 of 30 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 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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