Care Home: Lime Tree Court

Similar services:

• The Maypole Nursing Centre
• The Briars
• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home

What the care home does well All prospective users of the service can be confident that their health, social and personal care needs are fully assessed prior to them being offered a place at the home; this is to ensure that both parties are confident that their individual needs can be met appropriately. Staff provide personal care and support to service users in such a way that promotes and protects service users privacy and dignity. The meals provided are freshly cooked on the premises offering variety and choice to meet people`s individual needs and are provided in an unhurried manner, with assistance being given discreetly where required. The home encourages people to raise any concerns and has a complaints procedure to ensure that people using the service can raise any concerns or complaints and be confident that they would be addressed. The home ensures that there are sufficient numbers of staff on duty at all times to meet the needs of the people using the service. What has improved since the last inspection? Since the last inspection improvements have been made in relation to the environment in which people live, adding to their choice and comfort. The changes include installing a parker bath for those who prefer a bath to that of a shower, providing a large screen television to enable those with visual impairments to partake in watching the television with greater ease and comfort and visitors are now directed to a different door for access to the home, since the front door that was in use opened out onto the hallway and communal sitting room creating a draught, which has added to service users comfort. As a result of listening to those who use the service a more structured variety of activities is provided for service users to choose to partake in if they wish. What the care home could do better: We identified several areas of the medication system which are in need of improvement. As a result of this we have made specific requirements in order to help ensure that medication is audited, recorded, stored and administered safely so that the health needs of people are not compromised. There must be a more proactive approach to any complaints or concerns identified with appropriate follow up, recording and notification to ensure people`s well being is maintained. All concerns must be logged in the complaints book to demonstrate that these have been fully investigated and resolved. Two written references must be obtained before appointing a member of staff to ensure that people are supported and protected by a robust recruitment procedure. Key inspection report Care homes for older people Name: Address: Lime Tree Court Church Street Twyford Buckinghamshire MK18 4EX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Handscombe     Date: 2 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Lime Tree Court Church Street Twyford Buckinghamshire MK18 4EX 01296730556 01869278100 georgierixon@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Georgina Rixon Name of registered manager (if applicable) Mrs Georgina Rixon Type of registration: Number of places registered: care home 23 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 who can be accommodated is: 23 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 categories: Dementia - DE Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Lime Tree Court care home is situated in the peaceful and pleasant village of Twyford, in Buckinghamshire. The home is located at the end of a quiet country lane and is close to the church. The home is registered for the care of 23 older persons, some of which have a dementia type illness. The building and gardens are enclosed providing security for service users but allowing them to mobilise freely within the grounds. The Care Homes for Older People Page 4 of 31 Over 65 0 23 23 0 Brief description of the care home garden areas are well maintained and contain patio areas for service users to sit and enjoy the outdoors. Local amenities include the church, a village shop and a public house, all of which are visited by service users in the company of staff. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over one day on the 20th April 2010. The purpose of the visit was to see how the service is meeting the National Minimum Standards. Prior to the inspection we required the service to complete an Annual Quality Assurance Assessment (AQAA), which enables them to evaluate the quality of their service and forward to ourselves when asked. This initially helps us to prioritise the order of the inspection and identify any areas that may require more attention during the inspection process. Results of this inspection report are derived from discussions with staff during the inspection, viewing service users records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the visit, information provided to us in the completed AQAA, returned surveys which we sent to the service prior to our visit to distribute to service users and staff members and any other information that we have received about the service in order to gain an understanding of how the service meets the service users needs and how it impacts upon their lives. Care Homes for Older People Page 6 of 31 We looked at how well the service was meeting the key standards set by the government and have in this report made judgments about the standard of the service. