Care Home: Merstone Hall

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What the care home does well The home is well managed by Mr Janczewski. People living at the home told us they were well cared for by competent staff and receive the care they need. Visitors to the home are always made welcome. People are supported to maintain contact with family and friends, enabling those living in the home to continue enjoying relationships that are meaningful to them. They also said that the food was good. The complaints and adult protection procedures ensure that residents` and their representatives` well being and comfort is important to the home and that any concerns raised will be properly investigated and resolved. The home is comfortable, clean and homely with a welcoming atmosphere and reflects the individual needs and preferences of the people living there. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the care needs of people. Staff are well trained to meet the nursing needs of people in their care. Recruitment procedures are robust, which means that people living at the home can be assured they will be cared for by suitable members of staff. The day to day running of the home and management of people`s finances is good. What has improved since the last inspection? Most of the requirements from the previous inspection have been met. Medication records now clearly state individual needs and what variable dosages have been given. The home now ensures that all required documentation for new employees is in place prior to them starting work and that recruitment policies and procedures are correctly followed. A training matrix is now in place enabling the home to easily identify any staff training required. Quality assurance systems have been improved by the introduction of more audits, gathering more feedback about the running of the home and an annual development plan. What the care home could do better: Following this inspection two immediate requirements were made regarding health and safety risks and needing urgent action. These were: A risk assessment must be completed in relation to unrestricted windows and any necessary action taken. This is to ensure that people are not put at risk of injury. All bed rails in use must be reviewed and any action taken. This is to reduce the risk of injury to people living at the home. A follow up visit has since been made to Merstone Hall and the home has addressed these requirements. Seven other requirements and four good practice recommendations were also made. Pre admission assessments must be completed fully before people move into the home. The Statement of Purpose should be updated to ensure that people are able to contact relevant external agencies should they wish to do so. Care records and assessments must contain sufficient guidance for staff. All records must be signed and dated. This is to ensure that staff are able to fully and safely meet peoples` needs. People must be supported to engage in development and review of their care plans. Care plans must be legible. People living at the home should be consulted regarding the care they received. Action must be taken to ensure that razors are capped and stored safely. This is ensure that people living and working at the home are not put at risk of harm. There must be appropriate systems in place to monitor and review the effectiveness of care plans in meeting peoples` needs. This is to ensure that people receive the care they require. The home should ensure that people are provided with opportunities to transfer into chairs to promote skin integrity in accordance with their personal preferences. All care documentation should be written in clear plain English so that anyone reading the file can easily understand what is written. People must be provided with appropriate support to meet their social and leisure needs. This is required to meet their social needs. Waterproof flooring must be provided within the laundry. This is required to reduce the risk of cross infection. Foot operated flip top bins should be provided in areas where people receive personal care, and bin liners should be used. Key inspection report Care homes for older people Name: Address: Merstone Hall 20-22 Florence Road Bournemouth Dorset BH5 1HF     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: Joanne Pasker     Date: 1 7 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 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) © 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 30 Information about the care home Name of care home: Address: Merstone Hall 20-22 Florence Road Bournemouth Dorset BH5 1HF 01202309813 01202304128 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Merstone Hall Ltd Name of registered manager (if applicable) Mr Marek Janczewski Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability terminally ill Additional conditions: The maximum number of service users who can be accommodated is 45. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender. Date of last inspection Brief description of the care home Merstone Hall is a large detached property located close to all the amenities in Boscombe and is a short level walk from these. Parking is available directly outside the Care Homes for Older People Page 4 of 30 Over 65 0 0 45 0 0 45 45 0 45 45 0 4 0 6 2 0 0 9 Brief description of the care home home and on the surrounding roads. There are outdoor seating areas to the front and rear of the building with easy level access for wheelchair users. Merstone Hall has a wide selection of accommodation set on three floors, all areas being serviced by a passenger lift. The rooms are of varying sizes and many have full ensuite facilities. The communal areas situated on the ground floor consist of two lounges, one of which is very large and a separate dining room. The large lounge is shaped to ensure those people wishing not to participate in a larger group or organised activities can find quieter corners to sit in. In addition there is a sizeable reception area. The home is registered to provide personal care for up to 45 older people, 32 of whom can require nursing care with a maximum of six younger adults. Mr Marek Janczewski is registered with CQC to manage the home on behalf of Mr Zamir Afghan. Additional charges to the fees charged include hairdressing, chiropody and newspapers. 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 quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place on the 17 December 2009 over a period of approximately seven hours.The purpose of the visit was to assess all of the key standards. The inspection was carried out by one inspector and one area manager, however the term we is used throughout the report to reflect the findings of the Care Quality Commission (CQC). The registered manager Mr Marek Janczewski, was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including reports made to CQC by the home; the annual quality assurance assessment (AQAA) completed by Care Homes for Older People Page 6 of 30 the registered manager; discussion with people living, visiting and working at the home; a tour of the premises; review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. During the course of the inspection people were asked their views on the service provided at the home. They commented: Staff very caring and friendly; The company is good , the food is quite good and We are very happy with the care provided here. 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: Following this inspection two immediate requirements were made regarding health and safety risks and needing urgent action. These were: A risk assessment must be completed in relation to unrestricted windows and any necessary action taken. This is to ensure that people are not put at risk of injury. All bed rails in use must be reviewed and any action taken. This is to reduce the risk of Care Homes for Older People Page 8 of 30 injury to people living at the home. A follow up visit has since been made to Merstone Hall and the home has addressed these requirements. Seven other requirements and four good practice recommendations were also made. Pre admission assessments must be completed fully before people move into the home. The Statement of Purpose should be updated to ensure that people are able to contact relevant external agencies should they wish to do so. Care records and assessments must contain sufficient guidance for staff. All records must be signed and dated. This is to ensure that staff are able to fully and safely meet peoples needs. People must be supported to engage in development and review of their care plans. Care plans must be legible. People living at the home should be consulted regarding the care they received. Action must be taken to ensure that razors are capped and stored safely. This is ensure that people living and working at the home are not put at risk of harm. There must be appropriate systems in place to monitor and review the effectiveness of care plans in meeting peoples needs. This is to ensure that people receive the care they require. The home should ensure that people are provided with opportunities to transfer into chairs to promote skin integrity in accordance with their personal preferences. All care documentation should be written in clear plain English so that anyone reading the file can easily understand what is written. People must be provided with appropriate support to meet their social and leisure needs. This is required to meet their social needs. Waterproof flooring must be provided within the laundry. This is required to reduce the risk of cross infection. Foot operated flip top bins should be provided in areas where people receive personal care, and bin liners should be used. 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. Care Homes for Older People Page 9 of 30 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 10 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 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed but the shortfall in relying on just professional assessments sometimes means that the person cannot be sure that the home can meet their needs. Evidence: The home has a Statement of Purpose which provides information on the services and facilities provided. This requires amendment to remove reference to the Healthcare Commission. This body merged with the Commission for Social Care Inspection in April 2009 to form the Care Quality Commission. We reviewed the pre-admission assessment of a recent admission for someone to the home. It was unclear where the information had been gathered from and who had completed the form, as the writing was not clear. It contained insufficient information for staff to be able to formulate a care plan from although the local borough and countys assessment form and care plan were also present, to help complete this Care Homes for Older People Page 12 of 30 Evidence: process. Two other care files viewed did contain fully completed pre admission documentation. Two surveys were received back from two healthcare professionals prior to the visit. They said that they thought the home always assessed people to ensure that accurate information was obtained and the right service was planned for individuals. Care Homes for Older People Page 13 