Care Home: Manor Gate

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What the care home does well Manor Gate provides a pleasant and homely environment for people to live in. There are good assessments and care plans in place to make sure that people`s needs are identified and met in the way they want them to be. Staff were seen to treat people with respect and those spoken to had a good understanding of people`s needs and they were observed helping people to be as independent as they could be. There are good systems in place to make sure that staff are recruited safely and staff told us they are being given opportunities to access training to help them carry out their role and they feel supported by the management team. People are able to take part in various recreational activities and are able to choose the level of their involvement. Leadership in the home is good and there are some quality monitoring systems in place to ensure the home is run in the best interest of the people living there. People told us that they are satisfied with the care they receive at the home and are happy living there. Their relatives told us they had chosen the home mainly for the location as their relatives had previously lived in the village and `It couldn`t be better`. What has improved since the last inspection? An assistant manager has been employed and she developed opportunities for people with dementia to take part in numerous activities and leisure interests and is increasing her knowledge by attending relevant courses. At the last inspection we said that care plans must be person centred and include more detail to make sure staff know what to do to meet people`s needs and we found that this has now been done. We also said that work should continue to improve the environment and we found that a new bath has been installed and the bathroom re-decorated and new flooring laid in the extension. What the care home could do better: The manager must re-send documents for registration to us as soon as possible. All staff must have sufficient knowledge about safeguarding adults to make sure any concerns are reported and people are kept safe. Staff must also receive training relevant to the work they are to perform to make sure the needs of people living in the home will be met. We made some good practice suggestions that may help to further improve the standard of care for people living in the home. We said that pre-admission assessments should identify who provided the information and their level of involvement. They should also detail whether the person is able to make decisions about how they wish to be treated and following the assessment a letter must be sent to the person telling them that their needs can or cannot be met within the home. Care plans should include detail regarding people`s preferences of a male or female carer and how their privacy and dignity is to be respected. They should also show that people are given the opportunity to be involved in their reviews. These things would mean that there is better information to help staff care for people. Improvements to the environment should continue to make sure the home is maintained to a good standard. Key inspection report Care homes for older people Name: Address: Manor Gate 190 Causeway Wyberton Lincs PE21 7AR     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: Elisabeth Pinder     Date: 1 1 1 1 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: Manor Gate 190 Causeway Wyberton Lincs PE21 7AR 01205366260 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: lawrence@manorgate.co.uk Mrs Mary T Rodrigues,Mr Herman V Rodrigues care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: One PD place for age 59 . Date of last inspection Brief description of the care home Manor Gate Care Home is a converted Victorian farmhouse with a purpose-built annexe, situated in the village of Wyberton, close to local shops and approximately one and a half miles from the market town of Boston. It is registered to provide care and accommodation for up to fifteen people over the age of 65 years, within the category old age and dementia. One place falls within the category of physical disability under 65 years. The home also has three day-care places, however, current legislation does not regulate these. There is a garden to the side of the property and car parking space for four cars; Care Homes for Older People Page 4 of 28 Over 65 14 14 0 0 0 1 0 3 1 1 2 0 0 8 Brief description of the care home further parking is outside the frontage of the home. The current fees for the home range from £360 to £446 with additional charges made for hairdressing, chiropody, newspapers and personal toiletries. Information about these costs, as well as the day-to-day operation of the home, including a copy of the last inspection report, is available from the main office of the home. 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: 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: The quality rating for this service is 1 star. This means that people who use the service receive adequate quality outcomes. This was an unannounced visit and it formed part of a key inspection. It focused on key standards which have the potential to affect the health, safety and welfare of people who use the service. The visit lasted approximately six hours and took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since our last visit in 2008. The Commission are trying to improve the way that we engage with people who use services so that we gain a real understanding of their views and experiences of social care services. During this visit we used a method of working where an Expert by Experience visited the home as part of the inspection. An Expert by Experience is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Care Homes for Older People Page 6 of 28 The expert met and talked to people living in the home, visitors and staff. Before we made our visit the manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of people through their care records and assessing their care. We spoke to people who use the service, two members of staff, the assistant manager, the homes manager and two visitors. Before our visit questionnaires had been sent to five people using the service and to four staff, those returned to us will be mentioned throughout this report. 