Care Home: Kirby House

What the care home does well We saw that people enjoyed the food provided, they liked the range of menu options and the choices on offer each day. We saw that staff were sensitive and knowledgeable about the people who they cared for. We found the home to be clean and tidy, and people living there have personalized their own bedrooms. There is a good range of `organized` activities for people living at the home. We saw good liaison with health care professionals, and good `end of life` care being provided. Staff receive good support from management, and good training to enable them to undertake their roles. What has improved since the last inspection? The service has become part of the Geriatric Outreach project, which provides people who live at Kirby House more medical support and aims to reduce hospital admissions. The project also focuses on `end of life` care to improve the quality of life for people who are nearing the end of their life. What the care home could do better: The service could improve care planning, by including medication management in the care plan approach, and in ensuring care plans are signed and dated by the staff member undertaking the review, and when possible the person to whom the care plan refers to. The provider should look at providing more one to one activities to support the social and emotional needs of less independent people living at the home, particularly those with dementia and other more complex needs. The provider should ensure that there should be an assessment in place regarding any equipment which has the capacity to restrain e.g. bed rails. The provider should look at improving the furnishings at Kirby House to have less `institutional` style chairs in the communal lounges. Parts of the home, in particular the communal areas and corridors, are looking shabby and worn and would benefit from re-decoration. The provider should consider whether there are sufficient staff on duty throughout the day to ensure all care needs are catered for, including the emotional and social needs of people living at Kirby House. The provider should make sure there is evidence to show that new staff are being supervised at all times prior to the CRB checks being returned. Staff should ensure that rooms containing hazardous substances are kept locked when not in use. The managers at Kirby House should apply to be registered with the CQC as managers as soon as possible. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kirby House Kirby Lane Leicester Forest East Leicestershire LE9 2JG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Fiona Stephenson     Date: 2 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 27 Information about the care home Name of care home: Address: Kirby House Kirby Lane Leicester Forest East Leicestershire LE9 2JG 01162394286 01162390817 gburrell@leics.gov.uk www.leicestershire.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leicestershire County Council Social Services care home 40 Type of registration: Number of places registered: 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 sensory impairment Additional conditions: The maximum number of service users who can be accommodated is 40. The registered provider may provide the following categories of service only:- Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Old Age, not falling within any other category - Code OP (40) Dementia - Code DE (8) Mental Disorder - Code MD (8) Learning Disability - Code LD (4) Physical Disability - Code PD Care Homes for Older People Page 4 of 27 Over 65 8 4 8 40 8 4 0 0 0 0 0 0 (8) Sensory Impairment - Code SI (4) Date of last inspection Brief description of the care home Kirby House is a care home providing personal care and accommodation for forty older people. The home is part of Leicestershire County Council, and is located close to both Leicester Forest East and Kirby Muxloe. Local shops and village life is accessible, with public transport being available into Leicester City. Kirby House is a purpose built home. It has 40 single bedrooms (no en-suite facilities), with communal lounge and dining areas being provided on both the ground and first floor. People can get to the first floor via the stairs or a passenger lift. Kirby House has a respite facility offering accommodation, and a specialist re-ablement unit for four people who need to re-gain skills before returning home. Kirby House offers a small day care service for residents living within the community and for those residing at the home. The maximum weekly fee is £499.80. There are extra costs for people living at Kirby House, such as payment for chiropody, the optician and hairdressing services, and the fee will depend on the services received. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a visit to the service. This is the first key inspection to the home since 25th June 2007. We (the CQC) visited Kirby House on Friday 22nd May 2009. The managers ,and the staff in the home helped us during the visit. The visit started at 9.15am and finished at 6.20pm. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We did this by, - talking to the people who live in the home and their relatives, - talking to staff and management, - watching how people are given support, Care Homes for Older People Page 6 of 27 - looking at records. We looked at the Annual Quality Assurance Assessment (AQAA). This is a document the provider (the person who owns the service) sends to us at the CQC, and it tells us what the provider thinks about the service they deliver to people who live at Kirby House We also looked at the surveys called Have your Say About.. which are sent out to people who live and work at Kirby House. We received 16 surveys back from people who live at the home and their relatives, and nine from staff. The surveys from people living in the home and their relatives, were all positive. Typical comments were: I am very happy with the the ethos of Kirby House...carers and managers are first class, committed and friendly. Kitchen staff excellent. varied entertainment for residents. It is a really friendly and open care home, people are always ready to help and