Care Home: Mavesyn Ridware House

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What the care home does well People like living at the service. Comments from people living there include: "I have been her for three years now, the accommodation is great, food good and the staff are very helpful and kind. I have no family myself and feel very much that this is now my home, and I am very happy with that". "Very happy with care received, always someone to talk to about things, and the care and support I get is satisfactory for me". The service completes an assessment to decide if the are able to meet people`s needs. This covers areas such as physical and mental health, personal care and social care needs. People are having their health and personal care needs met. People see the doctor when they are ill and have access to specialist health care staff including Community Psychiatric Nursing staff. People like the meals and there is always a choice of food available. The service has introduced a picture menu. People are provided with good communal and private accommodation. People can make their bedroom their own bringing in their own possessions. Progress has started in making the environment more suitable for people with dementia care needs. What has improved since the last inspection? Since our last key inspection the service has made progress in a number of areas. Improvements have been made in the care planning process giving staff more information on people`s care needs. Arrangements are now in place for people to receve dental check ups. Progress has been made in providing people with a varied and stimulating lifestyle. People now have more opportunity to take part in activities including having the change to take part in activities out of the service. The service has also made progress in meeting the social care needs of people with dementia including buying some sensory equipment and giving more consideration to their needs when organising activities. The service is also addressing people`s spiritual needs. People are now being better protected. Staff are now fully aware of safeguarding issues and how to refer any concerns. Progress has been made in making sure all the staff records are up to date. Staff have received up to date fire training and there have been fire drills completed. The service has also addressed a requirement we made in relation to safeguarding one person`s money. The service is now recording its falls audits. What the care home could do better: The service has made progress since we did our last key inspection. This progress needs to be maintained and the service further developed. We made some requirements at this inspection. Although fall risk assessments are being completed the service needs to make sure that information from falls is transferred into the care planning process. This will make sure that all staff are up to date with information on people`s needs. We required that the service review its current use of bed rails. Assessments must be accurate and show that bed rails are required. Where bed rails are in use they must be safe and appropriate for the bed. This will make sure that people are kept safe. Issues of hygiene were identified during this inspection and therefore we require the service to ensure that it has robust systems in place to make sure that the risk of the spread of infections is controlled. Whilst the recruitment procedure is generally safeguarding people the service must ensure that when information is revealed during pre employment checks that there is evidence that the information has been checked and risk assessed. We also made some recommendations on how the service can improve the care it provides to the people living there. Key inspection report Care homes for older people Name: Address: Mavesyn Ridware House Church Lane Mavesyn Ridware Near Rugeley Staffordshire WS15 3RB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Capron     Date: 0 9 0 6 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 29 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 29 Information about the care home Name of care home: Address: Mavesyn Ridware House Church Lane Mavesyn Ridware Near Rugeley Staffordshire WS15 3RB 01543490585 01543490585 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mavesyn Ridware Residential Home Ltd Name of registered manager (if applicable) Mrs Sandra Margaret Black Type of registration: Number of places registered: care home 21 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: 21 The registered person may provide the following category of service 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: Old age, not falling within any other category (OP) 21 Physical disability (PD) 8 Dementia (DE) 6 Date of last inspection Brief description of the care home Mavesyn Ridware is located off a public transport route near to Armitage and Handsacre. It provides care and accommodation to 21 older people. The service stands Care Homes for Older People Page 4 of 29 Over 65 0 21 0 6 0 8 1 8 0 1 2 0 1 0 Brief description of the care home in its own grounds with stunning views, the gardens are well maintained and offer appropriate seating areas for the people who use the service. The service has a large lounge, conservatory and separate dining room. Bedrooms are single occupancy and some have an en-suite facility. The current range of fees are not included in the Service User Guide. People are advised to contact the home directly for this information. The most recent inspection report is available from the home upon request. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection undertaken by two inspectors. It lasted approximately 11 hours. We used information we have about the home to help us plan this inspection. We looked at information the home has given us in relation to incidents and accidents. We call these notifications. We have used any information we have about Safeguarding referrals and complaints people may have made about the home. We spent time during this inspection talking to people who live in the home and to the staff who support them. We also spent time looking at care records as part of our case tracking process. This enables us to make judgments about the homes ability to provide a service to the people who live there. Since the last key inspection we undertook a random inspection to check the progress the service had made in meeting the requirements made at the previous key inspection. We found that the service had made progress in addressing all of the requirements. