Care Home: Manor House Care Home

What the care home does well Thorough assessments are carried out before people are admitted so that the home can be sure it can meet their needs. Potential service users and their representatives are encouraged to visit and are given plenty of information about the service offered. A relative said, "..... It is a very difficult time to choose care for one`s relative. Manor House is the next best thing. It`s like a house, small and homely, with very good staff". The needs of service users continue to be assessed during their stay and their care plans are kept up to date which helps staff know about their needs. People receive healthcare when they need it and routine health checks are carried out. Specialist advice is sought when necessary. Many of the service users looked cheerful and satisfied. Many of them have memory loss and staff were sensitive and caring towards them. Positive comments were received from relatives, such as "Staff are always helpful and knowledgeable"; "Manor House is a friendly, homely environment and the day to day care is a settled daily, weekly routine. The staff are constant, caring and attentive which is a great asset to my mum and indeed me as I can confidently leave my mum while away on a holiday. Staff are helpful and I feel I can speak to any on duty"; "I am very happy with the staff who look after my relative. They always seem caring to him and know what he needs". Service users have opportunities to participate in social activities. Outings are arranged and entertainers visit the home. They are also encouraged to help with tasks in the home and make cakes, etc. This helps give people purpose and interest. The chef prepares nutritious food and meets the needs of service users with special or individual dietary requirements. Choices are available at mealtimes and substantial snacks inbetween. Family and friends are welcomed into the home. Service users and their relatives are encouraged to raise any concerns they have and they said any issues raised were always dealt with. The home is generally well maintained and decorated and furnished to a good standard, though improvement is required in an area of safety as set out below. Staff are given relevant training and thorough vetting checks are carried out before they are employed. The home is managed well by Ms Leighann Jewitt, who has implemented a series of quality assurance measures, which also help ensure that service users and their relatives can express their views about the service provided. What has improved since the last inspection? There is now more evidence to show that service users are involved in drawing up their plan of care. Staff are caring and sensitive towards people with dementia and they now gather more information about people`s life history, which will help staff during their work with them. Well designed signage has been fixed to doors which helps people with dementia locate toilets and bathrooms. Various areas of the home, including a lot of bedrooms, have been refurbished. The chef has attended training specifically about nutrition for older people, and this has led to improvements in the quality of food provided. Regular meetings are now held with service users and their relatives, so they can give their opinions about the quality of care provided and suggestions for improvements. A health and social care professional, who completed a survey, said "recent changes in ownership of Manor House has resulted in improvements, e.g. more substantial meal provision and new decor". What the care home could do better: Immediate action needed to be taken to ensure that a bath was not used, as the hot water was too hot for the safety of service users. Fitting of suitable thermostatic controls on baths will help reduce the potential for the bath water to be too hot and reduce the likelihood of a serious scald occurring. Key inspection report Care homes for older people Name: Address: Manor House Care Home High Street Easington Lane Tyne And Wear DH5 0JN     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: Janine Smith     Date: 0 8 1 2 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 House Care Home High Street Easington Lane Tyne And Wear DH5 0JN 01915170155 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): N and H Sahajpal R H R and J Bal B and P Dulai Name of registered manager (if applicable) Type of registration: Number of places registered: care home 29 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: The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of sevice only: Care Home only- Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Older Persons Code OP, maximum number of places: 29 Dementia- Code DE, maximum number of places: 4 Physical Disability- Code PD, maximum number of places 4 Date of last inspection Brief description of the care home Manor House is a twenty-nine bedded care home for older persons requiring personal care. The home does not provide nursing care. The home accommodates residents on Care Homes for Older People Page 4 of 28 Over 65 4 29 4 0 0 0 Brief description of the care home two floors, the first floor being accessed by a passenger lift. There is also a stair lift to the first floor, though this is rarely used. As the home is located on top of a hill, there are some changing levels within the building reached by small flights of stairs. The home was converted from a former vicarage. It is situated off a main road and is within easy reach of local amenities and is accessible by public transport. There is a car park to the front of the building accessed by a steep, sloping entrance drive. 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: Before this visit we looked at information we have received since the last visit on 15th and 19th February 2007; how the service dealt with any complaints and concerns since the last visit; any changes to how the home is run; the providers view of how well they care for people; the views of people who use the service and the staff. Since the last inspection, the ownership of the home has changed but the manager remains in post. An unannounced visit was made on 8th December 2009. During the visit we talked with people who use the service, visitors, staff and the manager. We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept and checked that the staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to make sure it was clean, safe and comfortable. We also checked what improvements had been made since the last visit. Care Homes for Older People Page 6 of 28 We told the manager what we found. We have reviewed our practice when making requirements, to improve national consistency. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? There is now more evidence to show that service users are involved in drawing up their plan of care. Staff are caring and sensitive towards people with dementia and they now gather more information about peoples life history, which will help staff during their work with them. Well designed signage has been fixed to doors which helps people with dementia locate Care Homes for Older People Page 8 of 28 toilets and bathrooms. Various areas of the home, including a lot of bedrooms, have been refurbished. The chef has attended training specifically about nutrition for older people, and this has led to improvements in the quality of food provided. Regular meetings are now held with service users and their relatives, so they can give their opinions about the quality of care provided and suggestions for improvements. A health and social care professional, who completed a survey, said recent changes in ownership of Manor House has resulted in improvements, e.g. more substantial meal provision and new decor. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 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 who may use the service and their representatives have the information needed to make sure that the home can meet their needs. Evidence: A new resident had had his needs assessed by the manager, who also obtained important information from his care manager, so that she could be sure the home would be able to care for him properly before a place was offered. His relatives said they had looked at other homes but preferred this one and had been given plenty of information, including the Service User Guide, which helped them know what they could expect. A contract had been agreed with him and was held on file. Contracts were also seen on two other files viewed. Another relative said in a survey, We were given appropriate information of what was available to us. We were also given time to settle in before a final decision was taken. Care Homes for Older People Page 11 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 that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The care three people received was looked at in detail to form a view of how well their needs were being met. Their care records were up to date and comprehensive. A range of assessments are carried out, including nutrition, risk of falls and help needed with moving and transferring. These assessments help inform carers about the help they need with everyday tasks or life in general. Service users or their representatives had been involved in drawing them up. Information had also been gathered about peoples past lives, which is important when supporting people who have memory loss or dementia type illnesses as it helps staff understand and communicate more effectively with them. The care records showed that service users had had contact with their general practitioners and community nurses when necesssary. Routine check ups from the chiropodist, dentist and optician were carried out. Their weight was monitored Care Homes for Older People Page 12 of 28 Evidence: regularly and any special dietary needs or risk factors identified and met. Advice had been sought from other health care professionals when appropriate, for instance, occupational therapy and speech and language therapy. A relative spoken to said the care provided was very good; she was kept informed and carers looked after the relatives too when they were distressed. She was confident her father was getting the medication he needed at the right time. He had seen the doctor when necesssary and has routine eye, dentistry and chiropody. She felt the staff were well trained and there were enough of them. She said her father was always clean and well dressed. One person who had dementia, had come to live in the home as it was unsafe for them to live alone. This person had been unable to settle and did not want to stay. The manager had ensured that Social Services were informed of this so that they could be helped by an Independent Mental Capacity Advocate (IMCA), which is a legal safeguard for people who are not able to make decisions for themselves due to dementia. Relatives who completed surveys said, I am very happy with the staff who look after my relative. They always seem caring to him and know what he needs; In our opinion, everything they do they do well. My mother is now 96 and went into Manor House when she was 89. I dont think she would have got these last seven years if she had not gone into Manor House. Two general practitioners who completed surveys said the home always met peoples social and health care needs and respected privacy and dignity. One commented, well looked after residents. The other said, friendly, capable staff. Many of the service users have memory loss. The manager and staff were seen to be very sensitive and caring when responding to service users anxieties due to their memory loss. The system for handling and storing medication was discussed with a senior member of staff. Appropriate procedures were described and a random check on the records showed that these were being kept properly. The home has a good simple system for clearly identifying where a service user is allergic to particular medications by using different coloured name cards in the medication records. Appropriate procedures were described for handling controlled medications but none were prescribed at the time of inspection. Staff confirmed the training they had received about medication and evidence of this was seen on the staff record looked at. Care Homes for Older People Page 13 of 28 Evidence: 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 who live here are able to make choices about their life style and are given sensitive, caring support. Evidence: Records and discussion with the manager, staff and a relative, showed that service users are offered regular opportunities to participate in a range of social activities, including exercises, bingo, music. They are also offered opportunities to go out on short walks, or outings to the metro centre, Dalton shopping centre and