Care Home: Key West

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What the care home does well Individual needs assessments were made before people were admitted to the Service so that their diverse needs were identified, planned for and individually met. People who use the Service had individual plans of care which demonstrated that their health and care needs were being met. They were being treated with respect and their right to privacy was upheld. The Service provided a good programme of activities and services that benefited people living here. Meals were varied and enjoyed by people. Good practices for handling complaints and abuse were being followed ensuring that people who live at the Service were fully protected. People were living in a most comfortable and homely environment. The Service had a good level of well trained staff to ensure that the people living here were safe and their needs were met. The Service`s management ensured that systems were in place that promote the interests of people living here. What has improved since the last inspection? No requirements were made at the last inspection. Since then the Manager had achieved a Registered Managers Award. Several bedroom carpets had been changed and areas of the premises redecorated as part of the Service`s ongoing maintenance policy. What the care home could do better: All prescribed medicines must be stored securely and the cupboard containing cleaning materials must be kept locked at all times. Key inspection report Care homes for older people Name: Address: Key West 203 Tamworth Road Long Eaton Nottinghamshire NG10 1DH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anthony Barker     Date: 0 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Key West 203 Tamworth Road Long Eaton Nottinghamshire NG10 1DH (0115)9732031 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: laszekmajta@tiscali.co.uk Mrs Hilary Ann Majtas,Mr Leszek Jan Majtas care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 1 Day Care Place 1 PD Place. On a named person basis for the person named in the notice of proposal letter. Date of last inspection Brief description of the care home Key West is based in a detached building situated on the Tamworth Road out of Long Eaton. It provides care for 9 older people within seven single rooms and one double room. One of the single rooms has en-suite facilities. All parts of the building are accessible to the people living here. It is a family run care home with one of the Providers being the Services Manager. Care is provided by a group of part time and full time staff, plus the Manager. 0 Over 65 9 Care Homes for Older People Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Care Quality Commission (CQC) is trying to improve the way inspectors engage with people who use services so we gain a real understanding of their views and experiences of social care services. We asked for an expert by experience to join us at this inspection. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The time spent on this inspection was 7.5 hours and was a key unannounced inspection. Survey forms were posted to people living at the Service, their relatives, staff and external professionals before this inspection and 16 people responded. The expert by experience was introduced to the Manager at the start of her visit and she was given a brief introduction to the Service. At the end of her visit there was a debriefing with the Manager present. The expert by experience spoke to five people living at the Service, two staff and one visitor. We spoke briefly to several people living at Care Homes for Older People Page 5 of 28 the Service and to the Manager and one senior care assistant. Records were inspected and there was a tour of the premises. Two people living at the Service were case tracked so as to determine the quality of service from their perspective. This inspection focussed on all the key standards and on the progress made towards achieving the requirements and recommendations made at the last key inspection on 5th March 2007. The Managers pre-inspection, Annual Quality Assurance Assessment (AQAA), self assessment form was reviewed prior to this inspection. She informed us that the Services fees ranged from £391 to £419 per week. Care Homes for Older People Page 6 of 28 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 7 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual needs assessments were made before people were admitted to the Service so that their diverse needs were identified, planned for and individually met. Evidence: One of the people case tracked had been recently admitted and their file was examined. This person was self-funded and the Manager said she had visited the person, at their home address, two weeks before admission and made a full assessment of their needs. This was to ensure that the Service could meet the persons needs. However, she had not recorded this assessment. A full and extensive written assessment of this persons needs, dated the same day of admission, was on file and provided staff with information about the individuals particular needs and preferences so these could be met. This recorded assessment was very person centred, with many areas where the person had been asked about their personal preferences. People who completed a pre-inspection survey were positive about their decision to choose Key West for them or their elderly relative to live. Care Homes for Older People Page 9 of 28 Evidence: There was substantial evidence, from a range of sources, that the Service was well able to meet the needs of people living here. These people, their relatives and