Care Home: Melbourne House Nursing Home

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What the care home does well People have an assessment of their needs prior to entering the home, this means there is less chance of people being admitted inappropriately. People complimented the quality and choice of foods offered saying it was `excellent` or `very good`. People have access to plenty of health care services within their community. People are cared for by highly qualified staff who are well trained in their job. What has improved since the last inspection? The building has been extended to improve the amount and choice of living space for people. A Human Resources Manager and Revenue Manager have been appointed within the Company to support human resources and the administration of the home. A home administrator had also been recruited and was due to start working imminently. What the care home could do better: People need a more comprehensive assessment of need when they are first admitted to ensure no care needs are overlooked. Care plans need to be in place for all people including those receiving short term care. Ambiguity over people`s allergies needs to be clarified to keep people safe. Management of medications needs to be improved so people are kept safe. The allocation of staff within the home needs to ensure that all people`s care needs are met. Recruitment systems need to be improved to ensure people are safeguarded from potentially unsuitable workers. Clearer systems are required within the management of people`s finances to ensure necessary safeguards are in place. The management of water temperatures and fire safety within the building needs to ensure people are kept free from preventable risks within their environment. Key inspection report Care homes for older people Name: Address: Melbourne House Nursing Home Aspley Lane Aspley Nottingham NG8 5RU     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: Helen Macukiewicz     Date: 0 5 0 2 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 30 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 30 Information about the care home Name of care home: Address: Melbourne House Nursing Home Aspley Lane Aspley Nottingham NG8 5RU 01159294787 01159294787 javid0612@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Eastgate Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Whose primary care needs on admission to the home are within the following categories Older persons code- OP The maximum number of service users who can be accommodated is 48 The registered person may provide the following categories of service Care Home Code- N To service users of the following gender Either Date of last inspection Brief description of the care home Melbourne House is a purpose built two-storey building providing care for up to 48 older people with one named person who is outside the category of registration. There are 3 lounges, library space, hairdressing room and a large dining room providing ample communal space. There is a lift to the first floor and the building is wheelchair accessible. The home is set within its own grounds, which are accessible Care Homes for Older People Page 4 of 30 Over 65 48 0 1 4 0 3 2 0 0 9 Brief description of the care home to people who live in the home. The service is close to local amenities in Aspley, which is on the main bus route into the City of Nottingham. At the time of this Inspection the registered person told us that the range of weekly fees were in accordance with Nottingham City and County Council rates, there is an extra charge for en-suite bedrooms. Newspapers and hairdressing are not included in the fee. Care Homes for Older People Page 5 of 30 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 inspection was unannounced and involved a visit to the site on 5 February 2010. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who use the service and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Where possible, we include evidence from other sources, notably District Nurses and Social Workers. We also use information gathered throughout the year, to support our judgments. This may include notifications from the provider, complaints or concerns and the pre inspection questionnaire, which the provider is required to complete prior to a visit to the service. On this occasion we did not have a self assessment prior to the visit. The primary method of inspection used during the visit to this service was case tracking. This involved selecting four people who use the service and tracking the care they receive through review of their records, discussion with them where possible, the care staff and observation of care practices. All of the key standards were inspected on Care Homes for Older People Page 6 of 30 this occasion. The acting manager referred to throughout this report had been in post for 4 weeks at the time of this Inspection. She had previously been acting in the capacity of Deputy Manager at the home. There were 30 people living at the home at this time, just over half required residential care, the remainder required nursing care. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? 