listen to you. they look after me well, always friendly and helpful. My bedroom is nice and always clean, toilets are always clean and my clothes are always washed regularly. the staff treat the residents with respect and try to involve them and to stimulate them when possible. food choices excellent. Some people completing the survey said the home could do better by: having more activities involving the residents. provide more activities instead of residents sitting watching television. perhaps having one extra person per day shift or part there of to respond to residents requirements more quickly. I would like to see more attention paid to helping the residents to exercise and socialize, however I understand that staffing levels do not allow for these sort of activities. It would be helpful to have a separate visitors room with team making facilities..many times we have had to sit in a crowded lounge which is quite awkward. Two people commented on the decor: I have no criticism of the general care, only that I feel the decor appears quite shabby in places. There is a general dowdiness about Kirby House. It would benefit from refurbishment. The decor is in need of a complete overhaul. Staff who responded to the survey on the whole felt supported by management and felt that they gave good care to people living in the home. They said: The home makes a conscious effort to meet the needs of individuals. overall all our service users are very well cared for. all the carers give maximum care to all clients. They also felt that the home could do better by having proper hand overs on all shifts. pass on information more consistently and in depth...often staff hand overs are very short.. the management could be more supportive of staff roles at times. We spoke with four people who live at Kirby House during our visit, and one relative who was visiting the home during the inspection. Everyone we spoke with was very positive about the care being given at the home. The relative we spoke with said their mother had received excellent care and the staff were lovely...the staff go beyond what they have to do. We spoke with seven members of staff during our visit to the home who told us about working in the home and gave us their views. We checked all the standards that the Care Quality Commission has decided are key standards during this inspection. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report to make sure we respected their confidences. Care Homes for Older People Page 8 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The service could improve care planning, by including medication management in the care plan approach, and in ensuring care plans are signed and dated by the staff member undertaking the review, and when possible the person to whom the care plan refers to. The provider should look at providing more one to one activities to support the social and emotional needs of less independent people living at the home, particularly those with dementia and other more complex needs. The provider should ensure that there should be an assessment in place regarding any equipment which has the capacity to restrain e.g. bed rails. The provider should look at improving the furnishings at Kirby House to have less institutional style chairs in the communal lounges. Parts of the home, in particular the communal areas and corridors, are looking shabby and worn and would benefit from re-decoration. The provider should consider whether there are sufficient staff on duty throughout the day to ensure all care needs are catered for, including the emotional and social needs of people living at Kirby House. The provider should make sure there is evidence to show that new staff are being supervised at all times prior to the CRB checks being returned. Care Homes for Older People Page 9 of 27 Staff should ensure that rooms containing hazardous substances are kept locked when not in use. The managers at Kirby House should apply to be registered with the CQC as managers as soon as possible. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 27 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. Kirby House provides good information to help people make an informed choice as to whether this is the right home for them. Evidence: We looked at the information given to people who are interested in making Kirby House their home. We saw that the service user guide and statement of purpose provided all the necessary information. The service is currently owned by Leicestershire County Council, who are in the process of selling the service to another care provider. The managers will be updating the information in the guides once the service has been registered with the new provider. We case tracked a person living at the home who had recently been admitted. We looked at the assessment undertaken by the social worker to assess what their needs were, and we saw that the staff had used this information well to ensure that they could, and were meeting this persons needs since arriving at Kirby House. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at Kirby House are met well. Evidence: We looked at the care records of the people we case tracked, and spoke with the staff who supported their care. We also spoke with people who live at the home and their relatives. We found that people living at Kirby House receive good health and personal care from the staff who work at the home, and from external health care workers who support the staff at Kirby House in providing good quality care for people living at the home. During our visit we observed staff working well with health care professionals to provide good end of life care to a person living at the home. The people we spoke with were very pleased with the care being received. Throughout the day we watched how staff supported people living at Kirby House, and saw that at all times people were treated with dignity and respect. We also saw and heard laughter when staff and residents were enjoying a joke with each other. We looked at Care Homes for Older People Page 13 of 27 Evidence: the care records and saw that these had been updated regularly but they had not always been