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. Whilst care plans and assessments do reflect peoples needs, these could be improved to be more legible, detailed, person centred and drawn up together with each individual. Medications are generally well managed. Staff treated people with dignity and respect however some improvements could be made with regard to discussing care plans with individuals and ensuring people have the opportunity to move positions during the day, to ensure that their rights are upheld. Evidence: Four care plans were examined in detail during this inspection. Nutritional and pressure risk assessments had been completed. For some people food and fluid charts had been completed. The registered manager advised that staff shared the findings from these on handover. Charts had not been totalled. The home must ensure that there are appropriate systems in place to ensure that any decline in dietary intake is highlighted. The resulting care plan must be monitored to ensure that this meets the individuals needs and promotes their well being. Care Homes for Older People Page 14 of 30 Evidence: One persons nutritional care plan was seen to use a medical abbreviation for one of their needs and it was discussed that all care documentation should be recorded in clear plain English, so that it is easily understood by all reading it. Moving and handling assessments are completed on admission and reviewed. For one person the assessment stated that they required a hoist to transfer, but did not state which hoist or the size of sling. Records would benefit from increased information to ensure that staff can assist people safely. Five people were observed remaining within wheelchairs throughout the day. The home should ensure that people are provided with opportunities to transfer into chairs to promote skin integrity in accordance with their personal preferences. The cathether care plan for one person lacked detailed guidance regarding the expected fluid intake for this individual. Wound care plans had been maintained and reviewed regularly. These records were discussed with the Registered Manager, as where people had more than one wound the recording system did not easily enable monitoring of individual sites to measure the efficacy of the care plan. At present the MUST assessments are kept separately. The Registered Manager advised that they plan to integrate these within peoples care records. For some people work had been completed to develop their life history and further information regarding their views and preferences. These were person centred and provided clear guidance to staff on how to meet peoples personal care and social needs. Care records did not include any further evidence of people being involved in developing their plans of care. The hand writing in some care plans was difficult to read, therefore consideration should be given to the format of care records to enable residents participation. People had been assisted to meet their personal care needs. There were adequate supply of toiletries. In several rooms uncapped razors were found stored in a tumbler with toothbrushes. This practice poses a risk of injury to both staff and people living at the home. Action must be taken to ensure that razors are capped and stored safely. Care records evidenced that people receive support to access appropriate healthcare services, including the GP, District Nurses, Dentist, skin specialist and Speech and Care Homes for Older People Page 15 of 30 Evidence: Language Therapist. The two surveys received from healthcare professionals indicated that they felt the home always monitored, reviewed and sought advice to ensure that peoples health needs were met. Five surveys were received from people living at the home. They all said that the home always ensured that they received any medical care they needed. When asked if they received the care and support they needed, 1 said always, 3 said usually and 1 said sometimes. Medication records were properly kept indicating that residents receive prescribed medicines at the correct times and in correct amounts. Records showed that when a medicine is prescribed as having a variable dose (i.e. take 1-2 tablets) the amount given was well documented, meeting a previous good practice recommendation made in the last random report. Fridge temperatures were recorded and within the acceptable temperature range. Some medicines found stored in the fridge did not need to be and the home were advised to remove them and store elsewhere. The home had appropriate policies relating to palliative care and sought input from specialist nurses as appropriate. Within one care plan there was an Advanced care plan providing detailed information regarding persons wishes, however this had not been signed or dated. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements could be made to ensure that people are provided with appropriate opportunities to meet their social and leisure needs and that individuals dignity is respected. People are happy with the standard of food served and visitors to the home are made welcome at any time. Evidence: The home has a programme of social activities. This includes a range of musical entertainers and open house with another care home nearby. A local minister visits regularly. On the day of inspection people five people were sat in the dining room doing painting. These individuals were without support or assistance for a considerable part of the morning. Only one person was able to engage in this activity independently, leading to one person falling asleep and the remaining service users becoming disengaged. Christmas carols were played within