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 8 of 30 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 9 of 30 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 have the information and assessment they need to choose a home that is suited to their needs. Evidence: The information about the home was contained within two main documents, known as the statement of purpose and service users guide. Information was largely accurate about the home although recent changes to staffing and the management arrangements needed updating. The acting manager told us that she gives a copy of the information to relatives and there was a copy displayed in the foyer. She said she intended to provide information in every persons bedroom in the near future, to improve communication. Three people told us they had been given opportunity to visit the home before they decided to live there. One person had not visited due to being in hospital and told us Care Homes for Older People Page 10 of 30 Evidence: that relatives had helped them choose the home. Most people told us that the home had been chosen as it was near to family and friends which would make it easier for them to visit. All of the people we spoke with and the surveys we received indicated that people were not clear whether they had been given a terms and conditions of residency contract to inform them what to expect from the home. Some people told us their families dealt with this side of things. People did tell they had received some information or a brochure about the home. People had their needs assessed prior to moving into the home, and staff obtained copies of transfer notes, social services and health assessments, which they kept in the persons care file. Once admitted, people had a further assessment of their needs, although we found that this was brief and was not always person-centered. Care Homes for Older People Page 11 of 30 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 are cared for in a private and dignified way. Gaps in short term care planning and in the management of medicines leaves them exposed to preventable risks. Evidence: All expect one care file showed that people had a plan of care in place, where fully completed these were very comprehensive and regularly reviewed. However, one person receiving short term care did not have a full care plan, although daily care records showed they had care needs that required the intervention of staff. The need to ensure all people living in the home have a plan of care was a requirement of the last Inspection that has not been met. Staff had clearly made progress in making care plans more person-centered and the acting manager told us that staff had received training in person-centered care. However, most care files we saw did not support fully that the person had been involved in their preparation, and only one we saw had been signed by the person themselves. We talked to people about whether they got involved in their care plans. Some people did not know what these were and others said they had not been offered Care Homes for Older People Page 12 of 30 Evidence: any. People had been subject to recorded risk assessments in areas such as skin care, continence, falls and nutrition, all of which had been regularly reviewed. There was plenty of evidence in care files of visits from health professionals in the community such as district nurses, skin care specialists and continence nurses. G.P. visits were also regularly recorded. Visits by the chiropodist and dentist were also recorded in files. People told us that they had easy access to a GP as it was located next door to the home and had requested a Doctor when they were needed. People told us a chiropodist visited to care for their feet on a regular basis. People who had wounds had separate care plans in place for these, which demonstrated that staff were managing wounds well. The acting manager told us she was hoping to obtain a camera for use when charting wound progress, to enable more accurate monitoring. We looked at the management of medicines within the home. In a sample of records, we saw that all but one medication that staff had administered was signed for on the medication administration charts (MAR charts). The acting manager and support manager both told us that MAR charts were reviewed regularly by senior management. Medications were stored correctly, including controlled drugs. There were systems in place for monitoring the temperature in the treatment room and drug storage Fridge. There was an agreed homely remedies policy, although the copy on display was missing the information that told the nurse what medications had been approved. There was lack of clarity on peoples allergy status. Conflicting information regarding peoples allergies was seen on the MAR charts and care files. When we entered the building we found that the medicines trolley was not secure and that a medication had been left out and within reach of people moving independently around the home. We brought this to the attention of qualified staff at the time. Staff had ensured that people were dressed in such a way as to promote their dignity. The need for staff to uphold peoples dignity and privacy was highlighted within the care files that we saw and staff training records showed they had attended training in this area. The people we spoke with told us that staff had regard for their dignity and knocked on bedroom doors before entering. The people we spoke to were dressed smartly and were wearing jewellery and accessories. One person told how much they Care Homes for Older People Page 13 of 30 Evidence: liked their makeup and were wearing this. One survey told us that one aspect the home did well was to make residents comfortable. One relative told us on a survey that general care for residents was very good. We did view one shared bedroom where there were two people in residence. No screening to protect privacy was in place in the room although the acting Manager told us this was available, this was not in the vicinity of the room. Care Homes for Older People Page 14 of 30 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 lead a lifestyle of their choosing although more social activities would enhance lifestyle. People have good quality meals provided. Evidence: Peoples care files showed that staff were identifying their hobbies and interests and with the exception of a person admitted for short term care, all had a plan of care to meet their social needs in place. There was less information available to support peoples