Care Home: Maddalane

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What the care home does well This small home is said by people who live here and regular visitors to be friendly and welcoming. The home owner lives on the premises, and leads her team of carers in providing good care, treating the residents with respect at all times. The staff team morale was good, and they were proud of the care they provide and their teamwork. Residents agreed that they enjoy their meals, and we saw that a good variety of quality food is provided. Social activities and outings are provided to suit the residents, sometimes planned, sometimes spontaneous. Residents told us thay like the outings and the food - `you get well looked after`, said one. Another said, `I love it here`, and `the carers are all lovely`. Staff said, `this is a happy home and a great place to work`. The house is clean and comfortable, and the residents appreciate the improvements that are being made to their environment. What has improved since the last inspection? Care plans had been re-written to ensure that staff know what care and support residents need, and how they prefer it to be given. Televisions had been provided for residents in their rooms, to receive the digital signal, so they can all see the programme of their choice. Two further bedrooms had been provided with en suite toilets, without losing any of the space in the room. The residents appreciated the improvements that the home owner was working on `gradually bringing the place up`, said one who was very pleased to show us their private room. Staff training had been provided in Fire safety and First Aid, to ensure that staff respond well in an emergency for the care and protection of residents. Training had been provided in Moving and Handling, to ensure the safety of residents and staff. The recruitment procedure had been followed consistently, to show that all checks had been done to protect residents from potential harm. What the care home could do better: We recommended that the care plans include a summary of diabetes care, for those residents who need this, to ensure consistency in the absence of the home owner. We were advised that this was carried out shortly after the inspection. We recommended that the home owner observes professional guidance with respect to safe storage of medicines that need to be refrigerated, and when, in the future, she needs to administer controlled drugs. We recommend that the home owner commissions an assessment by an Occupational Therapist, for advice on making the environment, and especially planned alterations, as suitable and accessible as possible for the people who live at Maddalane. The plans include wheelchair access at the front door, an accessible shower, and en suite toilets for the remaining bedrooms. We found that one window on the mezzanine floor opened wide, and all residents would have access to it. We were advised that a restrictor has been fitted since the inspection. We recommend that checking window restrictors is included in the regular check of each room that is carried out by staff.When the home owner looks after cash on behalf of any resident, every transaction must be recorded, and signed for by the resident, or by two staff, and these records must be kept up to date, to show an accurate record of the person`s money. We found that some doors were open, although they were labeled fire doors. The home owner has arranged for a visit from the Fire Safety officer, and will take advice on which doors must be kept shut, for the safety of all the people who live in the house, and fit automatic closers to them. Key inspection report Care homes for older people Name: Address: Maddalane 158 Victoria Road St Budeaux Plymouth Devon PL5 1QY     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: Stella Lindsay     Date: 1 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Maddalane 158 Victoria Road St Budeaux Plymouth Devon PL5 1QY 01752360253 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Susan Carol Currie care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 8. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Maddalane is situated in a residential area of St Budeaux. It is close to the shops at St Budeaux Square and also transport links into Plymouth. The home is owned and managed on a day-to-day basis by Mrs Susan Currie who took over ownership in January 2008. The home offers six bedrooms: a single and a double bedroom on the ground floor and three single and one double bedrooms on the first floor. A seventh bedroom with en suite toilet had been provided, on the mezzanine floor, which was awaiting registration at the time of this inspection. On the ground floor there is a bathroom and toilet suitable to be used by people with Care Homes for Older People Page 4 of 28 Over 65 8 0 Brief description of the care home restricted mobility, as well as a shower room and toilet. A further bathroom and toilet is situated on the first floor: the bath is fitted with a chair again to assist people with restricted mobility. A stair lift provides access to the mezzanine level and there are three further steps to the first-floor landing. A lounge, dining room and conservatory are situated on the ground floor and provide pleasant communal areas. Outside is a level patio area which leads to the laundry room. Maddalane is registered to provide care services to older persons (OP) whose assessed care needs on admission do not fall within the categories of dementia or physical disability. The weekly fees at the time of this inspection ranged from 370 to 460 pounds and is dependent upon the level of support required by each person. Items not included in the fees were hairdressing, chiropody, newspapers and magazines, clothing and toiletries. Information regarding the services provided at Maddalane can be obtained directly from the home. The last inspection was carried out on 12th June 2008. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place on 9th and 11th June 2009. One inspector carried out the inspection, but the report refers to we as it was carried out on behalf of the Care Quality Commission. Prior to the unannounced inspection we sent questionnaires to people who live at the home, and to people who work there. Seven residents and three staff completed and returned these. The Service Provider sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It gave us some numerical information about the service. Care Homes for Older People Page 6 of 28 During our visit we spoke to the seven people who were living at Maddalane, the Home owner and three other staff members. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them, met with them and observed staff working with them. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at Maddalane. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: We recommended that the care plans include a summary of diabetes care, for those residents who need this, to ensure consistency in the absence of the home owner. We were advised that this was carried out shortly after the inspection. We recommended that the home owner observes professional guidance with respect to safe storage of medicines that need to be refrigerated, and when, in the future, she needs to administer controlled drugs. We recommend that the home owner commissions an assessment by an Occupational Therapist, for advice on making the environment, and especially planned alterations, as suitable and accessible as possible for the people who live at Maddalane. The plans include wheelchair access at the front door, an accessible shower, and en suite toilets for the remaining bedrooms. We found that one window on the mezzanine floor opened wide, and all residents would have access to it. We were advised that a restrictor has been fitted since the inspection. We recommend that checking window restrictors is included in the regular check of each room that is carried out by staff. Care Homes for Older People Page 8 of 28 When the home owner looks after cash on behalf of any resident, every transaction must be recorded, and signed for by the resident, or by two staff, and these records must be kept up to date, to show an accurate record of the persons money. We found that some doors were open, although they were labeled fire doors. The home owner has arranged for a visit from the Fire Safety officer, and will take advice on which doors must be kept shut, for the safety of all the people who live in the house, and fit automatic closers to them. 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Accurate information is available, and visits from prospective residents are welcomed. Care is taken to ensure that the service is offered appropriately. Evidence: The Statement of Purpose had recently been up-dated, to provide accurate information about the service, including recent alterations and developments. Preadmission assessment was in progress for a person who was considering coming for a short stay. The home owner had gathered information about their care needs, in order that the staff be prepared. They were coming for day care, to meet current needs, and to get to know the service. The owner was considering with them the possibility of a pet accompanying them, and any necessary arrangements. In surveys, staff said that they are always given up to date information about the people they care for, and residents said they had been given enough information so that they could decide that this was the right home for them. Two had visited family Care Homes for Older People Page 11 of 28 Evidence: members in the home before they had moved in. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff have a good understanding of the residents care needs. They work well with health care professionals to promote the residents good health, and have good knowledge of health issues. Evidence: Each resident has a care plan. We examined three in detail, and found that good details were included, so that staff would know exactly what the person needed. Moving and handling assessments were written, including any equipment that was needed. The daily preferred routine was written, and a personal profile was seen. There was a place for the staff and client to sign to say they agreed, but these were not seen to be filled in. There should be evidence that the resident has been consulted, and staff names should be written, for accountability. All the residents who completed surveys said that they always receive the care and support that they need, and all staff who completed surveys said that they are given up to date information about the people they care for. We found that a resident who had been discharged after a hospital stay had not had their care plan rewritten, but Care Homes for Older People Page 13 of 28 Evidence: this was done during our visit. Staff were able to describe how they provided care, including the use of new equipment. The Manager told us that she had visited this person before they were discharged, and made sure that equipment was provided before they came home. This resident told us they thought the staff were wonderful, in the way they used the new equipment. A visiting professional told us that a resident they had worked with had been treated with respect but also recognition of the areas where she needs tactful supervision. One resident told us that all staff were trained to deal with their particular personal care needs. The home owner had extensive knowledge of diabetes care. We advised that a daily care summary with respect to diabetes care be written, so that staff could continue to offer consistent care in the absence of the home owner. There was evidence of collaborative work with visiting District Nurses with respect to diabetes, catheter care, and Parkinsons disease. Staff were pleased to tell us that the home owner had recognised symptoms that had previously gone undiagnosed in a resident, and helped this person to obtain medical treatment and equipment, so that their quality of life improved. We saw that administration and recording of medication was carried out with care, to ensure that residents would get the correct medicines. There was no lockable fridge for medication that needs to be kept chilled. No controlled drugs were in use. The home owner was considering installing suitable storage, to be prepared for this necessity. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are involved in meaningful activities of their own choice. Mealtimes are enjoyable, with a good variety of home cooked food. Evidence: Residents told us they could get up and go to bed when they wanted, and that they could have a bath or shower at a time that suited them. We saw that one resident enjoyed clearing up after meals with staff. New televisions had been provided. We saw digital televisions that had been fixed to wall brackets in peoples bedrooms. One resident told us that he paid extra to have a sports channel in his room, for the football. The home owner told us that she was planning to improve access to the garden, and encourage residents to be interested in the garden. During our visit, she took a group of residents to a garden centre, to choose plants and enjoy tea and cake. People told us afterwards how much they had enjoyed the afternoon. There is a white board, to display the menu of the day, and any planned activities, but we saw that it was not always filled in. A resident told us that they do not know when Care Homes for Older People Page 15 of 28 Evidence: outings will happen, but they go out for drives, go shopping - I love it here, they said. Earlier in the year, there had been planned trips to Mount Edgecombe and Saltram House, and a Coffee Morning in the home. The home owner had ensured that all residents have had opportunities to go out. A social worker observed that there had been plenty of activity and outings providing mental stimulation. They do some very good meals, we were told - Sunday is nice - we have a little tot. We saw special dietary and eating needs recorded in peoples care plans. Special cutlery and plateguard were seen to be used, and help offered when necessary. During this inspection, pork casserole was served for lunch. One resident was given an alternative by choice. This was followed by apple crumble, home baked with ingredients that would suit the dietary needs of all the residents. The menu had been displayed on the notice board. A very nice meal, said a resident. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents at Maddalane are protected by the home owner and staff who treat them with respect, have good skills of listening and observation, and are willing to take action when necessary to protect them. Evidence: The arrangements for responding to complaints are outlined in the homes Statement of Purpose. No formal complaints had been received by the home or the Care Quality Commission. Residents also have the opportunity to voice their opinions in Residents meetings, when changes in personnel are introduced, and proposed changes to the building discussed. In surveys, all respondents said they find that staff listen to what they say and act on it. Visiting professionals told us they see their clients being treated with respect. Staff have been given the Whistle blowing policy. One staff member told us that there had been an occasion when bad practice was brought to the home owners attention, and she dealt effectively with it, to improve the quality of life for a resident. There had been an incident in the home affecting the safety of a resident. The home owner informed the Social Worker, who said they were pleased that she always phones to discuss any problem, and is open to advice and collaborative work. The home owner was currently working with the social work team to ensure that a Care Homes for Older People Page 17 of 28 Evidence: resident would have proper access to their own money. She was able to work with the Safeguarding Team in the interests of residents. All staff who spoke to us had received training in the Protection of Vulnerable adults, and understood their own responsibilities. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The house is attractive, clean and comfortable. The home owner has introduced improvements, and is in the process of making further changes, to provide a good environment for the residents. Evidence: The location and layout of the Maddalane is suitable for the needs of those currently living in the home. The house has retained much of its character and period features making it an interesting and attractive care home. A book is kept where staff may write any problems they find, and it was evident that requests were dealt with promptly. There is a small step to the front door, with no grab rail. The home owner told us that they are planning to fit decking to provide a level entrance. There is currently a dining room, separated from the lounge by a bathroom. The home owner told us that they plan to increase the communal space and open up the communal area with more light and space by removing this bathroom, keeping the toilet, and creating an accessible shower under the stairs where there is currently a shower used only by staff. It would be advisable to obtain an Occupational Therapists assessment to ensure that space is used suitably, and appropriate equipment is provided. In the AQAA, the home owner told us that their plans include the provision of a decked area at the back of the house, with ramped access, so that all residents could enjoy the patio, with a shaded area. Residents confirmed that they had got out Care Homes for Older People Page 19 of 28 Evidence: to the courtyard in the recent good weather. Two residents were sharing a room, who were not related. The home owner said that they had been happy to agree to this, but there was no record of discussion or consultation with their representatives. Two bedrooms had been provided with en suite toilets, without losing any of their existing space. They had been provided with hygienic wall cladding, for easy cleaning. We found that water was running too hot from a bath tap. The home owner told us that a thermostatic valve was fitted the week following this inspection, to ensure that safety of residents using the bath. This should be included in the regular checks carried out in the home to maintain safety. The laundry was in good order, but its floor was not easily cleanable. The home owner said that when the building work is complete they will lay new flooring. Soiled clothes are taken through the dining room to the laundry in the back yard. This is not ideal, but good hygiene was maintained by containing items in bags. The home owner told us that paper towel holders were fitted in communal bathrooms and toilets the day after this inspection, to maintain good hygiene. Disposable gloves and aprons were available for the protection of staff and residents from infection during personal care or dealing with laundry. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are caring, competent, well trained and well supported. Evidence: All residents who completed surveys said that staff were always available when they need them. They take good care of everyone, they said - you get well looked after, and the carers are all lovely. The staff themselves considered that they had a good team -we are all very committed, they said, we provide good quality care. We were given a staff rota, which showed that two care staff were employed normally from 8am till 8pm. When we arrived at the start of this inspection, the home owner was providing care for residents, with the assistance of one young employee. Of the seven residents who were accommodated at the time, three needed help with personal care. The young carer was clear about the limits to her role while she was under 18. There are no night staff. The home owners live on the premises and are on call every night. Residents are all able to use their call bells. This service would not be suitable for a person who frequently needed care during the night, or who was unable to call for assistance. We looked at the documentation with respect to two staff who had been recruited since the last inspection. We found that the checks needed to avoid potential harm to residents had been gathered. Care Homes for Older People Page 21 of 28 Evidence: Staff had received induction training, with appraisals from the home owner including observation and feedback. Each staff member had a chart on their file, showing at a glance the training they had received. There had been good provision of training over the past year, including Moving and Handling, First Aid, control of infection, safe administration of medication, and the Protection of Vulnerable Adults, as well as Stoma care and catheter care. There is good information available with respect to care of people with diabetes. Training on other conditions such as Parkinsons might be considered for future training sessions. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home owner leads her team in providing good individualised care to the people who live at Maddalane. She is keen to meet all health and safety requirements. Evidence: Mrs Sue Currie has owned Maddalane since January 2008 and in that time she has built up a strong relationship with the people living in the home and with her staff team. A resident said, they are gradually bringing the place up, while staff told us they love working here, as the people are so well cared for, like a family. Mrs Currie has several years experience in working in care homes and has run a guest house and worked as a foster carer. She has a National Vocational Qualification at level 3 in Care. She told us that she has almost completed the Registered Managers Award, and would let us know when she receives her certificate. Evidence of her attendance at numerous training events was seen including POVA (Plymouth City Council), first aid at work (4 days), safe handling of medicines, manual handling, food hygiene, and nutrition was seen during her application to register as the Provider of Maddalane, Care Homes for Older People Page 23 of 28 Evidence: which was approved on 25th January 2008. Her Deputy Manager is also engaged in the Registered Managers Award. Feedback from residents and other interested parties had been gathered. Suggestions were also gathered at residents meetings. We saw the minutes of the meeting held in March, when new staff and residents were introduced, and suggestions for outings were discussed. Two residents said they were not warm enough in their rooms, and Mrs Currie assured them that this would be dealt with promptly. The home owner looked after money on behalf of some residents, at their request. She had been keeping their money in a bank account, which was not in their name. This is in breach of regulations. She agreed to draw the money and keep cash on their behalf. She also arranged for locks to be fitted to drawers in their private rooms, which may mean some residents are more confident to keep their cash in their own room. One record that we saw had not been up-dated for over a month. These must be kept up to date, to maintain accuracy. If the resident is unable to sign for themself, two staff signatures should verify each transaction. We saw evidence that the fire alarm system had been professionally serviced on 07/05/09. The fire risk assessments were due for up-dating following the recent building work. Staff had received professional fire safety training on 25/07/08. There was no evidence of up-dates, and staff who we spoke with had no knowledge of any video or other training resource being available in the home, but there had been a fire drill the previous week. A book has been put in each bedroom for a weekly safety check, to be signed by the staff member who carries out the check, for accountability. This will include checking the window restrictor is secure, the fire door closes, and the call bell works. The home owner informed us that a visit from the Fire Safety Officer was expected during the month following this inspection. She had sent them a new floor plan following the completion of building work and the creation of another bedroom. She was awaiting advice with respect to which fire doors need to be kept shut for the protection of residents. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 20 When the home owner looks 30/07/2009 after cash on behalf of any resident, each transaction must be recorded, with the residents signature if they are able, or two staff signatures. No residents money is to be kept in any bank account that is not in their own name. This is on order to protect residents money. 2 38 23 The home owner must ensure that fire doors are kept shut, unless an approved hold-open device is fitted. This is in order to protect residents in an emergency. 19/08/2009 Care Homes for Older People Page 26 of 28 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 There should be evidence that residents have been consulted in the drawing up of their care plans, to ensure that as far as possible, their care is consistently delivered in the way they prefer. The home owner should refer to professional guidelines to consider how to provide safe storage for medication that needs to be kept chilled, and to prepare for the safe storage and administration of controlled drugs. It would be good practice to commission an Occupational Therapist to assess the premises and facilities, and in particular the planned improvements, to ensure that the environmental adaptations meet the needs of the residents in detail. The home owner should ensure that when rooms are shared, this is by the positive choice of both occupants, with support if they need it to make this decision, and a record kept of consultations. Staff should have fire safety awareness up-dates every six months, to ensure residents safety in the event of an emergency, and these must be recorded, so the manager can show who has updated their training. 2 9 3 22 4 23 5 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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