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The service has made progress since we did our last key inspection. This progress Care Homes for Older People Page 8 of 29 needs to be maintained and the service further developed. We made some requirements at this inspection. Although fall risk assessments are being completed the service needs to make sure that information from falls is transferred into the care planning process. This will make sure that all staff are up to date with information on peoples needs. We required that the service review its current use of bed rails. Assessments must be accurate and show that bed rails are required. Where bed rails are in use they must be safe and appropriate for the bed. This will make sure that people are kept safe. Issues of hygiene were identified during this inspection and therefore we require the service to ensure that it has robust systems in place to make sure that the risk of the spread of infections is controlled. Whilst the recruitment procedure is generally safeguarding people the service must ensure that when information is revealed during pre employment checks that there is evidence that the information has been checked and risk assessed. We also made some recommendations on how the service can improve the care it provides to the people living there. 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 29 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 29 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. Information is available about the service but this should be in a format that is more easily understandable to people. People can be confident that an assessment will be completed prior to the service deciding if they can meet their needs. Evidence: The service provides information about what it offers to people. There has been some updating of the Statement of Purpose but there remain some omissions such as information about the manager and the staff and information about the regulator. We saw a service user guide. This is available in the service but is not routinely provided to people. The presentation and format does not lend it to be easily accessible to people. The format is not user friendly and is not available in a large print or an easy read version. Examination of three files confirms that an assessment of need is completed prior to a decision is made to offer a person a place. The amount of information was adequate in Care Homes for Older People Page 11 of 29 Evidence: forming an appraisal of peoples needs and capabilities. The service tells us that either the manager or deputy conducts the pre admission assessment either in a persons home or in hospital. People are invited to visit the service before moving there and once admitted people have a trial period to decide if they wish to remain and to decide if the service can meet their needs. Since our last visit the service has started to put in place arrangements for meeting the needs of people with dementia. All staff are in the process of undertaking training in dementia care, some signage has been put in place to aid people to orientate themselves, social history and life story information is being sought and more suitable equipment has been provided to undertake activities. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service are treated with respect and have their privacy and dignity promoted. People are having their medication, health and personal care needs met but improvements need to be made in the way that risks are managed and recorded. Evidence: Case tracking of three people confirms that a plan of care is completed for each person. These have improved since our last key inspection and are satisfactory. However some contain unnecessary information and could be difficult for staff to use as a working document. Peoples health, personal and social care needs are generally identified in the care plan, for example we saw that peoples personal care and health care needs are covered giving staff information on how to meet these needs. We also saw that where needed a plan of communication is developed. We did notice that in one case there was no plan in place to aid staff to manage one persons difficult behaviour. We also noticed that some files need further information in relation to peoples social care needs which is of importance in understanding people especially those with needs relating to dementia. Plans are reviewed monthly by care staff but there is no evidence to show that people and their relatives are involved in care Care Homes for Older People Page 13 of 29 Evidence: planning although the staff tell us that they do discuss care issues with relatives. We would advice that a record be kept when such discussions take place. There is no evidence that the Care Manager contributes in the supervision of the care planning process although she tells us that she undertakes routine checks. We would recommend that management reviews of care plans are recorded. The service is responding to peoples health and personal care needs. A regular monitoring process is in place that includes nutritional screening, weighing and pressure care. We saw that people see the Doctor if they are ill and access specialist services such as Community Psychiatric Nurses and District Nurses. People have access to a chiropodist and since the last key inspection a dentist has visited to provide oral care. We saw that the service is addressing issues relating to tissue viability. One person was admitted with a pressure sore and is provided with pressure relieving equipment and during