Care Home: Neilston

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What the care home does well Neilston offers a warm welcome to visitors and provides a homely and comfortable environment for people who live there. The home is clean and generally free from offensive odours. Staff treat people with kindness and patience and know what to do if they witness or suspect abuse. What has improved since the last inspection? The home has complied with most of the requirements and recommendations made at our last inspection. For example: The risk posed by a basement stairway has been assessed and reduced by fitting a lock If people do not have a criminal records check before they start working at the home, other appropriate checks are made. Alternative arrangements have been made about people`s finances to make sure they are not paid into the owner`s bank accounts. Care plans now include information about people`s personal histories. Medication recoridng has improved What the care home could do better: The home should be able to demonstrate clearly that it can meet people`s needs before they move in. This includes making sure staff have the right knowledge and experience. Care plans must provide consistent, clear and detailed information for carers about how day to day care is to be delivered in all areas. Particular attention must be paid to managing challenging behaviour and the risk of falls. The home should support people to exercise choice about what they eat. Where people lack the capacity to make decisions for themselves, this should be managed and recorded in accordance with current legislation and guidance A risk assessment is needed of stairways and the use of stair lifts. Workers who apply for a job at Neilston must provide full information about themselves before they are offered a job there. Staff breaks should be organised so that people can be supported and supervised at all times. A better quality assurance system is needed so that shortfalls in the service can be quickly identified an remedied by the Providers the owners must comply with regulation by reporting accidents and incidents to the Care Quality Commission. Key inspection report Care homes for older people Name: Address: Neilston 47 Woodway Road Teignmouth Devon TQ14 8QB     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: Graham Thomas     Date: 2 6 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 28 Information about the care home Name of care home: Address: Neilston 47 Woodway Road Teignmouth Devon TQ14 8QB 01626774221 01626879395 joy@neilston.info Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Bryant Wescott,Mrs Joy Wescott Name of registered manager (if applicable) Mrs Joy Wescott Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Neilston is registered to provide care for a maximum of twenty-two older people who may also have dementia. The proprietors and registered providers are Mrs Joy Wescott and Mr John Wescott who live on the premises. Mrs Wescott manages the home on a day-to-day basis and Mr Westcott takes responsibility for the maintenance of the house and garden. Neilston is situated on a hill in a quiet residential area of Teignmouth, and is approximately one mile from the town centre. It is a detached house with a substantial garden. Car parking is available on the road outside. There are 18 bedrooms single Care Homes for Older People Page 4 of 28 Over 65 0 22 22 0 3 0 0 4 2 0 0 9 Brief description of the care home rooms and two double bedrooms. All have en-suite facilities. Accommodation is situated on the ground, lower ground and first floors. There are stair lifts to the first and lower ground floors. Communal space comprises a large lounge and a separate dining room with an adjoining sun lounge, which leads to the rear garden. Written information is provided for people considering going to live at Neilston and those who are resident. A copy of the most recent inspection report is available. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Please note: This report is based on a sample of the evidence available during our inspection process. It does not provide a comprehensive risk assessment of the home. Registered persons are reminded that it is their responsibility to assess and manage risks in accordance with the Care Homes Regulations 2001 and other relevant legislation. Before our visit to the home, Mrs Wescott completed an Annual Quality Assurance Assessment. This provided minimal details about the home. We reviewed our own records including notifications sent to us and whether we had received any complaints. We sent surveys to people and received five from people using the service. During a visit to the home we toured the premises, spoke with two visiting relatives or friends. We case tracked three people using the service. This Care Homes for Older People Page 6 of 28 means that we looked in detail at their records, spoke with or observed them and discussed their needs with staff. We also spoke with other people using the service and observed a lunchtime meal. We also made observations in the lounge before the lunchtime meal. Records about staff and the running of the home were examined and we discussed these with Mrs Wescott. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The home should be able to demonstrate clearly that it can meet peoples needs before they move in. This includes making sure staff have the right knowledge and experience. Care plans must provide consistent, clear and detailed information for carers about how day to day care is to be delivered in all areas. Particular attention must be paid to managing challenging behaviour and the risk of falls. The home should support people to exercise choice about what they eat. Where people lack the capacity to make decisions for themselves, this should be managed and recorded in accordance with current legislation and guidance A risk assessment is needed of stairways and the use of stair lifts. Workers who apply for a job at Neilston must provide full information about themselves before they are offered a job there. Staff breaks should be organised so that people can be supported and supervised at all times. A better quality assurance system is needed so that shortfalls in the service can be quickly identified an remedied by the Providers the owners must comply with regulation by reporting accidents and incidents to the Care Quality Commission. Care Homes for Older People Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 3 and 6 The homes assessment of peoples needs before they move in is not sufficient to ensure that they can be met by the home. Evidence: We looked at the files of two people who had moved into the home since our last visit. It was not clear how the home had decided that it could meet one persons needs on the basis of a thorough assessment. The person had been diagnosed with schizophrenia and Korsakovs dementia. Their file contained a joint agency plan which was dated after the persons admission to the home. A brief statement of the persons needs was seen in the file as well as some risk assessments such as those for falls and moving and handling. However, there were no clear goals identified in the persons plan. The identified risks were not well linked to the plan to show how these would be managed on a day-to-day basis. When we spoke with staff and looked at training records it was clear that they had not received any specific training regarding Care Homes for Older People Page 11 of 28 Evidence: schizophrenia or Korsakovs dementia. The other persons file contained a basic tick list style assessment which had been made by the home before the person moved in. Other assessments had been made by the home including, for example, nutrition and hydration assessments, and risk assessments for falls and moving and handling. Some information was sparse. For example, the only entry under medical history was reference to the persons poor short term memory. It was not always clear in the plans how the assessed needs and risks should be or would be addressed. Mrs Wescott has told us that the home does not provide intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10 Care planning in the home is inconsistent and does not always provide enough detail for carers. The care support provided to people is good in some areas such as personal grooming but weaker in others such as managing challenging behaviour. Evidence: During our visit to the home, we spoke with two visitors. One told us that that the staff were kind and patient and that people always looked well-groomed. The other stated that the home always called the Doctor when this was required and that people were provided with plenty of drinks and encouraged keep up their fluid intake. We looked at the care being provided for three people. Each person had an individual file that contained assessments and care plans. The format of plans used by the home has changed but has not yet been applied consistently. Some plans contained information in more than one format and a variety of current and up to date information. Some of this information appeared contradictory. For example, in two plans we saw information that people had both a low and a high risk of falls. Mrs Care Homes for Older People Page 13 of 28 Evidence: Wescott told us that in one instance the persons falls risk assessment had changed following a fall. However, this was not easy to follow in the plan. Another file contained many reviews and daily notes dating from 2007 but had no clear statement of the persons needs or how to meet them. This plan did, however, contain a regularly reviewed dependency profile showing, for example, assessments of nutrition and mobility. In one plan we saw that the persons needs had been identified and some specific information had been provided for staff. The plan stated that person had swollen legs. There were specific instructions for staff about this issue and regular reviews of progress made in treatment. Other areas of the plan were less clear. For example, the plan clearly stated that the person wandered and had a high risk of falls. It was less clear about how this was to be managed on a day to day basis. The files we looked at contained details of medical appointments for routine and specific treatments by health professionals. Examples included monitoring and treatment by a consultant Psychiatrist, optical treatments and treatments by Community Nurses. During our visit to the home one person was visited by a Doctor and a Nurse also visited. We saw records of regular weight monitoring and reviews of peoples nutrition. A record of dietary intake kept for all people in the home contained only details of drinks and biscuits or cake eaten during the day. However, during our observations at lunch time we saw that staff were aware of individual dietary needs. One person who is a diabetic was reminded and encouraged to follow a suitable diet. The homes cook was also aware of this persons dietary needs. We saw that people were generally clean and well groomed with clean nails and hair. Apart from one bedroom there were no offensive odours in