trips to the theatre. Entertainers are booked to visit monthly. As some service users have memory problems, staff involve them in activities like baking, domestic tasks or helping in the office. This helps them feel useful. Service users were observed chuckling as they watched a dvd of Bobby Thompson, a famous comedian in the area. One relative commented in a survey, Activities are available but residents have a wide ability and therefore for one person to do this on her own is difficult if the residents interests are to be met. There does seem to be long days of television but I am grateful for the social side. A relative confirmed they were welcomed into the home and visited daily. Another Care Homes for Older People Page 15 of 28 Evidence: commented in a survey, I visit everyday at different times which is good. I can also stay at mealtimes. The food is homely and well cooked and a choice was given. The manager is producing photographs of the meals on the menu place, which will help service users to make a choice of what is on offer. Lunch was taken with service users. There was a pleasant atmosphere and several service users chatted happily during the meal. Lunch comprised of roast chicken, potatoes and vegetables or cheese and onion bake, followed by a choice between currant sponge and custard or fruit and ice cream. Service users were observed to enjoy both choices of main meal. Fruit is provided daily and substantial snacks. Staff have been given training, known as Focus on Food, which helps provide them with the information and knowledge they need to meeet the nutritional needs of older people. This had produced immediate benefits, for instance for people with swallow problems who need a special type of diet. 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. People who live here are able to express their concerns and have access to a robust, effective complaints procedure and are protected from abuse. Evidence: The complaints procedure is made available to residents and relatives through the Service Users Guide. The complaints log book showed that manager had taken any issues raised seriously and took action to resolve the concerns. A service user said without any prompting or question, that she would tell Leighann (the manager) if she had any concerns. Another, who was sitting at the next table, also chipped in saying the manager was very kind and listens. A relative said they would readily tell the manager if they had any concerns and that she had always sorted out any issues in the past. Four service users in a survey said they knew who to speak to if they had a complaint. Four staff who completed a survey said they knew what to do if someone has concerns about the home. Two staff records were looked at showing that one had had safeguarding training and this had been booked for a new member of staff. A member of staff confirmed they had had safeguarding training, understood the whistle blowing policy and would readily raise any concerns with the manager. Care Homes for Older People Page 17 of 28 Evidence: Staff records looked at showed that they were vetted before offered jobs in the home and staff who completed surveys confirmed this was the case. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a well maintained environment, but their safety could be compromised by the failure to adequately control the temperature of hot water supplied to baths. Evidence: The building was toured and a sample of bedrooms looked at. Nine bedrooms have ensuite toilets. Bedrooms have been redecorated to a good standard and are homely and contain peoples personal effects. The home was clean and no unpleasant smells were noted. A relative commented in a survey, The surroundings are good, clean and fresh and updated regularly. Four service users said in a survey the home was always or usually fresh and clean. The passenger lift to the first floor was in working order. The home also has a stair lift from the ground to first floor. There are some stairs between different levels in the home as the building is on a hill. Room heaters with metal covers felt warm, but not hot enough to scald. The manager said the surface temperatures of the heaters were safe. Rooms were very warm. A window opening restrictor was found to be in working order. Boxes with see through windows have been fitted to bedroom doors and contain memorabilia and photographs important to the service user, to help them identify Care Homes for Older People Page 19 of 28 Evidence: their own bedroom. Some also have memory boxes in their rooms. New signage has been fitted to doors, which uses colours and graphics to help service users identify toilets and bathrooms. The manager said this had reduced the number of continence accidents as service users find the toilets more easily. Appropriate infection control measures were described by staff for dealing with laundry. Protective clothing is provided and staff have had infection control training. The call system box was coming away from the wall in a ground floor bathroom. The manager said repair of this was in hand. The temperature of hot water supplied to a bath was tested and found to be 60o centigrade, which is potentially very dangerous to service users if the bath temperature ws not checked before service users used it. This is more likely to happen if staff cannot check it easily. No thermometer was available in this bathroom and one had to be obtained from an upstairs bathroom to carry out this test. The manager said the bath was fitted with a mixer valve to control the temperature but despite this the temperature of hot water is well above that advised for the safety of vulnerable older people who are more at risk of scalds from hot water. The manager was advised to ensure that the bath was not used, a warning notice posted and staff advised of the dangers, until the temperature could be corrected. The water was checked in the ground floor bath later in the day after this problem was supposed to have been resolved but due to a misunderstanding, this had not been done. The log of the regular checks showed some occasions when the temperature had again been far too hot but nothing logged as to what was done about this. The manager was strongly advised that appropriate thermostatic controls should be fitted to each bath to prevent fluctuations in temperature. This issue was also identified as a concern at the last inspection when the home was under different ownership. 