staff, both in person and through our pre-inspection questionnaires, all without exception praised the Service and the way it meets peoples needs in a most person centred way. Comments from people included, The home does everything well in caring for me. I am very happy here. Relatives comments included, (Key West) looks after all the people in their care with real concern for their welfare. We observed, during this inspection, staff interacting positively with the people living here. These comments and observations show that commendable levels of care were being provided. The Home was not providing intermediate care. Care Homes for Older People Page 10 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the Service had individual plans of care which demonstrated that their health and care needs were being met. They were being treated with respect and their right to privacy was upheld. Evidence: Two people living at the Service were case tracked so as to identify the standard of care provided from their own perspective and from individual records and discussions with them, the Manager and staff. The files of these people were examined and these included useful and comprehensive records of peoples personal history and preferred lifestyles. Care plans clearly and comprehensively set out how peoples individual needs should be met by staff. A Care Plan - Outline Questions is completed on the day of admission and a Residents Care Plan is completed after the first week. These documents were holistic and person centred. Monthly reviews were taking place though there was little recorded evidence that a full consideration had been made of current and changing needs: mostly No Change was recorded against each care plan area. Therefore records did not fully support the observations we made, and comments made to us, about peoples needs being always well met. Individual files Care Homes for Older People Page 11 of 28 Evidence: contained peoples photographs and a single sheet, providing a Snapshot of each person living here, was kept at the front of each care plan file and Daily Record File section - these were of benefit to staff, particularly newly appointed staff. Daily records were appropriately worded though half of those examined were unsigned. Recorded risk assessments covered areas such as risks associated with falling and Tissue Viability and provided a means of measuring and minimising these risks. There were no recorded risk assessments associated with Moving & Handling. The Manager told us that there had been a system in place to address these risks and this had been phased out in preference to a new system that had not yet started. The Manager explained that key workers had responsibility for reviewing the risk assessment scores at intervals dictated by recorded levels of risk. These reviews were not being made at these intervals. For example, one case tracked person had had a Tissue Viability risk score of 10 recorded in early August 2009, indicating a high risk of having pressure sores. The District Nurse had appropriately been involved but no further scores had been recorded. Recorded risk assessments were largely unsigned. Peoples health needs were being met by appropriate contact with external health professionals and evidence of this was seen on files, from pre-inspection questionnaires and from speaking to people. We learned that a chiropodist visits every six weeks and visits to the Service are made by an optician. One District Nurse told us, in a pre-inspection questionnaire that, the Service is open to suggestions regarding patient care...I feel I can rely on the staff to provide after care to the patients I visit. Two people told the Expert by experience that when someone from the Service is in hospital the Manager visits very regularly. The administration of prescribed medicines was being recorded accurately and two signatures were being recorded beside hand written entries. There was evidence of daily audits of these records. Medicine blister packs were being stored in a locked cupboard. Although all prescribed medicines were being stored within a locked room some were stored, insecurely, in a cupboard without a door. The Manager had told us in her pre-inspection self assessment that controlled drugs had been administered in the past 12 months. She said that the Pharmacy had loaned the Service a suitable secure cabinet though this had been returned when the person no longer needed these drugs. The Manager said the Pharmacy is returning the cabinet for any potential future use. We examined the controlled drugs register and recording in this was satisfactory. The Manager informed us that the Services pharmacy provides staff with training in the safe use and recording of medicines: all staff who administer medicines have had this training this year. Care Homes for Older People Page 12 of 28 Evidence: People living at the Service were well dressed. People to whom the Expert by Experience spoke with were most positive about their quality of life. One person commented, My clothes are washed every day and I get everything back. One visitor told the Expert by Experience that staff always dress (the visitors relative) so that the person looks lovely and added that people living here are treated with respect and their dignity is maintained. The Expert by Experience told us she directly observed staff being helpful to people, showing caring attitudes and treating people with dignity and respect. One member of staff stated in their pre-inspection questionnaire that the Service provides the people living here, with everything they need to live their lives in dignity. The senior care assistant spoken with described how she meets the privacy and dignity needs of people living at the Service. Care plan records included peoples individual wishes at the time of their death. The Service is commended on the degree to which peoples privacy and dignity is respected and acted upon. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service provided a good programme of activities and services that benefited people living here. Meals were varied and enjoyed by people. Evidence: The Service was providing, and enabling people to take part in, a good range of activities both within the Service and within the local community. In the pre-inspection self assessment the Manager told us, We display a monthly activities poster. We noted, at the inspection, that several events had been and were planned. The Expert by Experience told us, One lady visits fortnightly to lead exercises and another does hand massage and has a chat. There had been a coffee morning on the previous Saturday to which friends and family had been invited. Information about a Christmas party and about a Christmas outing was given on the notice board. One relative, who completed our pre-inspection questionnaire, told us, Interesting activities are offered and the bonus of a hairdresser keeps everyone looking smart. The Service is commended on the social opportunities provided to the people living here. The Expert by Experience remarked on the reproductions of old advertisements and old photographs on the walls of the lounge, which she thought was useful for reminiscence. The Senior Care Assistant we spoke with made reference to organised Care Homes for Older People Page 14 of 28 Evidence: games that staff and the people living here play and added that those games that provide opportunities for reminiscence provide about five hours of activity a week. An Orientation Board was displayed in the entrance hall showing the day and date. The people living at the Service told the Expert by Experience that daily routines, such as having a bath and getting up and going to bed, are flexible, person centred and at times chosen by themselves. One person told her, When I go out I can come back at 10.30pm and it is not a problem. One person living at the Service told the Expert by Experience that, Visitors come at any time and they always get a cup of tea. The Manager told us that all but one person living at the Service has good contact from relatives. One case tracked person we spoke with showed us a record they kept of personal visitors - these numbered 14 in November. The Manager said in the pre-inspection self assessment that, Residents are encouraged to personalise their rooms with pictures, photos, ornaments and small pieces of furniture. The Expert by Experience said that all the people she spoke with told her that they had personal items in their rooms. She added, I saw photographs, ornaments and soft toys...one lady had her own telephone in her room. The Manager also told us that the people living here, or their family members, handle their own personal money - none is held on the premises. One person told the Expert by Experience that there was a lockable drawer in the bedroom and there was a safe in the office. None of the people was in need of an advocate, the Manager said. The senior care assistant told us that one person has a volunteer to take the person out. The Manager told us that she and her staff had received a three hour training course on the Mental Capacity Act (MCA) in November 2009. This had briefly covered the Deprivation of Liberty Safeguards (DoLS) legislation, she added. Also, the Manager had received a half days training, from Derbyshire County Council, on the MCA. She was still unclear about what may trigger an application under the DoLS legislation. We saw that food stocks were at a very good level in the kitchen. The four week rolling menu indicated that people were being provided with nutritious and varied meals. The Expert by Experience ate lunch with the people living here, during this inspection, and found it to be, well presented and tasty. People gave her a range of positive comments about the quality of the Services catering. These comments included, Food is very good...they know what you dont like...I get a cup of tea in bed before I get up. One person told the Expert by Experience that she is not hungry enough for sandwiches at 5pm so she has soup served in her room at 7.30pm. Care planning records included a good range of information about the personal food preferences of individuals. One relative told us in their pre-inspection questionnaire, Care Homes for Older People Page 15 of 28 Evidence: The meals always seem to be appreciated...tables are nicely laid...staff unfailingly offer tea or coffee when visitors arrive. The Service is commended on its standard of catering. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good practices for handling complaints and abuse were being followed ensuring that people who live at the Service were fully protected. Evidence: A copy of the Services written complaints procedure was examined and found to be well worded. This is normally displayed in the entrance hall but had been temporarily removed due to decoration. It explicitly stated that a complainant could approach the Commission directly rather than the Services Manager if they so chose, and also made reference to the Health Ombudsman. There had been no complaints received within the previous 12 months. The Manager could not find the Services Complaints Book within which any complaints should be recorded. People who responded to the postal survey said they knew how to make a formal complaint. People to whom the Expert