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: We identified several areas of the medication system which are in need of improvement. As a result of this we have made specific requirements in order to help ensure that medication is audited, recorded, stored and administered safely so that the health needs of people are not compromised. There must be a more proactive approach to any complaints or concerns identified with appropriate follow up, recording and notification to ensure peoples well being is maintained. All concerns must be logged in the complaints book to demonstrate that these have been fully investigated and resolved. Two written references must be obtained before appointing a member of staff to ensure that people are supported and protected by a robust recruitment procedure. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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. Prior to moving into the home, all prospective users of the service have their health, social and personal care needs assessed to ensure both parties are confident that their needs can be met appropriately at Lime Tree Court Evidence: Prior to moving into the home, an assessment of peoples health, social and personal care needs are assessed and discussed with them and any other persons involved in their care, such as their relatives and healthcare professionals, to ensure that the service can meet their needs appropriately and ensure that appropriate equipment and services are in place. Where an assessment has been undertaken by Social Services, the home also carries out its own care needs assessments with the service user. In discussion with service users it was highlighted that they were encouraged to visit the home to meet with other service users and staff and to gain a feel of the home to Care Homes for Older People Page 11 of 31 Evidence: enable them to make an informed decision as to whether the home is suitable for both their accommodation and care needs. Where it is not possible for them to visit, their representatives are invited to visit on their behalf. Information provided to us in the completed AQAA informs us that prior to moving into the home, all prospective service users are provided with comprehensive information about the home and the services it can provide through a service users guide and statement of purpose. Eight users of the service who completed surveys prior to this inspection told us that they received enough information about the home to help them decide if it was the right place for them before they moved in. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication practices at the home are poor and do not fully protect the well being of those using the service Evidence: Each user of the service has an individual care plan in place, detailing how their needs are to be met. In discussion with the manager, we were informed that the care plans were being supplemented with information to promote their overall well being in a more personalised way. Of the three care plans inspected, we chose to include one which had recently been updated and contained the supplemented information. This particular care plan was very much more person centred; it contained a profile of the service user which gave a good, brief account of the persons history, where they had worked, their likes and dislikes and their preferred daily routines. Whilst inspecting the care plans it was noted that where any risks are present actions are put into place to minimise such risks although there was evidence to suggest that the reviewing of the risk assessments need to be undertaken in a more timely way. At the time of writing this report, we have been informed that following the inspection, each service users care plan has been reviewed with their key worker and now contains up to date risk Care Homes for Older People Page 13 of 31 Evidence: assessments and have been supplemented with information to ensure they are individualised and more person centred. Suitable arrangements are in place for meeting the healthcare needs of those using the service. Once a week the local GP holds a surgery in the home and is available to meet with service users as required. Records of contact with healthcare professionals, including GPs, District Nurses, Community Psychiatrist Nurses, Chiropodist and other healthcare services are maintained and detailed in the service users care plans. The Commission received correspondence from a visiting GP who informs us that the manager and her team look after the residents to the highest possible standards and further adds that he/she continues to recommend them to my patients. Another healthcare professional, who visits the home regularly, informs us that he/she is always greeted by welcoming staff who know how the residents are feeling that day. He /she tells us that the service users are dressed accordingly so as to maintain their dignity and respect whilst providing them with their treatment. Service users right to privacy and dignity are discussed with staff during their induction and feedback from residents indicated that the staff treat them with respect and support their privacy and dignity at all times; this was clearly evidenced through observation on the day of this inspection and appropriate terms of address were used. As part of the inspection process we inspected the procedures around the storage, administration and recording of medication in which we found poor procedures taking place which could potentially place service users at risk of possible harm and does not act in their best interests for which requirements have been made within this report. During the last key inspection we had some concerns around the homes medication systems, although there was no evidence that the medication system was not working. These concerns were raised with the manager, at that time, who assured us that the homes medication system was robust and that it is monitored and reviewed. However, during this inspection it was evident that poor practices were taking place and the homes monitoring processes were clearly not working and in need of review. Whilst touring the home, we observed a carer clearly administering medication from her hand which is very poor practice and has the potential of contaminating the medication. When