the inspection the District Nurse came to dress their wound. Case tracking of three people shows that the service is meeting peoples personal care needs. People are well dressed, have a clear skin, are hydrated and their eyes and mouth are clean. The service completes daily records that confirms that peoples personal care needs are met. We would however advice that the system of daily records be streamlined to prevent the opportunity for adding information to the record after an event. The service has a risk management system in place that includes manual handling, nutrition, continence and falls. These are reviewed monthly. However we did notice that one person had had a fall and the care plan or risk assessment had not been updated. Bed rails are in place for one person. A risk assessment is in place but we feel that this has not been completed correctly and it is not clear that bed rails are appropriate for the person. We did not feel that the current bed rails are safe for the person concerned and we discussed this with the manager. This is an issue we have raised at a previous inspection. We found the administration of medicines adhered to procedures to safeguard people who use the service. The medicines in use storage is secure, with good environmental controls, including a medicines fridge. Our examination of the record of administration of medicines shows consistency, with no omissions observed. We advised that drugs when dispensed from droppers or tubes be dated when started. Staff signatures are up to date. Controlled drug arrangements and management are appropriate. We found an effective and smooth process of ordering, receiving, storing, administering and disposing of medicines. Records are complete and easy to follow Care Homes for Older People Page 14 of 29 Evidence: through, with no observed breaches in the system. We did discuss with the manager the need to ensure a system is in place for the use of as required medicines to make sure that all staff are aware of the circumstances when such medication should be given. All the staff administering medication are trained but the service still needs to put in place a robust system for checking their ongoing competency. People tells us that they are happy with the care they receive. Comments include: I have been her for three years now, the accommodation is great, food good and the staff are very helpful and kind. I have no family myself and feel very much that this is now my home, and I am very happy with that. I am pleased with the care staff and the doctors who come to see me, everyone is so kind and willing to help, they could do with more staff. Very happy with care received, always someone to talk to about things, and the care and support I get is satisfactory for me. Care Homes for Older People Page 15 of 29 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. Improvements has meant that people are provided with opportunities for stimulation through social activities that take account of their needs. People enjoy the meals and are provided with a choice. Evidence: We have raised concerns over the last few inspections about the lifestyle people have the chance to enjoy at the service. On this occasion we saw that improvements have been made. A programme has recently been put in place to provide people with a range of activities to provide them with stimulation during the day. These activities are completed by the care staff. The service needs to ensure that the programme is maintained to provide people with a varied and stimulating lifestyle. A schedule of activities has been developed and this is displayed in the hall way. Activities are scheduled for everyday expect Sunday. These include popmobility, crafts, music, dominoes, reminiscence sessions as well as skittles and pet therapy. In addition a trip out to a safari park has been arranged. Also once a fortnight three people have the opportunity to spend an hour out of the service either being supported to go for a walk or to go to the local village. We are also pleased to see that the service has started to provide equipment and activities suitable for people with dementia. The service has bought some sensory equipment, soft toys are available and staff are Care Homes for Older People Page 16 of 29 Evidence: talking to relatives about providing reminiscence items. We saw that one person has a memory box and several others have photo albums provided by relatives. We feel that on this visit that there was a much improved atmosphere. The lounge was well supervised with events taking place. Several people were reading the newspaper or magazines, sensory items were available and suitable music was playing rather than the television being on. There was communication between staff and the people that live there as well as between the people themselves. We observed one member of staff sitting with one person looking at the album with her. This contact appeared to help her to be less anxious. On our last visit we raised concerns over the services ability to meet peoples spiritual needs. We confirmed that one person that wished to follow their religion was being supported to do so. Records confirm that the manager has discussed peoples spiritual needs with them and people are satisfied with the current arrangements. She reports that they have asked to watch Songs of Praise and this is occurring. She also states that she is trying to find someone to provide a religious service and to then assess if people would wish this. We saw that routines are quite flexible. People that wish to can spend time in their bedrooms. We spoke to two people and they confirm that they enjoy being in their bedroom and do not wish to sit in the lounge. One person was watching the television in their bedroom and told us that this suited him. He also said that he spent time watching the wild life through his bedroom window. Two people tell us that there is flexibility about when they get up and go to bed. People also tell us that there is a choice of main meals. Visitors are welcome throughout the