by Experience spoke told her they had no complaints but felt they could approach the Manager or other staff if there was anything they were not happy about. She was given two examples of previous minor complaints and in each case they had been dealt with. She was told by a person living here, You get feedback, why it happened and why it will not happen again. Derbyshire County Council (DCC) Guidance on Safeguarding Adults, and associated Report Cards, was in place at the last inspection but the Manager could not find these at this inspection. As at the last inspection, there was no Safeguarding Adults policy/procedures in place specifically for Key West staff and the Manager to follow. Care Homes for Older People Page 17 of 28 Evidence: We discussed this with the Manager and she showed an understanding of such procedures: she knew, for example, the importance of immediately contacting Social Services in the event of suspicion of abuse of people living here. However, her understanding was weak on some points, including the need to consider suspension of staff in the event of suspicion of abuse. Some years ago she had undertaken a fourday Safeguarding Adults Training for Trainers course provided by DCC. The Manager told us that all staff had been provided with training, on keeping adults safe from abuse, in 2007. We had examined a satisfactory Whistle Blowing procedures document at the last inspection but the Manager was unable to find it at this inspection. The senior care assistant we spoke with showed understanding of how to safeguard vulnerable people and of whistle blowing. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were living in a most comfortable and homely environment. Evidence: All areas of the premises that were inspected on this occasion were found to be very pleasant, clean and tidy and the standards of furnishing and decoration were very tasteful. Three bedrooms were inspected and were found to be nicely personalised. The Expert by Experience concluded that, Key West is a clean, homely, welldecorated and comfortable home...the two bedrooms that I saw were attractive and personalised. People who completed our pre-inspection questionnaires spoke highly of environmental standards. One person who lives at the Service wrote that Key West is, comfortable and homely. A relative remarked on the premises being, well furnished and extremely clean. The Manager told us in her pre-inspection self assessment that, We have changed several bedroom carpets and have started to decorate the hall and stairway. There was evidence of the latter work taking place at this inspection. A partitioned wet room had been created on the first floor, with funding from Derbyshire County Councils Improvement Grant budget. This has benefited the wheel chair users. The premises were well maintained and the front exterior was particularly pleasing in appearance. The Service is commended on maintaining high physical standards. All the people living at the Service, and their relatives, who completed pre-inspection Care Homes for Older People Page 19 of 28 Evidence: questionnaires said that Key West was fresh and clean. Comments included, The Home is always clean and fresh...the Home always smells very clean. There were no unpleasant odours at the time of this inspection and the senior care assistant spoken with described good infection control practices. There were notices in the bathrooms and toilets stating that Towels are changed regularly but ask if you want one changed. Other displayed notices indicated a good level of attention paid to maintaining hygiene levels. One District Nurse told us, in a pre-inspection questionnaire, that, The Home is clean and welcoming. The Service is commended on maintaining very good levels of hygiene. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service had a good level of well trained staff to ensure that the people living here were safe and their needs were met. Evidence: The Manager sent us, before the inspection, a copy of a staffing rota for one week in September 2009. This was examined and indicated that there were sufficient staffing levels. The Manager told us, in the pre-inspection self assessment dated September 2009, that, We have had the same staff group for the past 3.5 years. We were told at the inspection that a further member of staff had been recruited in October 2009. The senior care assistant spoken with confirmed that there were adequate numbers of staff on duty. One staff member, who responded to the postal survey, commented that, there are often more staff working than needed enabling us to update care plans as key workers. The Manager told us that all care staff had achieved a National Vocational Qualification (NVQ) in Care at least to level 2. Additionally, three members of care staff had achieved an NVQ in Care at level 3. This is a commendable level of trained staff. The file of the most recently appointed member of staff was examined. All matters relating to her recruitment were satisfactory, except that the Services job application form did not ask the applicant to provide details of any criminal offences in respect of Care Homes for Older People Page 21 of 28 Evidence: which (s)he has been cautioned by a constable and which, at the time the caution was given, (s)he admitted, as required by the Regulations. The Services staff training matrix was examined. All care staff had completed fire training in April 2009 although the Manager, who provides a sleep in function each night had not undertaken any further interim fire training. All staff had completed other mandatory training courses, within the previous three years, except for three staff who had last received Basic Food Hygiene training 3.5 years ago. All staff had received training in dementia in February 2007. The senior care assistant spoken with confirmed she had attended several training courses over the past 12 months. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Services management ensured that systems were in place that promote the interests of people living here. Evidence: The Manager told us that she had completed the Registered Managers Award. She is very experienced, having been owner/manager of Key West for 22 years. The Manager was continuing to undertake the same training courses her staff have attended. For the past eighteen months there has been no deputy post and she explained to us that this has had some impact on the quality of the Services administration. There was clear evidence of the Managers approach creating an open, positive and inclusive atmosphere at the Service. One person living at the Service, who completed a pre-inspection questionnaire, told us, The staff are all helpful and friendly and have a positive attitude. A relative told us, in one of these questionnaires, that, I feel (my relative) is part of one big happy family which is very reassuring to me. Staff were Care Homes for Older People Page 23 of 28 Evidence: equally positive about working at the Service. Comments in their questionnaires included, We work well as a team and give great care and I feel that residents are treated as individuals and I love coming to work to help make this possible with Hilary (the Manager) and the team at Key West. One District Nurse told us, in a preinspection questionnaire that, Key West is a small residential home where both patients and relatives have a high opinion of the Manager and the care staff. The Manager is commended on achieving such a positive ethos at the Service. We examined the Services current Business Plan and Annual Development Plan. The latter had target dates to enable progress to be measured. In the pre-inspection self assessment the Manager told us that, Key West sends out Quality Assurance Questionnaires to residents and relatives, to find out their opinions on the quality of care provided. Satisfaction questionnaires were not being sent to external professionals. The Manager stated that the Service held no money on behalf of the people living here. There was a safe, and receipt book system, should they request that valuables were kept for them. The kitchen was clean and good food hygiene practices were noted. The Manager told us that the Environmental Health Officer last visited in April 2008 and gave the Service a four star, Very Good, rating. A copy of the certificate was displayed in the kitchen. A thorough range of environmental risk assessments were in place though these had not been up-dated since 2007. However, we examined records that confirmed that monthly Health & Safety checks are made of the premises. The cupboard containing cleaning materials, within the laundry room, was not locked when we inspected the room. The Manager locked the door once we pointed this out. Product Information Sheets were in place. Accidents were being recorded in order that accident patterns could be identified. The Manager showed us, in the pre-inspection self assessment, that equipment was being checked and maintained appropriately. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 13(2) All prescribed medicines must be stored securely. This will minimise theft and ensure that people receive the medicines prescribed for them. 01/01/2010 2 37 13 13(4)(c) The cupboard containing cleaning materials must be kept locked at all times. This will ensure the safety of people who may be in the laundry room. 01/01/2010 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 2 3 7 Evidence of pre-admission assessments of need should be provided through a recording of this process, kept on file. A summary of individuals needs should be recorded each month on care plan review records. Page 26 of 28 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 3 4 8 8 All records related to the people living at the Service should be signed by those completing them. Recorded risk assessments should be in place to reflect risks associated with the Moving & Handling of people living at the Service. The Service should maintain, in a suitably secure room, an appropriately designed cabinet for the sole use of storing controlled drugs. The Manager should inform herself so she is clear about what may trigger an application under the Deprivation of Liberties Safeguards (DoLS) legislation. The Service should have a Complaints Book, or sheets, within which any complaints can be recorded. The Manager should refresh and update her understanding of the procedures to follow should there be suspicion of abuse of people living at Key West. Written procedures should be in place regarding Safeguarding Adults and Whistle Blowing. The Services job application form should include a question to elicit details of any criminal offences in respect of which the applicant has been cautioned by a constable and which, at the time the caution was given, the applicant admitted. The three staff, who last received Basic Food Hygiene training 3.5 years ago, should be provided with this training as soon as possible. The Manager should undertake interim fire training so that she receives fire training twice a year. Satisfaction questionnaires should be sent to external professionals. The Services environmental risk assessments should be up-dated. 5 9 6 14 7 8 16 18 9 10 18 29 11 30 12 13 14 30 33 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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