Care Home: July V11 Ltd T/A Wykenhurst Residential Home

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What the care home does well People have access to written information to help them decide if they wish to move into Wykenhurst. The home makes sure that people`s needs are assessed before they move in, so that staff know the support that needs to be provided. People appreciate the care and support that they receive from the service. Medication is managed safely. The home provides a range of activities for people to take part in. People are supported to maintain links with the local community. People are confident that concerns will be listened to and resolved. Staff know how to protect people from the risk of abuse or neglect. Wykenhurst provides a safe and homely environment for people, and the home is kept clean and fresh. Staff receive the training they need to provide support for people living at the home. There are enough staff on duty to meet people`s needs. The home`s new management structure should help to ensure that the home is run in the best interests of people living there. What has improved since the last inspection? This is the first key inspection of the service since July VII was registered as the provider in November 2009. However, we carried out a random inspection in December 2009, to look at areas where people might be at risk. Since that inspection, the home has improved its risk assessment and care planning procedures, and has made sure that everyone who lives there is able to maintain their privacy by having a lock on their bedroom doors. What the care home could do better: The home does not always ensure that risks are adequately identified, and plans put in place to manage the risks. Record keeping is not always consistent. People are not always offered preventative health checks. There are shortfalls in the quality and variety of the food provided by the home. Key inspection report Care homes for older people Name: Address: July V11 Ltd T/A Wykenhurst Residential Home 17-19 Baggallay Street Hereford Herefordshire HR4 0DZ     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: Sarah Blake     Date: 1 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: July V11 Ltd T/A Wykenhurst Residential Home 17-19 Baggallay Street Hereford Herefordshire HR4 0DZ 01432278435 01432344705 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): July V11 Ltd T/A Wykenhurst Residential Home Name of registered manager (if applicable) Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: That service users are over 45 years of age That the maximum number of service users accommodated be no more than 24 people That there be no further service users admitted to Wykenhurst The registered person may provide the following categories of service only Care Home only Code PC to service users of either gender whose primary care needs on admission Care Homes for Older People Page 4 of 29 Over 65 0 0 0 27 0 27 0 27 0 27 to the home are within the following categories Mental Disorder Code MD maximum number of places 27 Physical disability Code PD maximum number of places 27 Old age, not falling within any other category Code OP maximum number of places 27 Dementia Code DE maximum number of places 27 Date of last inspection Brief description of the care home Wykenhurst is registered to accommodate up to twenty-seven adults who may require care due to a wide range of care needs. These can include (for those over 65 years) general frailty associated with increasing age, physical disabilities or mental health issues. People aged under 65 years who have care needs arising from their mental health may also be accommodated as well as one younger person with a physical disability. The home consists of adjacent Victorian period houses that have been converted to one property. It is located in one of the original residential areas of Hereford and is within easy reach of the city centre. There are also local facilities e.g. shops, church and public house in close proximity and it is on a main bus route. There is a shaft lift for access. There are sitting rooms, a separate dining room, a hairdressing room and a reasonably sized, accessible and secure garden. The schedule of fees is available from the home. Additional charges are made for hairdressing, chiropody, dry cleaning, toiletries and newspapers (2 papers are provided each day for general use). Care Homes for Older People Page 5 of 29 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 was an unannounced inspection. Two inspectors visited the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. We looked in detail at the records for three people living at the home. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the comments from the AQAA have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives and health professionals who work with the home. The information from these Care Homes for Older People Page 6 of 29 sources helps us understand how well the home is meeting the needs of the people using the service. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to written information to help them decide if they wish to move into Wykenhurst. The home makes sure that peoples needs are assessed before they move in, so that staff know the support that needs to be provided. Evidence: The home produces written information for people who are considering moving into Wykenhurst. This is in the form of a Service User Guide and a Statement of Purpose. We found that some of the information in the Statement of Purpose was not up to date, and might give people inaccurate information. For example, the owners of the home are named as Judith Jones and Lyn Rushgrove, when in fact the home is owned by a limited company, July VII Ltd. We saw that the Service User Guide is available in large print if required. We were shown some information about the home which had pictures to help people who need support with reading to understand what was written. This means that the home is Care Homes for Older People Page 10 of 29 Evidence: supporting people with communication needs. At the time of the inspection, the homes conditions of registration meant that no new people could be admitted into the home. Therefore we were not able to check the records of any people who were new to the home, to make sure that their needs had been thoroughly assessed. We saw copies of the forms which the home will be using to assess peoples needs. These were very detailed, and would provide good information for staff, so that they would know how to support people as soon as they moved in. Senior staff described to us how peoples needs would be assessed, and confirmed that they would always make sure that a full assessment was carried out before anyone moved into the home. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People appreciate the care and support that they receive from the service, but peoples needs are not always identified and met. Medication is managed safely. Evidence: The home has recently introduced a new system for planning and reviewing peoples care needs. At the time of the inspection, this system was only in the third week of full use. We looked in detail at the care records for three people who live at the home. We wanted to see how the home plans and reviews peoples needs, and to make sure that their needs are being met. Because there are people living at Wykenhurst with a very diverse range of needs, we wanted to make sure that the home can meet everyones individual needs. We saw that people had been asked about their preferences, for example, what time they like to go to bed and get up in the morning, and that these preferences had been incorporated into the care plans. This shows that the home is working to ensure that care is person-centred. Care Homes for Older People Page 12 of 29 Evidence: We found that, in general, where the home had identified a risk to peoples health and wellbeing, a plan was in place to manage and reduce the risk as far as possible. However, we saw that one person had recently had a fall which had resulted in an injury. The falls risk assessment had not been updated to include actions to reduce the risk of the person falling again. It is important that staff have up to date written information to help them support people. Records showed that one person was extremely underweight. The care plan stated that the person should be weighed every two weeks. Records showed that the person had last been weighed over three weeks earlier, and that they had lost weight in the previous two weeks. There were two entries in the records stating speak to District Nurse about weight loss, but there was no written evidence that the District Nurses had been consulted. The lead carer told us that the person had been referred to a dietician, but we could find no evidence of this. We asked staff to weigh the person while were at the home, and we saw that there had been no further weight loss. The persons food intake was being recorded on a chart. We looked at the chart at 11.30 a.m. and saw that there was no record of what the person had eaten so far that day. We were told that staff complete the chart at the end of the day. This is not good practice, as it is important that records are kept up to date. We have written to the home, requiring them to take urgent action to ensure that the persons nutritional needs are fully met. In our surveys, all ten people living at the home who replied, told us that they always get the medical care they need. While we were at the home, we saw that one person had needed first aid for a minor incident. Staff had provided the appropriate first aid and the lead carer had telephoned the GP for advice. When we looked at the records for one younger person who lives at the home, we found no evidence that the person had received regular well person checks at the surgery or had been offered preventative checks. The above three paragraphs show that the homes approach to accessing support from health care professionals is inconsistent: we saw examples of very good practice, but also examples of poor practice. We had previously visited the home in December 2009, to check on areas of concern. At that inspection, we made requirements that care plans must give staff the information they need to provide care and support for people, and also that care plans must be revised as appropriate when peoples needs change. We found that most care plans gave staff the information they needed, but that some information was not Care Homes for Older People Page 13 of 29 Evidence: transferred from the daily records into the care plans when peoples needs changed. We spoke to the responsible person, Ms Rushgrove, and she told us that because the home was only in the third week of using the new care planning system, some of the staff were not used to the new system. She explained that, under the new system, key workers would be responsible for ensuring that information would be added to the care plans as necessary. When we spoke to staff, we found that they were knowledgeable about peoples individual needs, and described the care and support that people needed. We saw that one person who is at risk of developing pressure sores had a pressure relieving cushion on their chair in the dining room. Staff were careful to make