Care Home: Madeira Lodge

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What the care home does well Since our last key inspection there has been a period where the home was under the management of another individual. This resulted in an unsettling period for individuals living in the home and staff. There were considerable changes in the staff and occupancy was low. However the registered manager has now returned to manage the home and a number of staff have also returned to work in the home as well as new staff being recruited. This has led to a stability of care and positive changes to care practices in terms of recording of care needs with increased input from community health services such as district nurses and additional training for staff around caring for individuals who may have high needs. We have also noted that there is now a sustained effort and commitment from the owner to address the environment of the home with improvements in the communal areas of the home. Individuals we spoke with during our visit commented on "how nice it is starting to look" "its so much better now". We note however that there remains improvements to be made and have commented on this in our report. In talking with staff there is clearly a commitment to providing quality care and meeting the needs of those that live in the home. There is a sense that staff have a real understanding of the individual needs and this is reflected in the information available in care plans about daily needs and routines. Individuals we spoke with commented on the "caring and friendly staff", "the home is well run, the staff are very careful and helpful" "the staff are all kind and considerate at all times". What has improved since the last inspection? We made a number of requirements following our random inspection which took place because of complaints and concerns which had been registered with us. The home has addressed the requirements made which has resulted in improved assessment of care needs specifically around skin integrity though there was a failure to make sure the requirement made about the use of nutritional assessments was met. We have repeated this requirement as a result of this inspection. The home met a requirement made in relation to improvements of the environment specifically around improved lighting and re-decoration of a toilet. What the care home could do better: We have made a number of requirements as a result of this inspection of the service. These relate to the completion of nutritional assessments where individuals maybe at risk because of poor health and a need to make sure dietary needs are clearly identified and evidence they are being met. Risk assessments must be completed about behavior which may present risk to the individual and others health and welfare. Staff must be provided with clear instructions and guidance about how to respond to challenging behavior so that individuals are as far as possible protected. As noted above improvements are being made to the environment it is important that these are sustained and further decoration and refurbishment is undertaken to bring the home to a more acceptable standard. We have made a requirement about staffing arrangements in the home whilst this has improved in terms of staff availability and recruitment of care staff with increasing occupancy this needs to kept under constant review.The homes use of dependency scoring will help in making a judgment about the level of staffing required specifically early morning and evening period. We have requested as part of the requirement evidence of how the home has reviewed the staffing and decisions made about any staff changes. We have identified shortfalls in training and recruitment and these must be addressed though we acknowledge that the home is making a real effort to improve the level of training available to staff. Key inspection report Care homes for older people Name: Address: Madeira Lodge 38/40 Birnbeck Road Weston Super Mare North Somerset BS23 2BX     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: John Clarke     Date: 1 8 0 3 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 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) © 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 28 Information about the care home Name of care home: Address: Madeira Lodge 38/40 Birnbeck Road Weston Super Mare North Somerset BS23 2BX 01934621846 01934414668 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Derek Herbert Butler care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To admit one named service user aged less than 65 years for respite care. Date of last inspection Brief description of the care home Madeira Lodge is registered to accommodate up to 40 people who are in the category Older People over 65 years. The home comprises of two adjacent properties overlooking Weston Bay, there are panoramic views across the bay from the communal areas at the front of the houses. All rooms have en-suite facilities and a number have attractive sea views. There is limited parking on a short sloping driveway. Madeira Lodge is owned by Mr and Mrs Butler, Mrs Butler has some minimal management input into the overall running of the business. 