Care Home: Kirlena House

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• The Maypole Nursing Centre
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What the care home does well All the residents and some of the relatives involved in the inspection of the service thought that the service cared for them or the person they support, well. One resident put in the survey for what the home did well, "Care for me." The people living in the home can be confident that they will be provided with the opportunity to continue to with their daily lives as they wish. They can also be certain that their concerns will be listened to and that they will be protected from possible abuse or harm by the systems in place. There are gradual improvements being made to the fitments and furnishings to make the environment pleasant and comfortable to live in. Staff are friendly welcoming and supportive and have be provided with the training and knowledge to care for them well. The service is run in the best interests of the people who live in the home. What has improved since the last inspection? The practices for control of infection have improved around the home with the placement of liquid hand soap and paper towels in some of the bathrooms, toilets and the laundry area. The programme of refurbishment has ensured that the flooring in some of the bedrooms has been replaced. What the care home could do better: There should be safe practices in place for medications when being transported around the home. They should be kept secure and not on an open trolley and at risk from being tampered with or taken. Key inspection report Care homes for older people Name: Address: Kirlena House 18 Kennington Road Oxford OX1 5NZ     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: Ruth Lough     Date: 2 1 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 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 26 Information about the care home Name of care home: Address: Kirlena House 18 Kennington Road Oxford OX1 5NZ 01865730510 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: enquiries@auditcare.com Mr Vedenath James Audit,Mrs Ellen Audit care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category of service only : Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Kirlena House is a registered care home for older people accommodating up to 12 residents. The home is located near Oxford in the village of Kennington, close to shops and transport facilities. The house itself is detached, with a patio area and large attractive garden at the rear. There is one shared bedroom and ten single bedrooms - all but one of the rooms have en-suite WC and hand basins. There is lift access to the first floor. The ground floor lounge overlooks the garden and there is a separate dining room. Care Homes for Older People Page 4 of 26 Over 65 0 12 12 0 1 8 1 0 2 0 0 8 Brief description of the care home The home provides 24-hour support through the care staff and does not provide nursing care. Kirlena House is the smaller of two homes privately owned by the same proprietors and in close proximity to each other. The home shares its policies and procedures with its sister home, Mon Choisy. The current range of fees is between £464 and £555 per week. Care Homes for Older People Page 5 of 26 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 was an unannounced key inspection process generated from the Adequate findings identified at the last assessment of the quality of the service by the commission in October 2008. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission before a one-day visit to the home. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The AQAA from this service was returned within the required timescales and gave a brief overview of what they provide and what they have developed to improve the service over the last 12 months. Care Homes for Older People Page 6 of 26 The registered manager was present when we visited the service on 21st October 2009, between 10:10 and 17:20. During the day the records for care planning, recruitment, and administration of the service were assessed. Three people using the service were involved with the inspection process. We met with three staff, and one visiting professional who were present in the home. The people who use the service and the staff who provide the support were also consulted about their opinion of what is provided, through surveys. Of the 11 people who are in receipt of support that we contacted, we received 7 responses at the time of writing this report. Some of the staff employed at the home, were contacted through surveys, of which we received 5 responses. Two professionals who regularly visit the service also returned surveys to the commission. From this visit it was found that the requirements and recommendations that were made to improve the service during the last inspection process have been met or in the process of being implemented. There was one area that will need to improve as to protect the people they support and one requirement was made to reflect this. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. Care Homes for Older People Page 7 of 26 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 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service have their needs assessed thoroughly before they are offered a place in the home. Evidence: The professionals who responded to the commissions survey thought that the care homes assessment processes for prospective residents of the home were usually accurate and used well to create the planned care to meet their needs. A sample of two care records, were reviewed to see how this process is carried out and if there sufficient detail obtained. From information available, it could be seen that assessments of individuals needs are usually carried out by a senior member of care staff and included using any referring social or health care professionals assessment to identify if the home will be able to provide support for them. The home use a commercially developed assessment and care planning record tool which appears to be used well and effectively and incorporates looking at a broad overview of all their health and personal care needs. Care Homes for Older People Page 10 of 26 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 people who use the service can be confident that their personal and health care needs will be planned for and met. Evidence: All seven residents who returned surveys confirmed that they thought the service was able to provide the care and support that they needed. One put for what the home did well, Care for me. During the inspection visit, additional positive comments were given by some of the residents about the support and care that they received. A relative wrote, The home care