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: The manager must re-send documents for registration to us as soon as possible. All staff must have sufficient knowledge about safeguarding adults to make sure any concerns are reported and people are kept safe. Staff must also receive training relevant to the work they are to perform to make sure the needs of people living in the home will be met. We made some good practice suggestions that may help to further improve the standard of care for people living in the home. We said that pre-admission Care Homes for Older People Page 8 of 28 assessments should identify who provided the information and their level of involvement. They should also detail whether the person is able to make decisions about how they wish to be treated and following the assessment a letter must be sent to the person telling them that their needs can or cannot be met within the home. Care plans should include detail regarding peoples preferences of a male or female carer and how their privacy and dignity is to be respected. They should also show that people are given the opportunity to be involved in their reviews. These things would mean that there is better information to help staff care for people. Improvements to the environment should continue to make sure the home is maintained to a good standard. 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. People are assured that the home can meet their needs by way of a clear assessment process. Evidence: We looked at the records of two people who had recently been admitted and these showed information had been gathered prior to their admission by the manager. The assessment forms were in the format where boxes were ticked to show the persons level of need. They generally contained lots of information about needs and preferences such as personal care, mobility, aids used, dietary needs including their likes and dislikes and social skills. However, they did not tell us whether the person was able to make decisions about how they wished to be treated or who gave the information and neither were dated. Letters confirming that after their assessment the home could/could not meet their needs had not been sent and the manager told us he had recently completed an audit and had identified this and he would make sure these were sent in the future. Care Homes for Older People Page 11 of 28 Evidence: A member of staff told us that she is given information about people before their admission and their specific care needs and surveys received returned to us from staff told us they are given up to date information about the needs of the people they support and care for. Surveys received prior to our visit from people living at the home told us that most people felt they received enough information about the home to help them decide if it was the right place for them and the majority said they had been given a contract/terms and conditions of residency. We spoke to two relatives who told us that they had chosen the home mainly for the location as their relatives had previously lived in the village and they were very satisfied with the care being provided. One relative told us It couldnt be better. Information about the service is written in the Statement of Purpose and Service User Guide, however they did not give clear information about the current charges or how people can access our reports and the manager told us he is currently updating both documents and will make sure this information is included. The service does not cater for people with intermediate care needs. 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 health and personal care needs of people are being met in a safe and dignified way. Evidence: We continued to case track two other people and looked at their care records. We noted that these have greatly improved since our last visit. Care assessments and care plans had been written on subjects such as general condition on admission, personal hygiene, continence, speech, pain, memory, nutrition, medication, allergies and leisure activities. However, not all care plans gave enough detail about how peoples privacy and dignity were to be met and this was discussed with the manager who agreed to make sure this was expanded. There was also no reference to peoples preferences regarding male or female carer and whilst it is acknowledged that the home does not currently employ any male carers this should be taken into consideration as the manager told us he carries out occasional care tasks. Care plans had been signed by the person or their representatives to show that they were in agreement with them, however, they did not show that people continued to be involved in any subsequent reviews/evaluations as these had only been signed by Care Homes for Older People Page 13 of 28 Evidence: staff. This was discussed with the assistant manager who agreed to address this. Risk assessments were in place for things like the use of bed rails, falls and mobility and these cross referenced with care plans. Records of visiting professionals were written showing people have access to other health care services when necessary. Daily notes were being written, however, these mainly read .... fine, as care plan and a discussion was held regarding writing more detailed notes each day to make sure staff know how the person is feeling and how their day has been. Files contained an assessment regarding peoples level of capacity to make decisions but these were not consistent, for example, one stated the person does not have capacity but another record in their file stated no lack of capacity. Staff spoken to about this had a clear understanding of this persons needs and how they would help them make choices, although they had not had specific training. Medication such as eye drops was being stored safely and staff had a good understanding of how medicines should be dispensed. Medication record sheets were completed correctly and staff told us that medicines were only given by staff that have completed the relevant training. Five surveys were received prior to our visit from people living at the home and four told us they always received the right care and support and one sometimes. All felt they always received the medical care needed and one comment read the home looks after my care needs well. Staff surveys gave positive indications that the service has made improvements. Comments read provide a high standard of care, individual care plans to suit individual needs and personalised care. Two relatives told us that staff keep them up to date with everything they need to know and they had a lot of confidence in the manager, they felt their relatives were being well cared for and their current needs were being met. They said staff are first class and I am happy with the care, it couldnt be better. 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. People are able to choose how they spend their time and maintain contact with family and friends. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: Information taken from the AQAA told us that activities are based on peoples interests and past history. Our visit took place on Remembrance Day and we saw people watching the televised service and talking to each other and staff about their memories of war. Since our last visit an assistant manager has been employed and part of her role is to offer a wider range of activities and make sure people are able to continue with past hobbies and experience new interests. The home now has a pet rabbit and one person spends a lot of time with it and his reactions around the pet were positive. Surveys received prior to our visit gave a mixed response regarding the provision of activities and meals. In the section titled what could the home do better comments read few more trips out and entertainment in the home and better food, more entertainment, more trips out, more one to one time. Another comment read wonderful entertainment, the food is excellent, I am very happy here. Care Homes for Older People Page 15 of 28 Evidence: Records showed that meetings are held where activities are discussed and showed what activities people had taken part in, these included a multi cultural day where different foods, flags and music from around the world were available and a topical quiz was held. The report written by the Expert by Experience read there was a programme of regular activities on the notice board and a list of 5 minute things to do if staff have a few minutes to spare. The assistant manager is new to the post but full of ideas. She had been on an art course and was going on one specially for dementia. A number of people had framed artwork on the wall and some people had been into the village for a water-colour painting session. A photo album showed people joining in Bonfire night and Halloween celebrations, blackberrying and days out to the seaside and elsewhere. An organist comes in fortnightly and on birthdays and two people play instruments. Lunch in the small dining room was at tables for four with tablecloths, place mats, serviettes and brightly coloured beakers. It was a happy, chatty meal brought in by the cook and care staff. the helpings were generous and wholesome and help was given if necessary. A weekly menu was on the notice board with a large easy to read todays menu where everyone could see it. A record is kept in the kitchen of peoples likes and dislikes and everyone seemed to be enjoying their meal. Orange or blackcurrant juice was offered to each person with top ups as required. It was a very unhurried social time. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at risk of harm as robust safeguarding procedures are not always followed. Evidence: Information taken from the AQAA tells us that a number of policies are in place to protect people from harm and protection of vulnerable adults forms part of staffs induction training. Surveys received from people living in the home told us they know how to make a complaint and who to speak to if not happy. One comment was written and this read no complaints, quite happy with everything. Information telling people who is on duty and what to do should they wish to raise a complaint was available in the side entrance to the home which is mainly used by relatives and visitors. The manager told us he plans to develop an easy read complaints document to go alongside this. No complaints or referrals to the Lincolnshire safeguarding team have been made within the last twelve months and during our visit people told us they didnt have any concerns. However, one care record looked at detailed an incident regarding two people living in the home a few months ago where a safeguarding referral should have been made. Information about the incident was inconsistent and had only been recorded on one of the persons records. Staff were able to tell us how they would identify abuse and what they would do about it, however, management failed to report the recent incident to safeguarding. Since our visit we have been told that Care Homes for Older People Page 17 of 28 Evidence: training in this subject has been arranged for December 2009. 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. People live in a comfortable and safe environment. Evidence: We looked at the two lounges, the dining room and three bedrooms and these were clean and tidy and people told us they were comfortable and they liked their bedrooms. They told us they were able to arrange them to their liking with personal items and those we saw showed this. However, one bedroom looked at by the Expert by Experience had a large number of electrical cables which gave a potential risk to the safety of the person whose room it was and to staff. The person living in this room told the Expert by Experience that there was nothing he wanted changing but said his room was cold, this was mainly due to the patio door being open and which he was unable to close. These issues were fed back to the manager who agreed to address them. Within the last twelve months a new bath has been installed and the room decorated and new flooring has been laid in the extension. No improvements have been made to the entrance area of the home, the carpet was worn and there was chipped and damaged paintwork in this area. The manager has written a plan of action following a recent quality audit identifying areas needing attention and has set timescales for this work to be carried out. During our visit there were no unpleasant odours in the home, however, one of the toilets and a handbasin were dirty and we were told that the cleaner was on holiday Care Homes for Older People Page 19 of 28 Evidence: and no one was able to cover this. Staff said they were covering this in the afternoons if they had time and when this was discussed with the manager he told us he would ensure staff would be deployed to cover cleaning responsibilities in the future. Three surveys received prior to our visit from people living at the home told us the home is always fresh and clean, two usually. One staff survey told us they felt the home could be improved by decorating and providing a water boiler in the kitchen instead of a kettle, another staff member told us a dishwasher would improve things. A comment written by a health care professional read communal areas could be improved and toilets and bathrooms upgraded. The Environmental Health Officer last visited on the 28th July 2009 and gave the service a three star rating. Some recommendations were made and the manager told us these are currently being addressed. 