religious needs had been fully supported. Social care plans did not make reference to any individual arrangements. There were some activities offered to people in the home and an activities coordinator had recently been employed. We spoke to the coordinator who told us they had experience of the role and had begun getting to know the residents. The coordinator told us that it was planned to improve the provision of activities by implementing a schedule of activities and involving the local community such as Schools and Churches but this was not yet organised. The range of activities that had recently taken take included a external entertainer, Care Homes for Older People Page 15 of 30 Evidence: sing-alongs, group discussions, bingo and spending time talking individually with residents. The surveys we received back from staff and discussions with people in the home told us that it was considered more outings would benefit people who live in the home. Some occasional outings had been enjoyed by people over the summer. Some people told us that days were long and they were at times bored and that activities dont happen very often. Some people did have their own magazines with them or other activities such as colouring books to keep them occupied. We spoke with relatives in the home who were visiting. The home appeared to have a number of regular visitors and relatives told us they were always made welcome and the staff were like friends. Relatives told us that they were kept to date of any changes or concerns they had about people in the home. We observed lunch being served to people. People we spoke with told us that a choice of foods was always offered and the food was excellent or very good and you get a choice at dinner time with a nice pudding. People told us they also had a choice of cooked breakfast each day as well as toast and cereals. We observed variable portions of food being served to people with different appetites. Plate guards and different types of cups were used by some people to help them maintain independence. We observed one person eating at the dining table with extremely dirty and unhygienic hands. People also told us you could have a choice of drinks and there were always plenty of drinks offered. Care Homes for Older People Page 16 of 30 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 have their rights upheld through an effective complaints process. Staff training ensures people are safeguarded. Evidence: People had the information they needed to raise concerns. A record of complaints was kept at the home, these included a record of what action had been taken which for most appeared to be appropriate. For one complaint we viewed there was possibly a safeguarding adult issues evident however this did not appear to have been considered in the resolution of the complaint. Dates complaints were received and whilst they appeared to be have been dealt with promptly no actual date of resolution was recorded. There had been 7 complaints raised about the home since we last visited. We saw information displayed on the foyer notice board and staff office, to direct people to local advocacy services. People were able to access the home complaints procedure in the entrance hallway. This included information for people on timescales and who they could contact with their concerns. The people in the home we spoke with said they would raise concerns with the staff or Manager of the home. One person told us you can complain and say what you want. Staff had received training on safeguarding and whistleblowing. The safeguarding procedures were available in the office. There had been no safeguarding issues at the Care Homes for Older People Page 17 of 30 Evidence: home since we last visited. All the staff we spoke with were able to tell us about the whistle blowing policy and said they had received training in safeguarding adults. They said they would report any concerns if they had any. Staff had also received some training on the mental capacity act and deprivation of liberty. People had an assessment of capacity in their files although these had yet to be completed. People who required equipment that carried an element of mechanical restraint, such as bedrails, had their need for the equipment fully assessed. Such assessment was subject to ongoing reviews. Consent forms for use of this equipment were in place but those we saw had not been signed as agreed to by relatives or the person themselves. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is suitable for meeting the stated aims of the home. Lack of fire protection in one area compromises the fire safety of that immediate area. Evidence: The home has been extended since our last visit and large lounge are has been added plus more bedrooms. People we spoke with liked the changes to the building and the lounge was well used. We examined management of fire safety and found that regular checks were in place. Staff told us they received training on a regular basis and as part of the induction when they started. We did view one are in the home where a shower room was currently being used as a storage area. This was so full the door did not open properly and as the rooms use was a shower room no fire detection system was in place. We viewed some bedrooms and spoke to people about the environment. People told us they found the home to be clean. One person told us they had brought in their own furniture to make their room individual and homely. One person said of their room it was quite nice. All of the people we spoke had personal possessions in their rooms to make them individual. The general opinion of people we spoke with and the surveys we received was that the Care Homes for Older People Page 19 of 30 Evidence: home was kept clean. We viewed a number of areas around the home where staff had ready access to protective gloves and