sure the person always sat on the cushion, and the lead carer showed an excellent understanding of how to prevent pressure sores developing. The pharmacist inspector had visited the home in January 2010, and had found that the home was generally managing medication safely. There had been a requirement made as a result of that inspection, that, when medication is to be given on an as required basis, there must be written information for staff about the circumstances in which the medication is to be given. We checked the medication records for someone who takes a painkilling medication as required. We saw that the care plan included written information for staff about how and when this medication should be given. It would be good practice to have this information available with the persons medication records as well as in the care plan. We observed a senior carer carrying out a medication round. This was carried out safely and the carer made sure that the medication had been swallowed before she signed to say that it had been given. This is good practice, as it reduces the risk of inaccurate recording. We checked some medication, to see if the homes record of the amounts in stock was accurate, and found that everything was correctly accounted for. During the inspection, we saw that staff were caring and kind in the way they supported people, and treated them with respect. We saw that staff made sure that they protected and promoted peoples privacy and dignity when providing care. Staff at the home have been encouraged to sign up to the Department of Healths Dignity Challenge. Dignity in Care is a Department of Health initiative which aims to end tolerance of indignity in health and social care services through raising awareness and inspiring people to take action. Care Homes for Older People Page 14 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities for people to take part in. People are supported to maintain links with the local community. There are shortfalls in the quality and variety of the food provided by the home. Evidence: In the AQAA, the home told us Activities have increased to deliver a more person centred approach. We saw that each person has an individual plan for social and leisure activities, which contains information about how they like to spend their time. There is also a weekly planner, which is completed by the key worker in discussion with each person. We were told that the home had marked Dignity Day with a cooked breakfast for everyone at the home, including staff and even the decorators who were working in the home at the time. At eleven oclock, we saw that people living at the home and staff all met together in the dining room for coffee and cake. Staff took refreshments to anyone who was unable or unwilling to go to the dining room. There was a relaxed and chatty atmosphere, with staff, visitors and people who live at the home all socialising Care Homes for Older People Page 15 of 29 Evidence: together. Staff told us that this also happens every day in the middle of the afternoon. We saw photographs of a recent Valentines Day party, and people told us that St Davids Day had been celebrated with home-made Welsh cakes. People living at the home had recently taken part in a sponsored walk in Hereford to raise funds for social events at the home. Records showed that people regularly go into town, usually with a member of staff to support them. Some people are able to go out alone, and this is encouraged if it is safe for them to do so. Some people are encouraged to take part in cleaning their bedrooms, and we saw that, for some people, this forms part of their care plan, to promote independence and retain life skills. There is a kitchenette next to the main kitchen, where people can prepare drinks and snacks at any time for themselves. Ms Rushgrove told us that people will also be able to use the kitchen in the newly extended part of the home in future for making drinks and snacks. Ms Rushgrove told us that the menus had been drawn up, taking into account peoples wishes and their dietary requirements. The weekly menus were displayed on the dining room tables. Unfortunately they did not all show the correct weeks menu. Lunch on the day of the inspection was fish fingers, with chips, baked beans and tinned tomatoes. People told us that they enjoyed the food, although it did not look very appetising, and there was a strong smell of frying pervading the dining room. It is important that the needs of older people who may have difficulty in chewing, and therefore may need a softer diet, are taken into account when planning menus. Menus showed that meals are varied, but that several main meals rely on processed food such as sausages, fish fingers, and corned beef. One days lunch was bubble and squeak with bacon and egg for the main meal, followed by treacle pudding or jelly, with a supper of ham or egg mayonnaise sandwiches or bread and butter with jam, followed by cake, and a late snack of pork pie. There was a bowl of fresh fruit in the dining room, and people told us that fruit juice and grapefruit is available at breakfast. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that concerns will be listened to and resolved. Staff know how to protect people from the risk of abuse or neglect. Evidence: In our surveys, everyone told us that they knew who to speak to if they had any concerns. Most people knew how to make a formal complaint, and we saw that each person had a summarised copy of the complaints procedure in their bedroom. The summarised complaints procedure was not very detailed and appeared to have been written for the use of care staff rather than for people living at the home. It did not include information that complaints can be referred to the Commission at any stage of the procedure. The homes records showed that there have been no complaints since the home has been registered. We saw copies of compliments from families expressing their satisfaction with the care provided at Wykenhurst. We, the Commission, have received no complaints about the home since it was registered under its new ownership. The home has shown that it passes on any concerns about the possibility of neglect or abuse to the appropriate authorities, and always asks for guidance if there is any uncertainty. We spoke to staff, who showed a good understanding of their role in protecting people Care Homes for Older People Page 17 of 29 Evidence: from the risk of neglect or abuse. Records showed that staff and managers had received training in these issues. One of the ways in which services can help to protect people is by ensuring that only suitable staff are employed. We checked staffing records and found that the home makes sure that all the required checks, such as Criminal Records Bureau (CRB) checks and two written references, are carried out before new members of staff start work. Care Homes for Older People Page 18 of 29 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. Wykenhurst provides a safe and homely environment for people, and the home is kept clean and fresh. Evidence: Wykenhurst consists of three adjoining houses in a residential street on the outskirts of Hereford city. The houses are all linked internally and have been adapted to meet the needs of the people who live there. There are four lounges, three of which have been newly decorated. The lounges are comfortably furnished with sofas and armchairs. Each lounge has its own character, and a senior member of staff described one as the old ladies lounge and one as the mens lounge. The dining room is a light and spacious room. As the home had only seventeen people living there at the time of the inspection, there was plenty of space for everyone to sit and eat comfortably. However, when the home is full, it is difficult to see how another ten people could be comfortably seated so that everyone can eat together. Ms Rushgrove has told us that the home has plans to provide more dining space if necessary. There is a large flat screen television in the dining room, and this is used for film nights. Care Homes for Older People Page 19 of 29 Evidence: At present, only one shared bedroom is occupied, although we were shown another empty double occupancy room downstairs, which was described to us as being suitable for people coming out of hospital. We saw that shared bedrooms had full length screening curtains, so that peoples privacy and dignity were protected. The home has installed new locks on all bedroom doors, as we had required them to do following our inspection in December 2009. Ms Rushgrove told us that every person living at Wykenhurst has been offered a key to their bedroom. We were shown a building in the garden, part of which is being refurbished to provide a garden room, which will be used for activities. The garden at Wykenhurst has suffered during the extensive renovation work, but we were told that a new member of staff will be working with the people who live at the home to make a sensory garden and to plant patio pots. Ms Rushgrove told us that she wants the garden to be somewhere where people can enjoy sitting and relaxing. The home was very clean, and we saw housekeeping staff cleaning and tidying throughout the day. One person told us in a survey the place is always clean. We saw that every bathroom had liquid hand wash and hand drying facilities available. Staff were wearing gloves and aprons when providing support with personal care. When we spoke to staff, they showed a good understanding of the principles of infection control. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive the training they need to provide support for people living at the home. There are enough staff on duty to meet peoples needs. Evidence: People were very positive about the staff at the home, and we saw that staff were kind and caring in their approach to everyone. People told us the staff are great and they really care about everyone. Records showed that all staff have done a three day induction training with the homes care consultant, and that this covered important aspects of working at the home. Some senior staff have attended training in person-centred planning, and some have attended Leadership in Care training. Training records showed that the home provides training for staff which gives them the skills and knowledge they need to provide care and support to the range of people who live at the home. For example, at the inspection in December 2009, we had recommended that staff were trained in current good practice in the management of behaviour which could pose a risk to themselves or others. We were pleased to see that some staff had attended this training, and that all staff would be attending it in the future. The home has clear recruitment procedures, which help to ensure that only suitable staff are employed. We saw that these procedures had been followed for recently Care Homes for Older People Page 21 of 29 Evidence: employed staff. We saw that one newly appointed care worker had been receiving instruction and supervision from the lead carer. The lead carer explained how the new workers care practice was being monitored and guidance given as necessary. Records showed that the new worker was an extra member of staff on each of her shifts. Notes of a recent staff meeting included details