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. People are protected by robust recruitment procedures and staff who are committed to training to update their skills and knowledge. Evidence: Surveys received prior to our visit from people living at the home all told us that staff are always available when needed, a specific comment read carers all do their job very well. During the day we saw staff respond to peoples requests for help and support and enabled people to be as independent as possible. A relative told us that staff are very friendly, very caring and her husband smiles at all the staff she said she was very happy with the care. The majority of staff surveys indicated that they felt there are usually enough of them on duty to meet peoples needs. They told us they receive regular training which is relevant to their role and that they meet regularly with the manager. Specific comments written read all staff know the residents, very friendly home, very good caring staff and small home, good atmosphere, good relationship with families. One survey from a health care professional told us the staff make a homely atmosphere and are always on hand when needed. During the visit staff told us they have regular supervision with the manager and good access to training courses, however, they felt they would benefit from dementia training as the majority of people living in the home have dementia or some degree of Care Homes for Older People Page 21 of 28 Evidence: confusion and had raised this during a recent staff meeting. This was discussed with the manager who told us that within the next three months dementia training will be made available for all staff. Staff told us they had completed training in subjects such as fire, first aid, food safety but they had limited knowledge about the new laws about protecting peoples rights and freedoms. Many of the staff have completed or are working towards a nationally recognised care qualification and records showed that a nationally recognised induction programme is used and the manager showed us documentation of the homes programme. Staff files contained all of the information needed to show that they have been recruited safety. We saw records of application forms, written references and identification and criminal record bureau checks. 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. People benefit from clear leadership and management arrangements within the home. Evidence: Since the last inspection clear leadership has been established and the providers son has taken over as manager. He is currently applying with us to become the registered manager. An assistant manager has been recruited and her main responsibilities include updating care plans, completing life histories, covering sickness and overseeing activities. During our visit we saw the manager talking with people about their daily lives and people told us they moved into this home because they knew the manager and his family. People also told us that many of the staff were local and this helped them feel at home. They told us that both the manager and assistant manager were approachable and supportive and there was a good atmosphere in the home. No one raised any concerns about the management. A survey received from a health care professional told us that the service has improved since a new assistant manager has been appointed, she is aware of peoples needs and reports problems promptly. Care Homes for Older People Page 23 of 28 Evidence: The manager told us he has recently attended several training courses in subjects such as moving and handling, dementia, first-aid, swine flu and the new laws around decision making. Staff told us they have regular supervision with the manager and records looked at were up to date. Systems were in place to assess maintenance and risks associated with the environment. However, we saw that not all windows had opening restrictors fitted and the manager agreed to address by the 19th November 2009. Systems were also in place to monitor the quality of care being provided and this included seeking the views of people living at the home and their representatives. A discussion was held around involving other health care professionals and the manager agreed to look into this. A comment/suggestion book has recently been put in the entrance area to the home and the manager said he will monitor and take any necessary action to address any comments. The last staff meeting was held on 6th November 2009 and topics of discussion included, a recent report from Lincolnshire County Council regarding the quality of care and standards in the home and the recent visit from the Environmental Health Officer. Staff told us they feel able to make suggestions and raise any concerns with the manager. Information provided in the AQAA told us that there are a range of policies and procedures in place and the majority of these had been reviewed in 2009. We were told of equipment maintenance and service dates and regular health and safety audits. Our records show that we are told about things that have happened in the home since our last visit that may affect the health, safety or welfare of the people who live there and we were told that plans to improve the service include training for all staff in health and safety and moving and handling. Systems are in place to help keep peoples personal money safe, this includes records to show when money has been deposited with the home, how much has been spent and what the money was spent on. Care Homes for Older People Page 24 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 31 8 A registered manager must 31/01/2009 be appointed, as the provider does not intend to be in full time day to day charge of the care home. This will ensure the service is run in the best interests of residents. 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 18 13 All staff must have sufficient 31/12/2010 knowledge about safeguarding adults and report any concerns. To prevent people from being placed at risk of harm or abuse. 2 30 18 All staff must receive training appropriate to the work they are to perform. To ensure the needs of people living in the home will be met. 31/12/2010 3 31 8 A registered manager must 31/01/2010 be appointed, as the provider does not intend to be in full time day to day charge of the care home. Some progress has been made but this still remains a requirement. This will ensure the service is run in the best interests of residents. 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 3 Letters should be sent to people to inform them that after the initial assessment the home could/could not meet their needs. Pre- admission assessments should record whether the person is able to make decisions about how they wish to be treated and identify who provided the information. Daily records should be written in more detailed to make sure staff know how the person is feeling and how their day has been. Care plans should show people are given the opportunity to be involved in any subsequent reviews or evaluations of their care. Care plans should record how people want their privacy to be respected and record their preference for a male or female carer. Improvements should be made to the entrance area of the home where the carpet is worn and the paintwork chipped and damaged. 2 3 3 7 4 7 5 7 6 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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