1 1 1 1 2 0 0 9 0 Over 65 40 Care Homes for Older People Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home, two inspectors completed this inspection of the service. As part of this inspection we looked at a number of documents and records relating to the service provided including: pre-admission assessments, care plans, health records, medication administering records, staff recruitment and training. We also had an opportunity to discuss with individuals living in the home their experience and views about the quality of the service provided at Madeira Lodge. We also spoke with staff members, deputy manager and manager of the home. The home provided us with a Annual Quality Assurance Assessment (AQAA) telling about the service they provide and areas of improvements since our last inspection of the service. We also received a number of responses to our Have Your Say questionnaire from individuals living in the home and staff. WE have used this information to help us in making a judgment about the quality of the care and service provided at Madeira Lodge. Care Homes for Older People Page 5 of 28 What the care home does well: What has improved since the last inspection? What they could do better: We have made a number of requirements as a result of this inspection of the service. These relate to the completion of nutritional assessments where individuals maybe at risk because of poor health and a need to make sure dietary needs are clearly identified and evidence they are being met. Risk assessments must be completed about behavior which may present risk to the individual and others health and welfare. Staff must be provided with clear instructions and guidance about how to respond to challenging behavior so that individuals are as far as possible protected. As noted above improvements are being made to the environment it is important that these are sustained and further decoration and refurbishment is undertaken to bring the home to a more acceptable standard. We have made a requirement about staffing arrangements in the home whilst this has improved in terms of staff availability and recruitment of care staff with increasing occupancy this needs to kept under constant review.The homes use of dependency scoring will help in making a judgment about the level of staffing required specifically early morning and evening period. We have requested as part of the requirement evidence of how the home has reviewed the staffing and decisions made about any Care Homes for Older People Page 6 of 28 staff changes. We have identified shortfalls in training and recruitment and these must be addressed though we acknowledge that the home is making a real effort to improve the level of training available to staff. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes pre-admission assessments so that they can make a judgement about the suitability of nthe individual and the capacicity of the home to meet the identified health and social care needs. Evidence: We looked at a number of pre-admission assessments and they were detailed and provided information about the health and social car needs of the individual. For one individual the home had received an assessment from the mental health team. Initial care plans had been completed for one individual showing needs around personal care. We spoke with one individual about their admission to the home and they told us how they had been asked about what help they needed and how the home was very welcoming. Care Homes for Older People Page 9 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 home completes care plans to an acceptable standard providing staff with the necessary information and care tasks required to met the identified care needs of the individual. The health care needs of individual are met with satisfactory practice around the administering and management of medication. However there must be more robust management of medication records and of medication which has limited life once opened. Evidence: We looked at a number of care plans for individuals in the home and they showed the range of care needs required and associated tasks. Moving and Handling assessment had been completed as were risk assessments for falls and mobility. Pressure Sore assessments had been completed and for one individual this highlighted high risk. This individual had pro pad cushion and staff confirmed they used cream to relieve and protect pressure areas. Trigger Checklist used to identify health needs and referral to nursing services. Dependency profile completed and care plans reviewed. For one individual we looked at there was identified risks around nutrition with associated weight loss. There was a detailed Food Preferences list and daily food intake record Care Homes for Older People Page 10 of 28 Evidence: was being kept however there was no Nutritional assessment completed. One individual has history of aggressive behaviour however there was no risk assessment completed identifying possible triggers and giving information about response and actions staff to take when behaviour occurs. We discussed this individual with the manager and raised the need to monitor their behaviour and risk to staff and residents, to ensure referral made to mental health team and if necessary Safeguarding team. Individual living in the home have access to range of health services including chiropody, dentist and where required district nurses visit the home. Records confirmed these services are made available to individuals. One individual we spoke with told us they can see the doctor whenever we ask. In our Have Your Say questionnaire we asked Does the home make sure you get the medical care you need? Seven respondents said Always and three usually. We looked at the arrangements for the management and administering of medication. Records had been completed as required with no gaps in the administering record. Alterations had been made to MARS administer record but there was no signature of the individual who had made the alterations or date when made. Medication given directly from packs rather then blister pack had dates when opened. However there was no date when eye drops for one individual had been started (these have limited life once opened). A fridge is available for medication which needs to be refrigerated and temperature of fridge had been recorded daily. Temperatures were at times below minimum of 8 degrees. Currently there are no individuals receiving controlled drugs there is controlled drug cupboard and separate