signed or dated. We saw that for people using bedsides, there had been no risk assessment made regarding their use. We looked at how medicines are given to people who live at Kirby House. We saw that medicines are given to people safely and hygienically, and we saw that in general the record staff have to keep on the medicines given (MAR Sheets) to people was accurate. There were a couple of minor errors but these did not impact on the safe giving of medicines. We looked at how medicines are stored, and we found again that in general medicines were stored correctly and safely. We did however see that the instructions for Calogen emulsion stated that once open it should be stored in the fridge, and this was being stored in the medicines trolley; and Clinutren is instructed to be stored at room temperature, and this was being stored in the fridge at 4oC. Care Homes for Older People Page 14 of 27 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 service generally provides a good daily life for people who live at Kirby House. Evidence: We saw that the service aims to make the routines of daily living as flexible as possible to suit the needs of people living in the home. There is no set time for people getting out of bed, and there is no set area where people living at the home sit; although there are places in Kirby House that people express a preference to sit during the day. The home has more than one lounge and as such people can choose to go somewhere where music is listened to, or to lounges where people are more sociable, or ones where people prefer quiet. The service has an activities co-ordinator who arranges organised activities for people who live at Kirby House. Day care is also offered at Kirby House and people living at the home who wish to be involved in the activities available for day care service users are able to. For people who are less independent, and who have more complex needs and require more one-to-one time for their social and emotional needs to be met there is less opportunity. Staff told us during the visit, and wrote on the Have your Say surveys that there is not enough time for them to support people on a one-to-one basis to provide activities and emotional and social support. Care Homes for Older People Page 15 of 27 Evidence: We looked at the menus, spoke with the assistant cook, and talked to people living in the home about the food provided at Kirby House. We also observed people having their meals during the visit. On the whole people expressed satisfaction with the food, although one person living at the home told us they thought the food was bland. We saw a good range of food on the menu, and saw that there was a good daily choice on offer. We saw that the dietary needs of all people living at Kirby House are catered for, with those on a gluten free, vegetarian and diet controlled diabetic diet being well supported. Visitors told us they are made to feel welcome in the home, and can visit at any time during the day or evening. Care Homes for Older People Page 16 of 27 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 living at Kirby House are safe and well protected. Evidence: We looked at the number of complaints the service has received. We were told that there have been two formal complaints but neither were upheld. Of the 16 Have your Say questionnaires that were returned to us, 12 people who replied told us that they knew how to make a complaint and who to speak to if they were unhappy about any aspect of the service, and of the four who didnt know how to make a formal complaint, two felt able to speak to someone if they were unhappy. Of the nine staff who responded, all knew what to do if someone had concerns about the home. We checked that staff had received training on how to ensure people living at the home are kept safe from abuse (Safeguarding training), and we were satisfied that staff knew what to do, and who to report their concerns to. There have been no referrals to social services under the Safeguarding reporting procedures. We saw that some equipment used to protect people can also be used as a restraint e.g. bed rails. We did not see any bed rail assessments which had been agreed with the person or their representative. Care Homes for Older People Page 17 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is clean and fresh and satisfactorily meets the needs of people living at Kirby House. Evidence: We looked at the communal lounges and dining room, and looked at the bedrooms of the people living at Kirby House whom we case tracked. We found the home to be clean and tidy and smelled fresh. We checked the laundry facilities and we were satisfied that the service is ensuring that infection control measures are in place. Before coming to visit, we had been told that the passenger lift was not working and a new part was on order. To enable movement around the home, stair lifts have been fitted. We saw that although this is temporary, it has had a negative impact on the lives of people living at the home. We saw that it takes staff a longer time to support residents in moving around the home, particularly at key times such as early morning. It also means that the stairwells have not been kept clear of wheelchairs and furniture, as the wheelchairs need to be stored near the stairs for when a person needs to use the chair lift again. Items of furniture are being stored temporarily in the stairwells because they cannot be taken up the stairs. There is a smoke room for people who smoke, however this is on the first floor and is more difficult for people who smoke and who live on the ground floor to access due to Care Homes for Older People Page 18 of 27 Evidence: the passenger lift being out of action. The furniture in some of the communal lounges is looking dated and institutional. The wallpaper in the communal lounges and corridors is also looking worn. We were told that the council has agreed to redecorating parts of the home but there has been no clear time frame set. The individual bedrooms have personalised with the individuals belongings from their previous home. We also saw the necessary aids and adaptations were in place for those