well for mother. They arrange visits from appropriate agencies, doctors, eye tests, district nurse etc. when needed. One visiting health professional thought that what the service does well is to support individuals to use the toilet frequently as to avoid wearing pads and protecting their skin. They also added that they are, very prompt with contacting them if they have Care Homes for Older People Page 11 of 26 Evidence: any issues or queries, about residents health needs. The sampled care plans showed that overall there was good detail and instruction given to staff of how to meet the needs of the person concerned. They also encourage visiting professionals such as the GP, district nurse and health specialist to record the outcomes of any consultation or treatment that they have carried out. This then aids staff to have a good understanding of the support they require or significant changes in need that may arise. Additional records are added to support the core care planning such as MUST(Malnutrition Universal Screening Tool) and dependency monitoring tools. The staff also carry out a falls risk assessment as to assist them in referring individuals to the primary care teams, Falls Clinic. There is also an evaluation document that staff use to monitor changes in the persons needs and care on a regular basis. Any review of care needs, including those involving social services, is recorded in depth and provides a good picture of the person concerned. The only area that could be improved is to ensure that any medication administration support they provide is recorded as part of the planned care as these had not been noted in the two care plans that were reviewed. The processes for the management of medications held in the home were assessed. We were informed that the medication policy and procedure had been reviewed and updated to reflect changes in guidance and best practices. We looked at the MAR(Medication Administration Record) charts that the service keep to assure that residents obtain their prescribed treatments and the method of storage and safekeeping of medications in the home. From reviewing the medication administration records it was apparent that staff were providing them as prescribed and recording appropriately in the records any interventions that occur. There are accompanying photographs of the individuals concerned as to assist staff to give the prescribed medications to the right person. However, they were advised to ensure that the photographs are named to ensure that do not get misplaced in the records they keep. Additionally, they were also advised to review what supporting information they provide to staff with the records, such as the most up to date medication policy and procedure as to ensure that staff are following them correctly. We were informed that none of the current residents are able or wish to manage their own medications. However, the home does have the relevant processes and document tools in readiness should and individual be able to do so. Medications are stored in appropriately in a locked cupboard in a secure area. Through Care Homes for Older People Page 12 of 26 Evidence: discussion with staff and observation of practices carried out it was apparent that there are some potentially unsafe practices for transporting medications, on drug rounds, in the home. They were advised to review the practices of using an open trolley for medication where the risk of them being tampered with, mislaid, or removed is high. The Registered Manager was able to inform before the end the inspection process that they would implement changes immediately to rectify concerns. This would be by interim measures of delivering medications to individuals separately until a secure closed trolley had been obtained. They advised us before this report had been completed that this would be in place before the 15th December. Care Homes for Older People Page 13 of 26 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 people who use the service are given the opportunity to exercise choice over their lives and be able to maintain their interests. Meals and menu planning meet their health needs and personal choices. Evidence: The people involved in the inspection process stated that they were enabled to continue with their lives as they wish and were able and were given opportunities to participate in activities that were provided. They also stated that their choices of when they got up in the morning, where they ate their meals, and the time of retiring to bed were supported by staff. A relative wrote in a returned survey in regard to what they do well for her mother, They respect her wishes, e.g., to be in her room to watch TV, whilst ensuring that she also goes to the lounge to meet other residents. We looked at the sampled care records to see how this information about personal choices for their daily lives is provided to staff. From what could be seen, some of this information is given in the various topics of the care plans, such as personal care, and included in parts in the social care plan documents that are kept separately from the Care Homes for Older People Page 14 of 26 Evidence: main records. Much more information was provided verbally by staff. This observation was passed to the Registered Manager during the day of the inspection who was also advised to look at expanding the documented detail of individuals chosen daily routines as to ensure that there is a consistent approach by all staff. The social care plan provides a summary of the person concerned, their interests, hobbies and preferences to participating in the activities provided. Staff also record the level of enjoyment and involvement the person has experienced whilst participating with an activity. From what could be seen some of this information is also used in the periodical reviews of care and support that are carried out. Through discussion with residents and staff and a review of records it was apparent there are a variety of activities provided. Most of which the care staff enable, such as games, quizzes and chair based exercises and a small number of visiting providers of musical entertainments are part of the general programme of events. We were entertained during the day of the inspection visit by one of the residents providing piano accompaniment which others and staff sang along to and enjoyed together. In the surveys returned to the commission the people who use the service generally felt that they enjoyed the meals provided at the home. This was confirmed during the discussions with some of the residents during the day of the inspection. The menu plan is carried out on a four weekly rotational programme that appears, from information provided by the residents who were involved with the inspection, to be enjoyed and in general