recording is made when given. No controlled drugs in stock. One individual manages their own medication and a risk assessment had been completed and this should be monitored to make sure they are continuing to be safe in performing this task independently. We spoke with individuals living in the home about the approach of staff. They told us that they always felt staff treat us with respect. One individual who spends alot of their time in their room said that staff respect this is my choice and it suits me. Another individual told us that when staff give them personal care its always done in a pleasant way I feel comfortable about it. Care Homes for Older People Page 11 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. The homes provides an environment where individuals are able to make choices about their daily routines and staff are flexible. There are good opportunities for meaningful activities and individuals are able to maintain their relationships with family and friends. Meals provided in the home are nutritious and varied and meet the dietary needs of individuals living in the home. Evidence: We spoke with individual about their daily routines and specifically whether they could choose how they spent their day, times they got up and went to bed. Individuals told us that its is up to us theres no restrictions I do as I please. We asked an individual who needs help to get and go to bed whether they could choose the time staff came to help or tell them they wanted to stay in bed. O yes I have said that and its never been a problem, the girls are very flexible. Individuals can choose to stay in their rooms as they wish and this was confirmed by one person we spoke with. There are no restrictions on visitors to the home and people we spoke with told us that staff are always very friendly they make people welcome. We spoke with a relative who told us staff are very approachable always tell me how my relative is and contact me if they are unwell or have had a fall. They also described the Care Homes for Older People Page 12 of 28 Evidence: manager as approachable and said the home was very caring like an extended family. Individuals who live in the home told us that there are a range of activities including bingo, games, quizzes and recently tai chi. They tole us there is enough going on for me there always something if I want to do it. However one individual told us that staff do not always have time to just sit and have a chat they are always busy and another sometimes it would be good for staff just to sit with us more. This was something commented on in the homes AQAA namely the need to spend more one to one time with residents. Respondents to our questionnaire said that the home arranges activities that you can take part in Always six, Usually two, and Sometimes two. One individual commented that they enjoyed the trips out and becoming more frequent. We asked individuals about the meals provided in the home and they told us that there is always a good choice, food is very good I enjoy my food here. We looked at the menu and they showed a good range of meals being provided with variety and choice. The home is able to provide special diets if required. On the day of our visit the meal was well presented and looked appetising. Respondents to our questionnaire told us that They like the meals at the home Always four, Usually five Sometimes one. Care Homes for Older People Page 13 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. The home has a complaints procedure in place and individuals felt able to make a complaint if they wished however there were some individuals who would benefit from having better access to the procedure and being further informed of their rights and how to make a formal complaint. The home has policies and procedures in place regarding the Safeguarding of Vulnerable Adults and staff are provided with the necessary training to identify and respond to any concerns they may have about possible incidents of abuse. Evidence: The home has received two complaints which were responded to in a professional manner. We received one complaint about the service which was also the subject of a Safeguarding investigation which at the time of this inspection was not concluded. We undertook an inspection as a result of the complaint and made a number of requirements about care practice in the home. This inspection has identified that these requirements have generally been met resulting in improvements in record keeping and assessment of individuals care need. We spoke with individuals living in the home about what they would do if they were unhappy about the service they were receiving and their awareness of the homes complaint procedure. They told us they would not hesitate in telling staff or the manager I would report it to the manager Not everyone we asked was aware of the homes complaint procedure and there was no evidence copies had been made available to individuals living in the home. Of the ten Care Homes for Older People Page 14 of 28 Evidence: respondents to our questionnaire eight said they were aware of how to make a complaint and two were not aware of how to make a formal complaint. Staff have completed Safeguarding training and the home has policies and procedures in place to respond to any concerns or allegations about possible abuse. We asked staff what they would do if they had concerns about care being provided in the home or possible abuse. They were very clear about reporting their concerns to the manager or social services. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in the environment of the home however this needs to be maintained to bring the home up to a good standard to provide a more a pleasant, homely and welcoming environment. Evidence: In looking around the home it was evident that since our last visit improvements have been made to the environment. New lighting has been installed in the communal lounges and hallway this has made the area brighter, more suited for older people, and was commented on by an individual as much better. Decoration of areas of the home included painting of paintwork in the hallways was taking place during our visit. We noted that individuals rooms and accommodation is of a good decorative order and a number have been, and we were told, will continue to be re-decorated and improved. There are also plans to further improve the environment and the exterior of the home during the summer. The front of the home is much improved with landscaped garden and re-decoration of the front of the home. In discussion with the owner we were assured further improvements would be made to update the home. Since our visit one of the toilet had been decorated and re plastered though there remained a problem with damp. We were informed by the builder present that this would be improved by the exterior being repaired and painted. It was noted that whilst areas had been cleared of old furniture there remains a considerable amount of furniture and old carpet stored adjacent to the boiler Care Homes for Older People Page 16 of 28 Evidence: presenting a potential fire risk. A shower area and toilet on the first floor had not been fully installed its completion would improve the facilities available to individuals living in the home. Carpeting in some areas specifically the hallway and lounge areas would benefit from re placement in that it is showing age and considerable wear. A toilet and bathroom on the ground floor was cold and uninviting and again would benefit from redecoration and refurbishment. The manager has undertaken a audit of the homes environment and identified areas which would benefit from improvement and some of the areas mentioned above have been included as requiring attention. We spoke to individuals about the environment and there was agreement from those we spoke with that the improvement had started to make a difference. Individuals told us that the home was always clean and respondents to our questionnaire all said the home was Always fresh and clean. One individual commented that the maintenance and decoration could be better. One individual also commented that they felt the domestic arrangements with only one domestic could be better and said that cleaning was not always done as well as it could because theres just her. Two staff commented in their questionnaire response: could improve the decoration as some of the paintwork is coming off and the home is very dated and would be nice if the lounges could be updated. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing arrangements must be based on the needs of individuals living in the home and whilst satisfactory there is some concern about the level of staffing being as required to meet needs in an efficient and effective way. Staff are recruited undertaking the required practice to protect individuals in the home however the home need to be more robust in the taking up of references. Staff receive training to enable them to fulfill their roles and responsilbilities however there are a significant number of staff who have not completed mandatory training which potentially places individuals living in the home at risk. Evidence: We looked at the staffing rotas for a period of four weeks. they showed that normally there are 2 staff on duty from 8am with additional two staff 10-8 and one 2-8. There are two waking night 8-8. At the time of our visit there were 26 individuals living in the home. In the AQAA completed in December when there were 22 individuals living in the home we note it stated that 11 needed help with dressing/washing, 19 washing/bathing and 3 needed two or more staff to help with care. We have received comments from individual living in the home that there are not always enough staff need more staff. One individual told us that when they ring for assistance I never have to wait long. We asked in our Have Your Say questionnaire: Are the staff Care Homes for Older People Page 18 of 28 Evidence: available when you need them? Five respondents said Always and five said Usually One individual commented more staff badly needed and staff are pleasant and helpful when time allows and another need more staff, so they are always available when needed.. In our questionnaire to staff we asked Are there enough staff to meet the individual need of all the people who live in the home? eight respondents said usually and one never. Since our last inspection the home has introduced dependency scoring which can be used to help in deciding the level of staffing required to meet the needs of individuals in the home. We looked at recruitment and selection records for five members of staff. We found that application forms had been completed as required with full and detailed history of past employment. CRB and POVA1sts checks had been undertaken and no individuals had started employment without a POVA1st check in place. Two references had been obtained however in one instance a reference had been obtained from a former work colleague and not from the employer this was a care home. We looked at the the training records for four members of staff they had all completed the mandatory areas of training: moving and handling, fire, health and safety, Safeguarding Vulnerable Adults. In two instances the moving and handling had been completed in 2006. In looking at the training audit there were a number of staff who had not completed SOFA or Moving and Handling training. Staff are currently undertaking training in nutrition, infection control and the home is be used as a venue for external training for other homes in the area. No staff had completed Mental Capacity Act training. Care Homes for Older People Page 19 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 