day. The service has a separate dining room overlooking the garden that provides a pleasant place to eat. People tell us they like the meals and that there is a choice. One person commented Lovely meals and another said Meals good. No complaints. The menu was displayed on a menu board and the service has developed a pictorial menu book to try and assist people with dementia care needs to make a choice. People tell us that there is a choice at breakfast and one person said that she chooses to have egg on toast every day. The service assesses peoples nutritional needs on a regular basis and regularly weighs people. Sufficient staff are available to provide people with support with eating. Care Homes for Older People Page 17 of 29 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 living at the service have access to a complaints procedure. People can be confident that staff are aware of safeguarding issues and know how to respond if they have any concerns. Evidence: Information about complaints is provided to everyone living at the service. We saw information in the entrance hall and in every bedroom we went into. People tell us that if they have any concerns they would tell the staff. There have been no complaints since the last time we visited. We, the commission, have not received any complaints. At the last key inspection we made a requirement that all staff should be aware of the agreed safeguarding procedures. When we undertook a random inspection in April 2010 we saw that this had been addressed. Staff had received training in safeguarding and could tell us about signs and symptoms of potential abuse. We saw that this had been maintained on this visit. Staff we spoke to could tell us about safeguarding issues. The manager is very confident about the process and aware of the need to always refer incidents promptly to the local authority. There have been no safeguarding issues since we visited last. Care Homes for Older People Page 18 of 29 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. People living at the service are provided with private and communal accommodation that is homely and welcoming. The service must have robust systems in place to ensure that the risk of the spread of infections is controlled. Evidence: The home provides people with good accommodation. Efforts have been made to provide a homely atmosphere and the decor of the service is of a good standard. There are suitable communal rooms including two lounges and a separate dining room. The dining room area was clean and conducive to enjoying a good meal. We looked at a sample of bedrooms and these provide people with good private accommodation. Most rooms are of a good size and are decorated and furnished in a modern style. People are encouraged to make their room their own with their own possessions. None of the bedrooms are lockable. We noticed that the service has started to introduce some environmental changes to aid people with dementia. These include names on bedroom doors, and signage on communal rooms. We would advice that this process continue by for example putting in further means for people to identify their bedrooms and further developing the decor of the corridors through the use of themes and colour. We looked at the laundry accommodation and it is currently inadequately equipped to Care Homes for Older People Page 19 of 29 Evidence: meet the needs of the service due to the dryer out of commission. This has forced staff to use every available space to air washing causing confusion and disorder. This has not been working for over a week. The service assured us that this was due to be repaired in the very near future. All the main rooms were clean and tidy. All staff have received training in infection control and we saw that protective equipment is available. However when we checked some commodes and toilets we saw dried faecal matter on the seats. We raised this with the manager and made an immediate requirement that this is addressed. We also noticed that there are several people with continence needs that require safe handling of affected linen. We advised the manager to use red alginate bags to avoid the need for staff to transfer soiled items during the laundry process. Care Homes for Older People Page 20 of 29 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. Adequate numbers of staff are available to provide people with the care they need. People living at the service are supported by a high number of qualified staff but cannot always be confident that all staff have up to date training. Whilst the recruitment process has improved the service still needs to take action to ensure that it has a robust system that is fully protecting people. Evidence: The service provides three staff on duty during the day and overnight. This level is adequate to meet the current needs of the people living there. The manager acts as a carer for two days a week. The manager confirms that over 50 of staff have obtained at least NVQ level two, a number having achieved level three. Staff we spoke to are aware of the needs of the people that live there. They could discuss their care plans and the risks involved. The service has a training schedule in place covering such training as medication, nutrition, diabetes, safeguarding and equality and diversity. Everyone has either completed or is in the process of completing training in dementia care needs. We did notice some gaps in the training records and that some training had been completed some years ago. We therefore advice the service to reestablish an effective training programme to ensure that all staff are up to date with their training. Care Homes for Older People Page 21 of 29 Evidence: We looked at a sample of staff files to check the services recruitment process. We saw that the manager has nearly completely addressed the requirement made at the last key inspection. All the files we saw have references and Independent Safeguarding Assessments and Criminal Record checks. However we noticed a disclosure on one employment check and when we raised