communal areas. Within the lounge some people were sat watching the television with the sound muted and carols playing. The Care Homes for Older People Page 17 of 30 Evidence: registered provider explained that this was one persons preference. Consideration should be given to how the different parts of the large communal areas can be used for different activities, as the television and music playing at the same time may be disorientating for some people. During the inspection one member of care staff was observed moving somebody in their wheelchair before engaging with them, or explaining where they were going. Further care staff were observed engaging with people living at the home in a friendly and respectful manner. Those service users spoken with confirmed that they are treated with dignity. Relatives confirmed that they are pleased with the care provided and that there is good communication from the service. Both healthcare professionals who returned surveys felt that the home responded well to peoples individual diversity needs. One person spoken with provided positive feedback on the meals provided and confirmed that the service meets their specialist dietary needs. Five people living at the home returned surveys prior to the visit. When asked if they liked the meals at the home, 3 said sometimes and 2 said usually. People were seen to be assisted as needed with their lunch however some people had to wait as there were only 2 staff assisiting in the dining room. Care Homes for Older People Page 18 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. Complaints procedures make sure that residents, relatives and representatives concerns and complaints are listened to and acted upon. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm support the people living at the home. Evidence: There have been no complaints made to the Commission about the home since the last inspection. The complaints book was seen and clearly recorded any concerns received and the actions taken and outcomes of these. There is a written complaints procedure that is available to people and their families or representatives. All of the people spoken with and surveys show that they knew who to approach with concerns but were not all aware of how to make a formal complaint. All of the staff surveys and the staff spoken with showed that they knew how to support people how to make a complaint. A copy of the Safeguarding Adult policy is available in the office and staff room. Safeguarding training is given to all staff and most have completed updates within the last year. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an on going programme of refurbishment ensuring the home is clean and comfortable, however improvements could be made to ensure the environment remains safe and secure. Staff have a good knowledge of infection control management although improvements could be made to infection control practices to prevent further risks from cross infection. Evidence: There is an ongoing programme of decoration and maintenance throughout the home. Since the last inspection new carpets have been fitted to the lounge, new dining tables purchased and the kitchen has been refurbished. Several bedrooms have been redecorated and new beds provided. Work has also been undertaken within the garden. When asked if the home was always clean and fresh, of the 5 residents who returned surveys, 3 said always and 2 said usually. Radiators have been guarded and heavy furniture such as wardrobes fixed to the wall to reduce the risk of injury. Window openings have been restricted in most rooms. One room was found where this had not been fitted, and an immediate requirement Care Homes for Older People Page 20 of 30 Evidence: was left in relation to this. A further visit was completed, where it was found that this requirement had been fully complied with. There are two wet rooms in use. A further two bathrooms on the first floor and one bathroom on the second floor are to be refurbished. Handwashing facilities consisting of liquid soap, and paper towels are available in bathrooms, ensuites and the laundry. Open bins were in use. These should be replaced with foot operated flip top bins, with bin liners fitted. The home has dedicated laundry staff that are available throughout the week. The home has industrial washing machines and driers that meet disinfectant standards. Staff spoken with demonstrated a good knowledge regarding infection control. The laundry area should have surfaces that can be easily cleaned. This area should not be used for storage of other goods. Part of the waterproof flooring is cracked and a further area is carpeted. This must be replaced with non-porous flooring to reduce the risk of cross infection. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in this home are protected by robust recruitment practices and supported by a skilled and competent staff team. Evidence: We reviewed the duty rotas, which told us how many staff were on duty at any time. They showed us that there were adequate numbers on duty at the time of inspection. Five residents surveys returned, indicated that 4 people felt that staff were usually available when needed and 1 responded always. Staff surveys asked the question Are there enough staff to meet the individual needs of all the people who use the service?. One answered usually and one answered sometimes. We reviewed three staff recruitment files. All contained the required documentation and appropriate checks, including PIN, IDSA and Criminal Records Bureau checks, were sought before employment commenced. The training programme for all staff was on going and a structured induction programme