aprons and we saw staff using these. The laundry was found to suitably equipped with functioning equipment. We found the laundry and one sluice area had some chemical cleansers in them which were potentially accessible to people as doors were not securely locked, staff removed these during our visit. Care Homes for Older People Page 20 of 30 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. Staff are suitably trained and skilled to meet peoples needs although shortfalls in recruitment and occasionally staffing, have the potential to adversely affect wellbeing of people living in the home. Evidence: We looked at staffing rotas for the home. One registered nurse was provided for each shift. In addition, during the mornings 4 or 5 care staff were provided depending on what staff cover was available and on two occasions only 3 care staff were identified on the rotas. In the afternoons 4 care staff were scheduled and this staffing level had generally been maintained. 2 care staff were scheduled for nights although on two occasions only one had been available due to short notice sickness. Domestic, catering and laundry staff were provided, in addition to care staff and qualified nurses. Future planned staffing rotas showed anticipated staffing levels of 5 care staff in a morning and 4 in the afternoon. There were low levels of sickness or annual leave on past rotas and this suggested that additional staff would need to be appointed to maintain anticipated staffing levels. Additional qualified nurses were being recruited at the time of this Inspection. Care Homes for Older People Page 21 of 30 Evidence: The surveys we received and discussions with people and staff told us that there were occasions where staffing levels were low and the would benefit from more staff or that there was not always enough staff. One person gave us a specific example of where they had to go to bed later than usual due to shortages of staff on night duty. The date given by the person correlated with a shift where staff numbers were lower than usual. In an internal monitoring report we saw that staff had raised concerns about being under pressure to get people up. The manager told us she was looking to introduce changes to shift patterns so that there was more cover for early mornings and bedtimes. The need to ensure adequate deployment of staff was a requirement of the previous inspection that has not been met. There was a comprehensive training programme in place for staff and this was an area where the home consistently achieved high standards. There was a training manager for the Company who held individual training records for all staff. Staff confirmed they received plenty of training opportunities. The home was recently awarded a certificate of achievement from Key Skills Training. Staff had achieved or were working towards National Vocational Qualifications in care. All staff we spoke to felt they were offered ample training at the home. They told they had regular updates in moving and handling and also specific training to help them care for people with particular conditions. Staff said they were well supported through regular supervision and appraisals. We looked at the personnel files for three staff. All had the required criminal records check in place and had been subject to a recorded induction when they first commenced. The induction was quite extensive and ran over a 2 day period. Staff covered whistle blowing, health and safety and safeguarding adults among other areas relevant to their role. We found that a full employment history had not been obtained for one member of staff. References sought had not been from the last employer. Both were from colleagues who had worked with the person as a care assistant, when the post they had applied for at the home was a registered nurse post. The home had appointed a new human resources manager who had tidied up existing personnel files and who had identified areas where improvements were needed. Staff told us about the induction they received which comprised of two days training after which they were supported to work through a skill based induction pack. Staff told us that the home was a friendly one where staff worked well together. Care Homes for Older People Page 22 of 30 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. Management of the home ensures that people are able to give an opinion on the services provided. Gaps in the management of personal monies and water temperatures present preventable risks to people living in the home. Evidence: The acting manager had recently left the Company and the former deputy had come forward as Manager for the home. She intended to register with us. She is a qualified nurse with management experience. Her promotion within the company left a gap within the deputy managers position and there were only 2 registered nurse, including the manager to cover day shifts. This meant that the manager had only achieved one supernumerary shift in the past 4 weeks rather than the anticipated 2 or 3 days/week. A support manager for the Company was providing additional management support and the provider told us that an administrator was also going to start working at the home. Additional registered nurses were being recruited at the time of our visit. Care Homes for Older People Page 23 of 30 Evidence: Satisfaction questionnaires were being sent out every 6 months. We saw that the outcome of the last two had been used to form an action plan for 2009. Data showed that the Company asked questions about a comprehensive range of areas relating to the service offered and care received. Regular internal monitoring visits were also in place from within the Company as required under regulation 26 and reports of findings were provided. The same matters requiring attention were raised on more than one report, however, there was no documented