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 in the home are trained, skilled and in sufficient numbers to support the people who live here. Evidence: A relative commented in a survey, The staff do no change and this gives good continuity for residents. They work very hard and as the years go by the needs of residents changes and sometimes it is clear that more staff are needed, e.g. for lifting, using hoists, etc, more staff on duty would be an advantage. The manager said she had recently increased the number of staff on duty through the night because of the increased vulnerability of service users. Discussion with the manager, staff and the rota showed that there is a senior carer and three carers on duty from 8 am to midday, then a senior and two carers until 8 p.m. Three carers are on duty through the night. They also employ an Activities Organiser between 1 p.m. to 4 p.m on five days, a cook, laundry assistant, cleaner and handyman. Four residents in surveys said the staff are always available when they need them and listened and act on what they say. Four staff who completed a survey said vetting checks were carried out before they started their job. All four said their induction training covered everything they needed to know very well or mostly. They had all received relevant training. Three said there Care Homes for Older People Page 21 of 28 Evidence: were always or usually enough staff to meet the individual needs of service users; one said there sometimes were. One commented, the home could do better if more staff when needed but it was not fully clear what was meant by this comment. Two staff records looked at confirmed that satisfactory vetting checks were carried out before they were employed. The record of a senior member of staff showed that they had had a range of training about medication, protection of vulnerable adults from abuse, nutrition, stoma care, falls awareness, eye care, risk assessment and epilepsy and had obtained a National Vocational Qualification (NVQ)at Level 2. Training had been booked for a new member of staff about safeguarding people from abuse, new legislation known as Deprivation of Liberty, Focus on Food and was to start NVQ at level 3. 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 management and administration of the home is based on openness and respect, generally has effective quality assurance systems though some improvement could be made. Evidence: The manager, Ms Leighann Jewitt, has been in post for fourteen years and is very experienced and caring. She continues to manage the home following the change of ownership. A member of staff said the manager and the owner who visits were easy to talk to and approachable. A relative of a service user said they had been worried about what changes might happen when the ownership of the home changed, but there had been no problems at all. She said one of the owners visited the home every day and sat with service users getting to know them, as well as relatives. The manager confirmed that one of the owners makes monthly visits to comply with regulatory requirements. Care Homes for Older People Page 23 of 28 Evidence: The manager carries out surveys of service users and relatives and analyses the results of these to identify where improvements are needed. A relative commented in a survey, More feedback from questionnaires, etc., would be appreciated although we now have a service users meeting. These meetings are held monthly. Another relative spoken to was aware of the meetings but chose not to attend. The Activities Organiser also speaks separately to service users who do not wish to attend the meeting to make sure their views are still sought, which is good practice. Various audits are carried out as part of the quality assurance process, although improvements are needed in respect of safety checks on hot water as stated earlier in this report. The manager carries out monthly audit and analysis of any falls and had increased night time staffing as a consequence of this. Evidence of maintenance and servicing checks were seen for the fire extinguishers, emergency lights, hoist, passenger lift, stair lift, electrical wiring, portable electrical appliances and gas system. Four staff who completed a survey said the manager regularly meets with them to discuss their work and gives them support. One member of staff commented that more staff meetings should be held so that all staff get an opportunity to attend as some staff have to stay on duty when the meeting takes place and miss out. The manager will review how this could be done. A staff record showed that training had been provided in medication, fire safety, moving and handling, first aid, food hygiene, infection control and health and safety. A new carer had done most of this training but was awaiting the certificates from the training course. A member of staff confirmed the health and safety training she had been given. The process for looking after service users money and invoicing for fees was looked at An appropriate system was in place, receipts were kept and a check on two balances was accurate. 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 1 25 13 Ensure that the bath, where 09/12/2009 the hot water temperature is too hot for safety, is not used until this is rectified. Ensure that staff have ready access to thermometers for checking the temperatures of baths before they are used by service users and that they do this every time. Older people are at risk of serious or fatal scalds, if they are immersed in baths with a temperature above 43o centigrade. 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 25 13 Correctly functioning and appropriate thermostatic controls must be fitted to baths in line with the advice given by the Health and Safety Executive in this regard. This helps to protect people from serious scalds from hot water. 26/02/2010 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 33 Look at ways of giving service users and other stakeholders feedback on the results of quality assurance surveys carried out and how this has led to improvements in the quality of service provided. Also look at ways to ensure that all staff get opportunities to attend staff meetings from time to time. 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. 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