of training, activities, updates on people living at the home, and reminders of good practice. We were told that staff meetings are held twice a week. Care Homes for Older People Page 22 of 29 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. The homes new management structure should help to ensure that the home is run in the best interests of people living there. Evidence: The home has recently appointed a new manager, who has not yet applied to the Commission to be registered. Ms Rushgrove told us that the application will be made once the manager has completed some more training. It is too soon to be able to judge how the new management structure will impact on the service people receive at the home. However, we found evidence that there have been many improvements, most of which are mentioned in this report. There is still work to be done to ensure that peoples needs are fully met at all times. Ms Rushgrove explained to us that the homes management structure consists of the manager who deals with all care issues, an administrator who deals with staffing matters such as training, and a lead carer, part of whose role is to liaise between the care staff and the manager. The manager has experience of working in a specialist Care Homes for Older People Page 23 of 29 Evidence: mental health service, and the lead carer is experienced in working with older people, so between them they have the skills and knowledge to support the range of people who live at Wykenhurst. Everyone who lives at the home has their own bank account, although some people need support to access and manage their money. Where this is the case, the home keeps records of all transactions, and we saw that these were accurate and up to date. Records showed that fire safety procedures are in place and are regularly monitored. We saw notes of a residents meeting held in February 2010, and these showed that people living at the home are able to make suggestions about the type of activities which the home can provide. There was no evidence that people living at the home had been consulted about the providers future plans for the home. Because Wykenhurst offers a home to people whose needs arise from mental health issues as well as older people whose needs arise from the ageing process, it is important that both groups of people are consulted about future plans for the home. One member of staff could clearly see that this is an issue which needs to be addressed, and suggested that people with different needs could be accommodated in separate parts of the home. The management team should consider how they will meet the needs of younger people with mental health issues alongside the very different needs of older people. Care Homes for Older People Page 24 of 29 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 9 13 Regulation 13(2). To make 26/02/2010 arrangements to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on a when required basis and what constitutes needed for a named person. To ensure staff know when and how to give the medication. Care Homes for Older People Page 25 of 29 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 8 13 (4) You must ensure that falls risk assessments are reviewed in cases where the person has experienced a fall since the risk was previously considered. This will assist the home in reviewing whether there is any further preventative action they can take following each fall. 28/04/2010 2 8 14 (1) and (2) You must ensure 30/03/2010 that, for any person at risk of malnutrition, a dietary plan is in place to include the times at which food should be offered, and an indication of what food should be offered, based on the advice of a suitably qualified professional and the persons own preferences. This is so that peoples nutritional needs are met. Care Homes for Older People Page 26 of 29 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 3 8 12 (1) You must ensure that 30/03/2010 records of food offered and eaten are kept up to date and provide an accurate and complete record. This is so that peoples nutritional needs are met. 4 8 12 (1) You must ensure that, 30/03/2010 where people are at risk of losing weight, their weight is monitored on a regular basis. This is so that they are not at risk of harm. 5 8 13 (1)(b) You must ensure that 30/03/2010 the advice of relevant health care professionals, such as District Nurses or the Community Dietician, is sought in respect of any person who is at risk of losing weight. This is so that peoples needs are met in respect of their nutrition. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 You should ensure that the Statement of Purpose contains accurate information about the service, and is updated as necessary. Care Homes for Older People Page 27 of 29 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 2 9 You should ensure that information for staff about medication which has been prescribed on an as required basis is kept in the care plan as well as with the Medication Administration Record (MAR) charts. You should ensure that the complaints procedure is written so that it is easy for people to understand. This is so that people are enabled to raise issues that concern them. You should ensure that the complaints procedure includes information that complaints can be referred to the Commission at any stage of the procedure. You should consider how you will meet the needs of younger people with mental health issues alongside the very different needs of older people. 3 16 4 16 5 33 Care Homes for Older People Page 28 of 29 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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