action plan to support the action that the former manager had taken to address issues arising. The manager told us that the Company handled very few personal finances for people living in the home. However, where money was held, there was an insufficient audit trail for finances kept at the home. There was a system in place to ensure that staff received regular supervisions and appraisal. Risk assessments of the homes environment were in place and ongoing incident report logs showed that staff were raising concerns relating to health and safety as and when they arose. However, we found that records of water temperature checks indicated that in some peoples rooms the reading were higher than recommended limits and had been over a period of months. No recorded actions had been taken to address this. Staff received regular health and safety and fire training. Following the inspection we were sent a list of service dates, which supported that equipment used by the home was regularly serviced. Care Homes for Older People Page 24 of 30 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 7 15 Plans of care must be in 31/03/2010 place for all identified needs. This is a requirement that has not been met. A new timescale has been provided for compliance. Failure to meet this new timescale may result in legal action. This will ensure that the needs of people using the service are fully met. 2 27 18 You must ensure the 31/03/2010 sufficient deployment of staff to meet peoples assessed needs. The timescale to meet this standard is extended. Failure to meet this standard within the new timescale may result in legal action. This will ensure that people receive care and support when needed and they remain safe. Care Homes for Older People Page 25 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 People receiving short term care must have their care needs identified through a plan of care. This is to ensure care needs are fully met. 31/03/2010 2 9 13 6) The allergy status of all 28/02/2010 people living in the home must be accurately recorded on both the care files and medication administration records. This is to ensure people are not put at risk by being given medications that they have an allergy to. 3 9 13 6) All medications that are given must be signed for. This is to ensure people are kept safe. 31/03/2010 4 9 13 6) medicines must be stored 28/02/2010 securely at all times. Care Homes for Older People Page 26 of 30 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 This is to ensure people are kept safe. 5 18 13 7) Consent must be gained for use of equipment that carries an element of mechanical restraint. This is to ensure people are kept safe. 6 19 23 4a) You must consult with the fire authority regarding the provision of adequate fire protection in the shower room currently used as a storage facility. This is to ensure the safety of the building. 7 29 19 and schedule 2. A full employment history and appropriate references must be obtained prior to appointing new staff. This is to ensure people are not exposed to unsuitable workers. 8 35 13 6) There must be a clear 31/03/2010 written record of all financial transactions made by the home in respect of peoples personal monies. All money must be separately accounted for and receipts kept for all 31/03/2010 31/03/2010 31/03/2010 Care Homes for Older People Page 27 of 30 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 deposits/withdrawals at the home. There must be a systems in place to calculate and administer any interest accrued from bank accounts to the respective service user if an interest paying account is used. This is to protect people living in the home. 9 38 13 4) Water temperatures must 31/03/2010 be maintained within recommended limits and staff must be aware of what the requirements for water temperatures are. This is to protect people living in the home. 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 1 The required changes to the Statement of Purpose and Service Users guides should be made, to improve communication to people about the service. People should be better informed about the terms and conditions of their residency so they are aware of their rights and what to expect from the service. The assessment of peoples needs on admission should be more person-centered to promote individualised care and further enable identification of care needs. 2 2 3 3 Care Homes for Older People Page 28 of 30 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 4 7 Care plans should be able to demonstrate involvement by the person themselves, or advocate and show their agreement to them. This is to ensure care is personcentered. The full homely remedies policy should be available to staff, to ensure people only receive those medications that have been approved. Shared bedrooms should have their own full privacy screening to promote peoples privacy and dignity. Peoples nails should be kept hygienic to promote infection control and dignity. 5 9 6 10 7 12 Peoples spiritual needs should be accounted for in any care planning, this is to ensure all peoples care needs are identified and met. People should have access to a more varied programme of social activity to enhance their lifestyle and choice regarding how they spend their day. The record of complaints should record when they were concluded, this would support that peoples concerns were responded to within timescales set by the local policy. potential safeguarding issues identified through complaints should be recognised and referred appropriately. The manager should provide an action plan following regulation 26 monitoring visits to support the action taken by the home to improve the quality of care and services. 8 12 9 16 10 33 Care Homes for Older People Page 29 of 30 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. 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