met their tastes and preferences. The majority of the main midday meals are not prepared in the home but are transferred from the sister home a short distance away. However, breakfast and evening meals are usually prepared in the home by the care staff. There is a designated dining room that can accommodate all the residents if they so wish, equally if residents choose to remain in their rooms or sitting separately in the lounge, they were supported to do this. Care Homes for Older People Page 15 of 26 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. The people who live in home can be confident that their concerns or complaints will be listened to and acted upon. The home has systems in place to protect the people living in the home from possible abuse or harm. Evidence: Residents gave mixed comments in both the surveys and during the inspection visit about how they thought staff listened to them and acted upon any concerns or complaints they had. One of the areas highlighted by some residents we spoke to was at times there was a language barrier as some staff did not have English as a first language. But they generally expressed that any concerns they had were addressed quickly when identified, none indicated that they had had cause to make a formal complaint. One person put in the survey that they did not know how to make a formal complaint. Residents are provided with details of the complaints procedure in the Statement of Purpose and Service User Guide and a copy is on display in a prominent area of the home. Information given by the registered manager was that they had not received any formal complaints during the last 12 months. They do not routinely record minor concerns when they are raised and they were advised to look at developing this as to assist with the overall quality monitoring of the service. The home has the necessary information for staff about safeguarding and protecting Care Homes for Older People Page 16 of 26 Evidence: residents from possible abuse and harm. Staff have access to a copy of the local interagency procedure and there is a whistle blowing policy in place to protect them should they have concerns. The topic is included in the induction training for new staff and is revisited periodically in the training programme provided to staff. Care Homes for Older People Page 17 of 26 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. The facilities in the home that have a significant impact on the comfort and well being of people who live there are gradually improving. Evidence: The home was purpose built over twenty years ago and can offer a mixture of a variable sized single and double bedroom accommodation for 12 residents. There are two main areas of internal communal spaces, the lounge at the rear of the home which overlooks the garden and the dining room situated just of the main entrance hall. The garden has a sheltered patio area for residents to sit in the warmer months which overlooks the lawn and flower beds. During the last inspection it was identified that although the home was decorated and maintained well there were some areas of improvement needed in the furnishings and fittings in the private and communal spaces. These were mainly in the quality of the beds, mattresses, bed linen and the screening in the shared bedroom. The condition of some of the commodes and toilet seats were seen to be either requiring repair or replacement. Additional concerns were seen about the management of control of infection in regard to the provision of liquid soap and paper towels in key areas in the home where staff and residents need to wash their hands more frequently. They were also advised to look at improving the storage facilities in the en suites for individuals toiletries and the provision of towel rails. Care Homes for Older People Page 18 of 26 Evidence: From what could be seen the majority of the concerns identified during the last of the inspection process are beginning to be slowly addressed. There has been a continual programme of redecoration and during the day of the inspection visit carpet fitters were in the home replacing flooring in some of the bedrooms. The Registered Manager has purchased new beds, mattresses, and bed linen to replace some of those which were most worn. We were informed that further new bed covers and linen were due to be put in place before the end of the week. A temporary repair had been made to provide better privacy in the shared room identified during the last inspection and we were informed that new curtains were ready to be hung when the new bed linen was in use. A small number of commodes and toilet seats had been repaired or replaced but there were still some that are not of a good standard. Care should be taken also to clean or replace the cords on the light pulls as a number of these were quite dirty and could assist with the spread of infection around the home. A number of the toilet brushes kept in the en suites and bathrooms were in a poor condition. These observations were passed back to the Registered Manager during the day who immediately implemented actions to rectify some of the concerns, which were completed before the end of the inspection. The laundry room had the required equipment and is not easily accessible to residents. It could be seen that it is kept clean and tidy and has the required liquid soap and paper towels for staff to use after handling soiled linen and clothing. A small amount of washing powder was left unsecured and the Registered Manager was advised to look at Control of Substances Hazardous to Health Regulations (COSHH) 1988 and how they should keep items like this, safely. The residents that were involved in the inspection and those participants in the survey thought that the home was kept clean, fresh and pleasant to live in. Care Homes for Older People Page 19 of 26 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 homes staffing levels meet the current needs of the people who live there and the complexity of the service provided. The staff have had the necessary training they may require and the recruitment process is carried out effectively and shows that they have a sought the required information they need for employing new staff. Evidence: Comments made by residents about the staff included that they were kind and friendly. There was no indication in the returned surveys or in the discussions with residents that there were any concerns about the numbers or availability of staff in the home. One visiting healthcare professional stated, The staff are always helpful and are very kind towards the residents During the day of the inspection staff were observed to be open, communicative and respectful to the residents. Encouraging them gently to either participate with what was going on and assisting them