asked if this was normal practice we were informed that it was not and the manager acted immediately on the findings and spoke to the carer involved to ensure procedures for administering medication in this way do not re occur and the homes policies and procedures for administering medication are adhered to at all times. Another shortcoming was that in which a service user who is prescribed eye drops had been administered a dose during the inspection which was clearly out of Care Homes for Older People Page 14 of 31 Evidence: date; the medication has a shelf life of 28 days after being opened and this particular medication had been opened on 10th February 2010. When we highlighted this to the manager the said medication was removed from the trolley and discarded. Whilst checking the medication administration records against the medication held in the medication trolley, it became apparent that there was a number of medication that were not accounted for; we found paracetamols in blister packs with no labels to ascertain who they were for, when they had been dispensed from the pharmacy and to whom they had been administered or the dates they had been administered. There were also some suppositories in a box which also had no label upon the box to inform who they were prescribed for or when they had been dispensed. Another pot within the medication trolley contained three tablets which the manager was unable to ascertain what they were and for whom. A packet of homely remedy tablets were also found in the trolley, two of which had been removed from the packet and written upon the packet it stated the service users name and that 2 tablets had been given at 18.00hrs. Upon enquiry the manager was unable to inform us of the date that these had been administered and thought they may have been given to the service user by a family member; these too were removed from the medication trolley for appropriate disposal. It was acknowledged that one service user is prescribed a schedule 2 controlled drug (Diazepam) and whilst viewing the records it was ascertained that that there was no audit trial in place to inform us of when the medication had actually been opened and when the administration had begun. We were unable to checked the medication in the controlled drug cabinet to see if it tallied with those on peoples medication administration records. We discussed the need for having a system in place to undertake such an audit and further reccommended that a clear system be put into place. As discussed with the manager, it would be good practice to obtain a bound hardback book with printed numbered pages for any controlled drugs and to follow the National Pharmaceutical guidelines around the safe storage, recording and administration for these types of drugs. We noted that the MAR (Medication administration records) were not being completed fully; the MAR allows one to carry forward the number of tablets from the previous record and if completed would provide an audit for peoples individual medication. Whilst viewing the medication administration records it was acknowledged that where people had not taken their prescribed medication the coding system was being used to explain the reason as to why it had not been administered and the staff member who had administered the medication signed the MAR accordingly. However, there were Care Homes for Older People Page 15 of 31 Evidence: instances where the MAR charts were handwritten and not supplied in printed format from the pharmacy. When it is necessary to handwrite on a MAR chart the member of staff should sign and date the chart and a second carer should check the entry for accuracy and initial the chart. In addition, the entry should include a reference to where the information was sourced, such as the prescribers name. The registered manager has since informed us that following the inspection actions were taken to address the medication shortfalls and poor procedures that were evident on the day. She informs us that she sought to investigate further on the homely remedy and it was ascertained that they had in fact been given to the service user, by a family member, when they had taken him/her home for a day and the rest to the staff to keep for the service user. The registered person must ensure that the homes medication policy addresses homely remedies and where people wish to take homely remedies, the GPs advice is sought to ascertain they are safe to use in conjunction with their prescribed medication and no contraindications are apparent. Likewise, the manager informs us that contact was made with the pharmacy, immediately following the inspection, and Paracetamol is now provided in individual boxes marked with the service users name, the dose and how often they should take it. We are further informed that a controlled drugs register has now been obtained and is in use. Care Homes for Older People Page 16 of 31 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 home provides a pleasant and relaxed environment in which residents are comfortable and well looked after. Service users are able to receive visitors at the home and there are no restrictions imposed on visiting unless requested by the service user themselves. Evidence: Discussions with service users was generally very positive acknowledging that the lifestyle experienced at Limetree Court matches their expectations and enables them to exercise choice and control over their lives. Contact with families, friends and the wider community is supported enabling those using the service to maintain social links. Service users are able to receive visitors at the home and there are no restrictions imposed on visiting unless requested by the service user themselves. Service users are able to entertain their guests in their own bedrooms or in the communal areas of the home. People using the service are able to take part in activities suited to their needs