who needed them. The dining room is set out nicely to create a pleasant dining experience for those who use the facility. The gardens also are pleasant to look out onto, and to use. Care Homes for Older People Page 19 of 27 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. There are sufficient staff to meet the health and personal care needs of people living at Kirby House to keep people safe. Evidence: We looked at the staff rota, the range of people with complex needs currently living at Kirby House, and observed staff doing their work. We saw that staff were very busy dealing with the personal and health care needs of people, and had little time to sit and talk, or provide social or emotional support to people living at Kirby House. People we spoke with during our visit, and some staff and people who live at the home who responded to our Have your Say questionnaire also felt there was not enough staff to support activities or one to one work with residents. We saw, and were told by relatives and people living at the home, that staff working for Kirby House are very caring and supportive of people who live there. One person said to us about their relative she has excellent care...the staff are lovely. We saw many examples during the day of our visit, of staff kindness and consideration of peoples needs. We looked at the recruitment procedures and records of staff working at Kirby House. We saw that the service had undertaken the necessary checks on staff to ensure they were safe to work in a care setting, but we did notice that there was no written Care Homes for Older People Page 20 of 27 Evidence: evidence to show that staff were being supervised and not left alone to undertake personal care until the CRB checks had come through. We looked at the training records and the AQAA. The AQAA told us that of the 23 care staff who work at Kirby House, 15 have a National Vocational Qualification in Care to level 2 (NVQ2). We were told that the County Council does not support people undertaking an NVQ3. We looked at the training records of staff, and found that staff have been provided with specific training to help them undertake their work effectively and safely. This training included Health and Safety, Moving and Handling, Food Hygiene, Dementia care, and Safeguarding Adults. Care Homes for Older People Page 21 of 27 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. Management and administration of Kirby House is good. Evidence: The service has two managers who job-share the post. The managers have not yet applied to be registered with the CQC. Both managers have previous experience in management roles, and many years experience of working in care. We spoke with staff on the day of the visit, and looked at what staff said about management support in the Have your Say questionnaires. Most staff felt well supported by management, although one member of staff felt that staff handover times were often very short, and important information has not been passed over in the past; another said at busy times management make no attempt to help care staff with clients,at times this would be appreciated. We saw that there are regular team meetings for staff and that staff receive on-going supervision to support them in their work. We saw that residents and relatives are Care Homes for Older People Page 22 of 27 Evidence: consulted on their views about the way the home is run, through resident meetings and consultation evenings. Through observation during the day, and by looking at the health and safety records we were satisfied that the service is ensuring that care practice is being undertaken in a way which keeps both the people who live at the home, and staff who support them, safe. We did see a room which had the sign keep this door closed at all times, and which had hazardous substances within, being left open on occasions during the visit. Care Homes for Older People Page 23 of 27 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 24 of 27 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The care plans when amended, should be dated and signed by the staff member undertaking the amendment, and if possible, the person to whom the care plan refers. The provider should consider including medication management in care planning. This should have the medication being prescribed, the reasons it is prescribed, and any side effects it may have on the person. The provider should ensure that the instructions relating to the storage of medicines are adhered to. The provider should ensure there is a system to double check that the staff member who has hand written MAR sheets, has written out the instructions correctly. The provider should ensure that the MAR sheets clearly show the dates medication is being administered. The provider should look at providing more one to one activities to support the social and emotional needs of less independent people living at the home, particularly those with dementia and other more complex needs. The provider should ensure that there should be an Page 25 of 27 2 7 3 4 8 8 5 6 8 12 7 18 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 assessment in place regarding any equipment which has the capacity to restrain e.g. bed rails. 8 19 The provider should look at providing the management of Kirby House with a clear timescale of when the redecoration of parts of the home is to take place. The provider should look at improving the furnishings at Kirby House to have less institutional style chairs in the communal lounges. The provider should consider whether there are sufficient staff on duty throughout the day to ensure all care needs are catered for, including the emotional and social needs of people living at Kirby House. The provider should make sure there is evidence to show that new staff are being supervised at all times prior to the CRB checks being returned. The managers should apply to the CQC to be registered as soon as possible. Staff should ensure that rooms containing hazardous substances are kept locked when not in use. 9 19 10 27 11 29 12 13 31 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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