when required. We looked at the staff rota to see how staffing was planned and carried out to ensure that a peak times of activities there were sufficient numbers available to provide support to the people living in the home. They were also reviewed to see what the Care Homes for Older People Page 20 of 26 Evidence: management arrangements for the day to day running of the service were. The staffing and management of Kirlena and its sister home, Mon Choisy are run in conjunction with each other with some members of staff working across the two homes at different times of the week. The two weeks of off duty that were reviewed shows that there are usually 3 members of care staff in the morning, 2 in the afternoon and 1 waking night and 1 on sleep-in duty to be called if support is required. What wasnt clear was the detail of when the Registered Manager was present in the home to lead in the day to day management of the service. What was noted on the rota was when the Registered Manager and Care Manager were on duty for the other home, Mon Choisy, and who was on call for both services as to give staff an indication of where they could seek support from a member of the management team. The registered manager provided information in the AQAA and during the inspection that all 10 of the care staff have attained an NVQ 2 or above. Some of whom are qualified nurses in their country of origin and are presently completing an NVQ 3 and 4 training to enhance their roles whilst they are working in England. Staff made comments in the returned surveys that they thought they were supported to obtain the training that they needed to provide the care to the people they look after. The training programme provided to staff shows that the core topics for safe working practices and safeguarding are topics that are revisited regularly. Medication, dementia, and Chair based exercises are additional topics that some, but not all have attended, depending on the roles they carry out in the home. All staff have had a training needs analysis carried out to assist with planning training in the home and for personal development. We looked at a recruitment and employment record for one new member of staff who commenced working in the home in the last few weeks as to see if the processes to ensure that the member of staff is fit for the role they have been employed for. The records seen supported that sufficient information had been obtained, a formal interview process had taken place and the new member of staff had undertaken an Induction training programme. They utilise a recruitment and employment checklist to support that the necessary information is obtained although this could be used with greater effect to identify the programme of shadowing and mentoring the new member of staff undertakes until they have sufficient knowledge and skills to work independently without close monitoring. Care Homes for Older People Page 21 of 26 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. That the service is run and managed in the best interests of the people living there. Evidence: From information given in the surveys and during the day of the inspection there was no indication that residents or staff thought that the service was not managed well. As previously highlighted the duty rota does not identify when the Registered Manager is present or leading the day to day delivery of the service. From discussion with him it was apparent that much of the daily routines, administration and supervision of staff, has been carried out by other members of the management team. He has been taking the lead for the business and financial management of Audit Care and the recruitment of staff. Although he has obtained an RMA and is a trained Social Worker he was unable to show that he has developed his knowledge and skills over the last 3 years for the role he is registered for. We looked at the methods they have in place for formally consulting with residents, relatives and any health or social care professionals who come in contact with the Care Homes for Older People Page 22 of 26 Evidence: home. They usually undertake an annual process of consulting with them through surveys and were able to show that they analyse and use the information for the development of the service provides. There are a small number of assessment and review processes in place to monitor some of the administration and delivery of care of the home. Although there are some areas that they could develop further such as regular checks on facilities and standards of hygiene around the home which would aid with maintaining a consistently good standard at all times. There is a programme of staff meetings and supervision that is carried out which supports that staff are kept informed of changes in care and the delivery of the service. However, the supervision records reviewed showed that recently there has been a slight delay in all staff obtaining the planned formal meetings for this due to demand on management time across the two services. A sample of the records for the administration and invoicing of small amounts of money that the service holds for some of the residents was reviewed. The records showed that any item, treatment or service that is purchased on a residents behalf is noted and receipts kept. Payment made on residents behalf for chiropody or hairdressing is not noted with individual receipts and the description of what has been provided not clearly written. This is an area that they could improve to ensure that they have a good audit trail and residents or their representatives are given sufficient detail of what their monies are being spent. This observation was passed back to the Registered Manager during the inspection visit. We looked at a sample of the records for the safe working practices and the maintenance of the home to see if there are satisfactory processes in place to ensure that the safety and welfare of the people living in the home is promoted and protected. The sampled records and information included fire procedures and checks, safe water temperatures, and PAT (Portable Appliance Testing) Testing supported that they have the necessary checks in place. Care Homes for Older People Page 23 of 26 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 26 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 The registered person should make arrangements for the safekeeping of medications in the home. You should make sure that the processes for transporting medications around the home protect the people you support. Using an open trolley to distribute medications leaves them open to be removed or tampered with. 18/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 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. 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