this with the manager she had been unaware of this and consequently this issue had not been discussed or risk assessed prior to employment. Care Homes for Older People Page 22 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service has improved but this needs to be maintained and the areas for improvement addressed to ensure that the service fully promotes the health, welfare and safety of the people that live there. Evidence: There has been no changes to the management of the service since we visited last. Since we visited last time the manager has devoted three days a week to the management tasks of the service and this has benefited the people living there. Progress has been made in meeting all the requirements we made at the last key inspection although there still remain areas to be developed. The manager informed us that she feels that her management commitment could be reduced to two days a week. We feel the current level should be maintained if the improvements are to be maintained and the service is to develop further. We continue to have some concerns over the management of the service and its ability to maintain the improvements and to further develop. The previous history of the service indicates that improvements are made in response to requirements we have made following inspections. Care Homes for Older People Page 23 of 29 Evidence: Progress has been made. People now have more opportunities to take part in activities and progress has been made in the care planning process, safeguarding, and meeting peoples health care needs. However there remain areas for improvement including infection control, training and risk management. The service has started to develop the system for reviewing and monitoring the service. A number of checks are being done on such aspects as medication, falls and health and safety. We did provide advice on ways to improve these and other areas to review including care planning and hygiene. The service had recently surveyed people that live at the service and relatives and these are due to be evaluated. We had, at the last key and random inspections, looked at the way they service looks after peoples money and the service had met the requirement we had previously made in respect of one persons finances. The service employs a handyman who undertakes a range of health and safety checks. We saw that water temperatures are checked monthly and that fire checks are being undertaken. Fire drills and now being undertaken and recorded. The fire authority has visited the service and given advice on record keeping and the completion of a fire risk assessment. They are to follow these issues up. The service provides health and safety to staff. Training in fire safety has been completed by all staff since the last key inspection. Most staff have up to date training in infection control but some staff training in such areas as moving and handling, food hygiene and emergency aid needs updating to ensure they are up to date with current practices. Care Homes for Older People Page 24 of 29 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 29 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 26 13 The service must have suitable arrangements in place to ensure that equipment such as commodes and toilets are kept clean and hygienic. This will prevent the risk of the spread of infection. 12/06/2010 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 8 13 The assessment for the 01/07/2010 person using bedrails must be reviewed to ensure that they are needed and if so that the bedrails are suitable for the bed and are safe. This will make sure that bedrails are appropriately used and that people are kept safe. 2 8 13 Risk assessments and care plans should be updated to reflect any changes in conditions. This will make sure that staff are aware of any changes and can respond 01/07/2010 Care Homes for Older People Page 26 of 29 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 appropriately to reduce the risks to people. 3 29 19 Where information is provided in pre employment checks a system must be in place that shows that the information has been considered and risk assessed. This will ensure that people are safeguarded. 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 17/07/2010 1 1 Information about the service should be provided to each person and in a format that is easily accessible, for example in large print. Care plans should be further developed to include sufficient information about peoples social needs including any information realting to dementia care such as challenging behaviour. A robust system of checking staffs competency to administer medication that includes observing staff should be put in place. This will make sure that the service is confident that staff are giving medicatio appropriately. Where medication is given on an as required basis a proctocol should be in place. This will make sure that staff are aware of when such medication should be given and that such medication is given in a consistent manner. To introduce the use of red alginate bags when washing soiled items. This will reduce the likehood of the risk of the spread of infections when transferring soiled items. To re-establish an effective training programme to make 2 7 3 9 4 10 5 26 6 30 Care Homes for Older People Page 27 of 29 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 sure that training is current and up to date. This will ensure that staff are up to date with current good practice. 7 31 The manager must have the knowledge of current up to date practices including methods of monitoring and reviewing the service and risk management systems. The service should further develop its method for reviewing and monitoring the service. Staff should complete relevant Health and Safety training to ensure they are up to date with current practices. 8 9 33 38 Care Homes for Older People Page 28 of 29 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. © 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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