the home, suggesting a satisfactory level of continence care. Throughout the day we saw that people who sat in the lounge were left unsupervised. During these periods we saw people arguing and one person who was particularly challenging towards another. There appeared to be no clear strategy for managing this challenging behaviour. We looked at how people were supported to take their medication. We found that there was secure storage for all medicines including a refrigerator for medicines that need to be kept cool. The sample of records that we examined was up to date and in good order. We saw that staff followed an appropriate procedure when administering medication at lunch time. Care Homes for Older People Page 14 of 28 Evidence: During our visit we saw that staff were very respectful towards people living in the home and treated them with patience and kindness. We saw that staff knocked on peoples bedroom doors before entering and closed doors when providing intimate care. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15 The daily life and social activities at Neilston are adequately catered for at Neilston. Further improvements are needed in promoting peoples autonomy and choices. Evidence: During the day of our visit we saw various short activities going on including catching a ball and a quiz. The home maintains a records of activities and this showed similar short activities taking place regularly. Between these activities, people living in the home, most of whom were sitting in the lounge, were left without staff attention for long periods. During these times we saw some people, one in particular, becoming agitated and challenging towards others in the room. This created a tense, unpleasant atmosphere. On one occasion we heard a person commenting to another here we go again. This was in contrast to the cheerful and supportive interactions we saw at other times between staff and people living in the home. Mrs Wescott and staff told us about individual excursions from the home for walks and trips to the shops and the seaside for which Mrs Wescott uses her car. The home has a Care Homes for Older People Page 16 of 28 Evidence: minibus though this has not been in use for some time. Both visitors told us that they were offered a warm welcome in the home at any time and always offered refreshments. One person told us that they could also take a meal in the home if they wished. We looked at how peoples autonomy and choices were promoted in the home. Neilston provides accommodation for people with dementia whose ability to consent to different aspects of their care might be temporarily or permanently impaired. In our examination of records and discussion with the manager and staff, we did not find evidence that issues of mental capacity were being considered and assessed routinely. Since our last visit Mrs Wescott has withdrawn from involvement in peoples individual financial arrangements. Small amounts such as bills for hairdressing are paid by the home and peoples representatives are invoiced where appropriate. We observed a lunch time meal and spoke with kitchen staff about the meal arrangements. The homes dining room is formally arranged with people sitting individually or in small groups. We saw meals being served by staff. The meal comprised of fish, chips and peas followed by sponge and custard. We saw that people were offered an alternative when they did not want the meal on offer. It was not evident how people less able to communicate might make a choice or express their preferences. People appeared to enjoy their meals and we heard comments such as lovely and that was nice. Some people received help with eating their meal. The help they received was unrushed and patient. While providing this help, staff maintained eye contact with the people whom they were helping and spoke with them about what they were doing. Gentle encouragement was given where people were reluctant to eat. We saw one person receiving reminders and encouragement to follow a diet appropriate to their needs as a diabetic. We saw that menus were arranged monthly consisting of a variety of dishes. No alternatives were shown on the menus. However, the cook was aware of individual preferences and specific dietary needs. The cook told us that sometimes, dishes such as cauliflower cheese would be prepared in advance for tea time, when care staff would prepare the meal. Meals actually taken by individuals were recorded. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18 People can feel confident that their complaints and concerns will be treated seriously and addressed. Staff are sufficiently aware of how to report any abuse if witnessed or suspected. Evidence: People who were able to return our surveys told us that they knew who to speak with if they were unhappy and knew how to make a complaint. Neilston has a complaints procedure which we saw posted in the homes foyer. In practice, few of the people living at Neilston would be able to follow a formal complaints procedure. Relatives with whom we spoke told us that they would be confident that any complaints taken to Mrs Wescott would be dealt with appropriately. We looked at the homes complaints record. This showed that one complaint had been made to the home since our last visit and recorded how this had been dealt with by Mrs Wescott. No complaints have been received by the Commission about the home since we last visited. Staff training records showed that there was an ongoing training programme regarding safeguarding vulnerable adults from abuse. The two staff with whom we spoke were clear about what might constitute abuse and how they would report this. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19 and 26 Although improvements have been made to Neilston since our last visit, more attention is needed to assess an minimise risks associated with stairways and stair lifts Evidence: Neilston is situated close to the seaside town of Teignmouth and all its amenities. There is ample free car parking space on the public road outside the premises and some limited parking in the homes driveway. Internally the home has a complex layout. Individual accommodation is spread over ground and first floors and a lower ground floor. There are mezzanine levels between the floors. In addition there is a basement level which houses the laundry, food store and staff accommodation. The home is decorated in a traditional homely style and has light and airy communal areas. These include a lounge and dining room with adjoining sun lounge which leads to the garden. Substantial gardens are situated at the rear of the property. Outside areas were not in use during our visit due to the cold weather. Since our last visit some improvements had been made in accordance with our requirements and recommendations. For example, a risk assessment had been produced concerning access to the basement area and a keypad lock fitted to the Care Homes for Older People Page 19 of 28 Evidence: door. Doors to toilets had been painted in one colour to help people orientate themselves around the home. Risk assessments regarding communal areas and stairways had yet to be produced. We noted that the mobility needs of people using the service had markedly increased since our last visit. We also saw that people were left unsupervised for long periods and saw one person using the main stairway unaided. An immediate requirement was made for the registered person to produce a risk assessment for the use of stairways and chair lifts showing how the risks were to managed in the short and longer term. Mr Wescott is responsible for the maintenance and decoration of the premises, assisted by a maintenance worker. A generally good standard of maintenance was evident during our tour. We saw a record of ongoing maintenance with tasks planned and completed. During our tour of the premises we saw evidence of ongoing maintenance and decoration. Relatives with whom we spoke said that they always found the home clean and without any offensive odours. In five surveys returned to us all stated that the home was always or usually fresh and clean. This was largely confirmed in our tour of the home when we found all areas sufficiently clean and all but one room odour-free. We discussed this with Mrs Wescott who told us how this would be addressed. In the shared toilet and bathrooms we saw that liquid soap and paper towels were available to limit risks of cross infection. The laundry is situated in the basement, well away from all other living and food preparation areas. We saw staff using aprons and gloves when handling laundry. The washing machine has includes a sluicing facility. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30 The staff at Neilston work well with the people living there. However, some improvements are needed to recruitment and training. Evidence: In the surveys returned to us, people told us that staff and managers always treated people well. During our visit we saw that staff treated people with kindness and patience. For example, during our observations at lunch time, one person became anxious because they thought they had to pay for their meal and had no money. Staff offered repeated, calm reassurances to the person and eventually reduced their anxiety. We have also mentioned in this report the patient and unrushed help given by staff to one person who needed help with eating. During our visit we saw that there were sufficient staff on duty clean the home, prepare meals and provide short activities for people living in the home. This level of staffing was reflected in the homes rota. At one point we saw that all the staff were taking a break together. This left people unsupervised and unattended. We looked at the files of three staff, including those who had recently been recruited. In two files we saw that the staff had been recruited from abroad on student visas. In the files we saw evidence of UK criminal records checks , identity checks and Care Homes for Older People Page 21 of 28 Evidence: confirmation of student status. The third file also contained criminal records checks and evidence of two references. However, the persons employment history was not clear or complete and there was no medical declaration. These elements of recruitment are required by regulation and are important in protecting people using services from potentially unsuitable workers. We spoke with this person who confirmed that they had provided references, and had undergone checks. They also told us that they had undergone a formal interview. Since our last visit Mrs Wescott had produced a training matrix so that staff training could be more effectively monitored. This and other evidence seen in individual files showed that staff were receiving training in subjects relevant to their roles such as moving and handling, medicines administration and food hygiene and dementia. Nationally recognised standards were also being used for staff induction training. We also saw that there was an ongoing programme of training for National Vocational Qualifications (NVQ). During our visit we met an NVQ trainer who visited the home to meet with two staff who were about to start courses. The staff with whom we spoke were not familiar with the diagnosed conditions of one person who had recently been admitted to the home and had no experience or training regarding these conditions. One staff member told that they had received training in dementia but that, due to language difficulties, they had found this difficult to understand. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35, 37 and 38 The Registered Providers co-operate well with recommendations and requirements made by the Commission. However, a more comprehensive and proactive approach is needed to quality assurance to ensure sustained and ongoing improvements to the service. Evidence: Mr and Mrs Wescott have owned and managed Neilston for 18 years. Mrs Wescott is a nurse who was trained and qualified in the Philippines and she takes responsibility for he day-to-day running of the home. She holds the Registered Managers Award and is a qualified National Vocational Qualification training assessor. Mr Wescott takes reponsibility for the maintenance of the home and takes other responsibilities such as the organisation of menus. During our visit we saw some evidence of ongoing improvements. Maintenance issues are recorded and dealt with in a planned way. Shortfalls identified at our last Care Homes for Older People Page 23 of 28 Evidence: inspection visit had largely been addressed. Some efforts are made to ascertain the views of people using the service and their relatives through the use of surveys. However, evidence in this report regarding, for example, staff recruitment, and risk assessment show that whilst the providers are generally compliant with requirements and recommendations, monitoring of the quality of the service is not sufficiently comprehensive or proactive to ensure sustained and ongoing improvement. The finances of people living in the home are generally managed by their relatives or other advocates. Mrs Wescott told us that in accordance with a requirement made at our last visit, payments that were being made directly into the homes business account for one person living in the home had ceased and alternative arrangements made. We looked at health and safety issues in the home. We saw that staff training included health and safety topics such as food hygiene and infection control. Risk assessments had been produced for various individual and environmental risks. Some improvements had also been made to safety such as the keypad lock fitted to the basement door. We saw that staff observed good hygiene practice when handling laundry by using gloves and aprons. We also noted that hazardous substances were placed in a secure cupboard when not in use. However, as mentioned in the environment section of this report, an immediate requirement was made concerning the homes sairways and stair lifts. Records of accidents and incidents were seen. Not all of these had been reported to the Commission in accordance with regulation. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 13 Risk assessments must be produced which include communal areas such as stairways and passages. Partially met. Immediate requirement made This is to reduce the risk of injury to people living and working in the home Partially met. Immediate requirement made regarding stairways and stair lifts 15/06/2009 Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must 01/05/2010 ensure that a full employment history without gaps and a statement of mental and physical fitness is obtained before offering employment to applicants. This is to protect people using the service from potentially unsuitable staff 2 37 37 Accidents and incidents 01/05/2010 detrimental to the welfare of people living in the home must be reported to the Care Quality Commission in accordance with regulation. This is a legal requirement and enables potentially serious patterns to be identified 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 12 Care plans must provide 31/05/2010 consistent, clear and detailed information for carers about how day to day care is to be delivered in all areas. Particular attention must be paid to managing Care Homes for Older People Page 26 of 28 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 challenging behaviour and the risk of falls. This is to ensure carers are clear about what care people need and to imnimise risks to individuals. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The home should ensure that it has conducted a detailed assessment of peoples needs before they move into the home and can demonstrate how the home will meet the identified needs. The registered person should ensure that, where people lack capacity, any decision making process is conducted and recorded in accordance with the Mental Capacity Act and associated guidance. The registered person should ensure that people less able to communicate are able to exercise choice in relation to meals and mealtimes. The registered person should ensure that staff breaks are organised so that there are always staff available to supervise and attend to the needs of people using the service. The registered person should ensure that staff are sufficiently trained or experienced to meet the needs of people who move into the home. The registered person should implement a comprehensive and proactive quality assurance system to identify clearly where improvements are needed. 2 14 3 15 4 27 5 27 6 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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