and abilities, which are provided both in group sessions and on a one to one basis Care Homes for Older People Page 17 of 31 Evidence: according to peoples wishes and abilities, which include listening to music, playing musical instruments, poetry, art and craft and hand massage. Service users are invited to attend performances at the local school if they choose, attend local church services with assistance provided from local villagers if required and for those who are unable to attend, a local vicar visits the home to offer a mid week service for those who wish to attend. People using the service have access to a visiting hairdresser and a podiatrist who visit the home regularly. The food provided in the home is of good quality, freshly prepared and cooked on the premises in a well equipped, clean and hygienic kitchen. The meals provided offer choice and meet the dietary needs of those using the service. Special diets are available to meet individual health and cultural needs. Users of the service are able to choose to take their meals in the dining room or in their own rooms if preferred on a small table beside their chairs. Guests are welcomed to join the service users if required. Care Homes for Older People Page 18 of 31 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 home encourages people to voice any concerns or complaints and has a clear complaints procedure in place although they are not always recorded appropriately to demonstrate that they have been fully investigated and resolved. People using the service can be assured of a proper response to any suspicion or allegations of abuse but the service needs to ensure robust recording and notifications of such matters. Evidence: There is an accessible complaints procedure in place enabling people to make a complaint or voice any concerns. All those who completed a survey informed us that they know how to make a complaint and who to talk to if they have any concerns should the need arise. Where people require the services of an independent advocate, the service will enable service users to access such a service. The home has systems in place to ensure that peoples financial interests are safeguarded, however, whilst viewing service users files, it was noted that an inventory detailing peoples belongings brought into the care home was not always fully completed. It is good practice to ensure that an inventory is completed for each service user so that it can be visited should any allegations or suspicions of theft be made. Care Homes for Older People Page 19 of 31 Evidence: There are policies and procedures in place to guide the manager and staff on how to respond to any suspicion of abuse, these are in line with the Buckinghamshire multi agency policies and procedures. Training is provided to all members of staff to assist them in becoming aware of their own care practices, to recognise signs and symptoms of abuse and to emphasise each staff members responsibility to whistle blow on any poor practice or concerns that come to their attention. Information provided to us in the completed Annual Quality Assurance Assessment (AQAA), informs us that there have been no safeguarding referrals or investigation undertaken during the last 12 months. However, during the period under review there have been two safeguarding issues brought to the attention of the Commission which the service had not notified us about; one was from the Local Authority and one from a member of the general public. The registered person is reminded that where there are allegations of, or instances of, abuse they must contact the Commission and notify them as required under regulation 37 of the Care Home Regulations 2001 and follow the interagency procedure for safeguarding adults. We discussed both issues with the registered manager and found them to have been dealt with although the service had not logged and documented them appropriately with details of of the actions taken and resulting outcomes. The registered manager assured us that she would ensure to document any significant events appropriately and notify the Commission as is required. Care Homes for Older People Page 20 of 31 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. Service users are provided with a clean, comfortable homely environment with their own belongings around them which is well maintained and equipped to meet their differing needs. Evidence: The home is centrally located within the village of Twyford and is not distinguishable as a care home, except for the sign alerting of its presence. The building is well maintained and provides a clean, homely environment for the people living there. Whilst touring the premises we found that the home was cleaned to a good standard with no offensive odours present. Accommodation for each resident is furnished and equipped to ensure them the right to comfort and privacy. Discussions with service users informs us that they are happy with their bedrooms and their surroundings, that the home is kept to a high standard of cleanliness at all times and that they were encouraged to bring small items of furniture and personal memorabilia with them, to personalise their rooms to their own liking, which was evidenced during the inspection. All rooms have call system with an accessible alarm facility, which allows people to call staff in the case of an emergency. Service users spoken to informed us that where they have had to use the alarm they had been answered swiftly and appropriately. Care Homes for Older People Page 21 of 31 Evidence: the home have made some changes to the environment to meet with peoples needs and to add to their choice and comfort which includes installing a parker bath for those who prefer a bath to that of a shower, a large screen television has been provided to enable those with visual impairments to partake in watching the television with greater ease and comfort, visitors are