was given to new staff. At the time of inspection 50 per cent of care staff held the level 2 NVQ award or above in care. Staff surveys indicated that they received relevant training that kept them up to date Care Homes for Older People Page 22 of 30 Evidence: and helped them understand the individual needs of people living at the home. Care Homes for Older People Page 23 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. People benefit from a stable management. They know that their views will be listened to and that their personal finances are well looked after. Overall, records indicate that the health and safety of people living, visiting and working in the home is well managed however some areas need to be more regularly reviewed and the home is responding to this. Evidence: Mr Janczewski is registered with the Care Quality Commission as manager of Merstone Hall. He has the qualifications and the experience to run the home well. Mr Janczewski is supported by the owners, Mr and Mrs Afghan and a team of experienced staff. People told us that they felt supported by the management team and that they could express any concerns that they had. The service has a business plan in place which is reviewed on a six monthly basis. Care Homes for Older People Page 24 of 30 Evidence: Surveys were issued to people living at the home, their relatives and visiting professionals. The outcome from these was reviewed and appropriate action taken. The home will keep money securely for those people who wish to do so. Records are maintained of all expenditure, supported by signatures and receipts. Finances were checked for two people and each tallied with the records kept. Many people living at the home use bedrails. During the inspection it was found that there was significant movement in three sets of bed rails and that in one persons room the bed rails did not match. Accident records included two incidents of peoples legs becoming entrapped in the bed rails. An immediate requirement was made stating that all bed rails must be reviewed and any action taken as necessary. The home has provided written confirmation of the actions taken in response to the immediate requirements made. A further visit was completed to the home and it was found that these requirements had been complied with. Accident records are maintained. These are audited every six months to identify any trends and the actions to be taken. Fire safety equipment has been maintained and tested as required. Fire drills have been completed each month and appropriate records maintained. The home has a fire risk assessment. The home is in the process of replacing those fire doors and seals that have become damaged. All staff have received fire safety training. A personal evaluation plan has been developed for each person living at the home. Lifting equipment had been tested in accordance with LOLER regulations. Care Homes for Older People Page 25 of 30 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 26 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 1 19 13 A risk assessment must be completed in relation to unrestricted windows and any necessary action taken. This is to ensure that people are not put at risk of injury. 18/12/2009 2 38 13 All bedrails in use must be reviewed and any action taken. This is to reduce the risk of injury to people living at the home. 24/12/2009 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 2 14 Pre admission assessments must be completed fully before people move into the home. This is to make sure that the home and the ndividual can be sure that they can meet their needs. 31/03/2010 2 7 15 People must be supported to 12/03/2010 engage in development and review of their care plans. Care plans must be legible. 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 People living at the home should be consulted regarding the care they received. 3 7 14 Care records and assessments must contain sufficient guidance for staff. All records must be signed and dated. This is to ensure that staff are able to fully and safely meet peoples needs. 4 8 13 Action must be taken to ensure that razors are capped and stored safely. This is ensure that people living and working at the home are not put at risk of harm. 5 8 15 There must be appropriate 12/03/2010 systems in place to monitor and review the effectiveness of care plans in meeting peoples needs. This is to ensure that people receive the care they require. 6 12 16 (2)[m] People must be provided with appropriate support to meet their social and leisure needs. 05/03/2010 12/03/2010 12/03/2010 Care Homes for Older People Page 28 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 required to meet their social needs. 7 26 13 Waterproof flooring must be provided within the laundry. This is required to reduce the risk of cross infection. 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 26/03/2010 1 1 The Statement of Purpose should be updated to ensure that people are able to contact relevant external agencies should they wish to do so. The home should ensure that people are provided with opportunities to transfer into chairs to promote skin integrity in accordance with their personal preferences. Medications should be stored according to the guidance given on each individual item. All care documentation should be written in clear plain English so that anyone reading the file can easily understand what is written. Foot operated flip top bins should be provided in areas where people receive personal care, and bin liners should be used. 2 8 3 4 9 9 5 26 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. 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