manager has the necessary skills and knowledge to manager the home in a competent and professional manner. The health and safety practice of the home helps to make sure individuals who live and work in the home are as far as possible protected from harm. Evidence: The manager has extensive experience of working in a care home setting and has been the manager of Madeira Lodge for twelve years. She has completed the required level of training. We spoke to individuals living in the home and they told us that she is approachable, the manager is always available to help sort out any personal problems. However one individual said that there is not enough contact with the manager. Staff were very positive about her approach and described her as supportive and someone we can always go to. Staff told us they have regular staff meetings. In our questionnaire to staff we asked Does your manager give you enough support and meet you to discuss how you are working? Two respondents said Regularly five Often and two Sometimes. Care Homes for Older People Page 20 of 28 Evidence: We looked at records relating to health and safety practice and found that fire alarm tests are undertaken weekly, emergency lighting monthly. Staff receive fire drill training the last being 04/12/09 and 3/03/10. Equipment used in the home is regularly serviced. Care Homes for Older People Page 21 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 27 18 The registered manager shall 30/01/2010 make sure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of individuals living in the home. This relates to the home reviewing staffing arrangements and to have in place means to measure needs of individuals. The home should refer to Department of Health Residential Home staffing guidence. This to ensure there are adquate staffing on duty at all times to meet the assessed needs of individuals in the home. Care Homes for Older People Page 22 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 7 13 The registered manager 30/04/2010 shall make sure that unnecessary risks to the health and safety of individuals are identified and so far as possible eliminated. This relates to the undertaking of risk assessments in relation to behaviour specifically aggression towards staff or others. The risk assessment to identify possible triggers to the behaviour and give instructions to staff about how to respond to the behaviour in order to as far as possible protect individuals from harm. 2 7 13 The registered manager 30/04/2010 shall make sure that unnecessary risks to the health and safety of individuals are identified and Care Homes for Older People Page 23 of 28 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 so far as possible eliminated. This relates to the undertaking of nutritional assessments where individuals are at risk because of poor health or other factors relating to their diet. 3 9 13 The registered manager shall make sure there are arrangements for the safe administration of medicines received into the home. This relates to ensuring where alterations are made to administering records they are signed and dated. Further that medication which has limited life once opened had date recorded when first used. 4 16 22 The registered manager shall supply a written copy of the complaints procedure to every individual living in the home. This relates to making sure all individuals are aware of how to make a complaint and are fully informed about their right to register any dissatisfaction or complaint 30/04/2010 30/04/2010 Care Homes for Older People Page 24 of 28 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 about the quality of the service they are receiving. 5 19 13 The registered manager shall make sure that unnecessary risks to the health and safety of individuals living in the home are identified and so far as possible eliminated. This refers to the removal of old furniture, carpet and other items stored adjacent to the boiler room. The manager to inform CQC when this requirement has been met. 6 27 18 The registered manager 28/05/2010 shall, having regard to the size of the care home and the number and needs of individuals living in the home shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of individuals. This refers to the need to review staffing levels particularly morning and evening after 8pm. using dependency scoring as a way of measuring needs of 31/05/2010 Care Homes for Older People Page 25 of 28 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 individuals. To provide CQC with evidence of how staffing has been reviewed. 7 29 18 The registered manager shall, having regard to the size of the care home and the number and needs of individuals living in the home shall ensure that persons employed by the registered manager to work at the care home receive training appropriate to the work they are to perform. This refers to all staff completing mandatory training namely moving and handling, Safeguarding Adults. 8 30 19 The registered manager 16/04/2010 shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2. This refers to obtaining references from last previous employer particularly where this has been a care home. To obtain written verification of the reason why the perspective employee ceased to work in position with vulnerable 25/06/2010 Care Homes for Older People Page 26 of 28 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 adults unless not reasonably practicable. 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 9 Ensure temperature of stored medication is maintained at the correct level and any faults in fridge temperature is rectified. Re-refurbishment of downstairs bathroom and toilet to make the room more inviting and update the facilities available in terms of bathing and washing. 2 19 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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