now directed to a different door for access to the home since the front door that was in use opened out onto the hallway and communal sitting room creating a draught, which has added to service users comfort. Care Homes for Older People Page 22 of 31 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 home has good recruitment procedures, to ensure that suitable staff are employed to look after their vulnerable clients. Staff are trained to meet the needs of people using the service Evidence: The staffing levels on the day of inspection were sufficient to meet the needs of the residents. The home generally has a good recruitment procedure in place to ensure that suitable staff are employed to look after their vulnerable clients. A selection of staff files was sampled all of which generally contained the relevant pre employment checks, references and their relevant qualifications. However one staffs file only contained one reference and not two as is required for which a requirement has been made within this report. It was also noted that staff files did not contain a recent up to date photograph, however, we have since received confirmation that all staff files now contain one. All newly appointed members of staff undergo induction training upon appointment to their posts, and are provided with ongoing training and encouraged to undertake the National Vocational Qualification (NVQ) in Care, which equips them to meet the assessed needs of the residents within the home and allow for personal development. Information provided to us in the completed AQAA informs us that of the twelve permanent care staff, ten have attained their NVQ at level 2 or above in Care Homes for Older People Page 23 of 31 Evidence: care. Four staff who completed a questionnaire, prior to our inspecting the service, inform us that their induction mostly covered everything they needed to know the job when they started and are given training relevant to their role, which keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. Observation throughout the inspection evidenced that there is a good feeling of teamwork amongst all the staff and those spoken to are very happy to be working at the home. One staff member told us its run well, I love the job, senior members are really approachable and do try and accommodate staff concerns Care Homes for Older People Page 24 of 31 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. Whilst poor procedures were evident the managers is addressing the weaknesses with a view towards providing improved and more consistent standards of service to service users and to ensure their best interests. Evidence: Both residents and staff informed us that the manager is very approachable and supportive and values their opinions and suggestions. It was felt that she runs the home in an open, transparent manner and in the best interests of those using the service. There are health and safety policies and procedures in place and the inspector discussed health and safety issues, saw maintenance records relating to maintaining a safe environment for residents and was satisfied that the home has good procedures in place. Whilst shortcomings were found during our visit (see section headed Health and Care Homes for Older People Page 25 of 31 Evidence: Personal Care) , the registered manager acted upon them swiftly and measures were put in place to ensure that the service was acting in the best interests of those using the service to ensure they are protected from any harm. Significant events in the home had not been recorded appropriately (see section headed Complaints and Protection) and appropriate notifications to the Commission had not been forwarded for which a requirement has been made within this report. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 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 Ensure that arrangements are in place and adhered to at all times for the safe storage, administration and recording of medications, at all times. To ensure the health, safety and welfare of people using the service. 27/06/2010 2 9 13 Review the medication 27/06/2010 practices and monitoring of these practices. To ensure the safe storage, administration and recording of medicines and to ensure that individuals receive their treatment safely and correctly. 3 9 13 Ensure that medication is given from fully labelled containers. 27/06/2010 Care Homes for Older People Page 28 of 31 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 This is to make sure that residents receive the correct medicines in the way that their doctor prescribed. 4 9 13 The registered person must ensure that the homes medication policy addresses homely remedies and where people wish to take homely remedies, the GPs advice is sought to ascertain they are safe to use in conjunction with their prescribed medication and no contraindications are apparent. This is to make sure that staff know in what circumstances to administer homely remedy medications and they can safely be given in conjunction with their prescribed medication. 5 16 22 Ensure to log all concerns in the complaints book. To demonstrate that these have been fully investigated and resolved. 6 29 19 Two written references must 26/06/2010 be obtained before appointing a member of staff. 26/06/2010 27/06/2010 Care Homes for Older People Page 29 of 31 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 This is to ensure the suitability of staff to work with vulnerable people. 7 37 37 Ensure that the Commission 18/06/2010 is notified of any accidents/incidents as listed under regulation37 within 24 hours. Where this is given orally, it must be followed up in writing. This will help to keep us informed about significant events in the home and ensure the health, safety and welfare of those using the service. 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 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!