Care Home: Newford Nursing Home

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What the care home does well Pre admission procedures are good. Adequate information is available to ensure people can make a judgment about the suitability of the home for them. Comprehensive assessments are carried out prior to admission and these are reflected in care plans established to meet peoples needs. People are always invited to visit the home prior to admission and multi-disciplinary assessments also obtained. There is continuity of care provided by a fairly static and committed staff group. Many have worked for several years in the home. This includes long-serving Managers also. The atmosphere is always relaxed, people speak positively about the home and staff morale and commitment is high. There is a good standard environment that is well maintained. All rooms are for single use and have en-suite facilities. Improvements to the environment are ongoing and provide a comfortable, relaxed homely place to live. Hygiene standards are high. The social and recreational needs of people are met. Two Activities Co-ordinators lead on activities and provide with other staff, a range of individual and small group activities to meet the needs of all people using the service. What has improved since the last inspection? Improvements and ongoing redecoration of both the communal and bedroom areas has continued. Presently the 4 small lounge areas are being redecorated and refitted to provide "themed" areas to provide alternative choices for people. The presentation of the home is good and to a high standard. DNAR (Do Not Attempt Resuscitation) elections are now all completed on the forms required by the PCT to ensure they will be appropriately actioned. A protocol has now been provided by the prescriber for the use of rectal diazepam. This gives clear instructions to staff in the event of seizure and will ensure the wellbeing of the person. An omission in the recruitment procedures has been rectified. All applicants for employment now sign a declaration about criminal convictions. Reports of monthly visits (Regulation 26) by the providers representative are now available in the home. All staff have recently undertaken training in first aid. Equality and diversity principles have been incorporated into the Company`s formats, including pre admission, care planning, staff recruitment and other areas of operation. This has been endorsed by staff training. What the care home could do better: Daily fluid intake charts must be completed accurately and must be reviewed by the nurse on duty. People on fluid intake charts must be offered/given drinks throughout the 24 hour period. None of the 5 fluid intake charts seen showed that drinks had been offered between 7pm and 8 or 9 am the following day. This must be urgently addressed to ensure people have sufficient intake to sustain their health and well being. Allegations of abuse must be referred immediately to the Social Care and Health Safeguarding Team and not investigated by the home. It is important that safeguarding procedures are always followed and take precedence over complaints. The home must be able to distinguish between safeguarding issues and complaints. Risk assessments must always be reviewed following falls. This is to ensure that risks to people are reduced or eliminated and are also known to all staff. Key inspection report Care homes for older people Name: Address: Newford Nursing Home Newford Crescent Milton Stoke-on-trent Staffordshire ST2 7EQ     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: Peter Dawson     Date: 0 7 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Newford Nursing Home Newford Crescent Milton Stoke-on-trent Staffordshire ST2 7EQ 01782545547 01782536364 newford@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Newford Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 40 Physical Disability (PD) 40 Date of last inspection Brief description of the care home Newford Nursing Home is registered to provide nursing care for up to forty older people. Of the 40 registered beds up to eight can be used for younger people aged between 30 and 60 years on admission who have a physical disability - there are no people currently in this category. The home also provides day care facilities for up to six older persons although younger adults with a physical disability can access two of the day care places. Day care is not provided at this time. The home is a purpose built single storey building situated approximately half a mile from the village of Milton. Care Homes for Older People Page 4 of 28 1 2 1 2 2 0 0 8 0 40 Over 65 40 0 Brief description of the care home All of the bedrooms are single rooms with an adapted en-suite consisting of toilet and wash hand basin. There are three assisted bathrooms, one has a `step-in bath and one `walk-in shower and there is one unassisted bathroom. There are five small lounges, a dining room with bar and a conservatory. There is a central kitchen and laundry facilities. The home is located within close walking distance of bus and road networks. There are parking facilities close to the main entrance. The fees charged by this home range from 516.00 to 528.00 pounds, with additional charges for hairdressing, toiletries, aromatherapy and taxis. 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: The last key inspection of this service was completed on 12th December 2008. The AQAA (Annual Quality Assurance Assessment) was requested and returned to us by the required date. This is an annual self-assessment carried out by providers of a service to quantify the outcomes for people using the service. Some information from the AQAA is included in this report. This unannounced key inspection was carried out on two days. On the first day by 2 inspectors from 8.30am - 6.30 pm and on the second day by one inspector lasting 2 hours. The Registered Manager was on duty on both days and we were able to obtain all the information we needed. A verbal feedback summary of the findings of the inspection were given to the Manager on both days. Care Homes for Older People Page 6 of 28 There was a relaxed atmosphere in the home, allowing open discussion with the people living there, visitors and staff. The majority of people were seen and many spoken with during the inspection. We also spoke with visiting relatives. All were positive about the care provided and the support given to them by staff. Staff spoken with were helpful and open and demonstrated detailed knowledge of the individual care needs of people. They confirmed that their training needs were met and they had the necessary support in their work. We inspected the communal areas of the home and a sample of bedrooms, confirming that environmental standards including hygiene were high. We inspected a range of records relating to the inspection process. These included care plans, risk assessments, staffing records, accident records, medication records and other documents as needed. Following a Safeguarding Strategy meeting we were asked to carry out an investigation of an incident referred under Safeguarding procedures. We spent considerable time looking at all relevant documents. We had discussions with the Manager and fed the results back to the Manager at the end of the inspection. We have made 2 requirements in this report as a result of our findings. We found that a requirement made at the time of the last Key inspection on 12th December 2008 had not been met. This related to ensuring that people had sufficient daily fluid intake to sustain their wellbeing. A further recommendation is made relating this. 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: Daily fluid intake charts must be completed accurately and must be reviewed by the nurse on duty. People on fluid intake charts must be offered/given drinks throughout Care Homes for Older People Page 8 of 28 the 24 hour period. None of the 5 fluid intake charts seen showed that drinks had been offered between 7pm and 8 or 9 am the following day. This must be urgently addressed to ensure people have sufficient intake to sustain their health and well being. Allegations of abuse must be referred immediately to the Social Care and Health Safeguarding Team and not investigated by the home. It is important that safeguarding procedures are always followed and take precedence over complaints. The home must be able to distinguish between safeguarding issues and complaints. Risk assessments must always be reviewed following falls. This is to ensure that risks to people are reduced or eliminated and are also known to all staff. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission procedures are good and ensure people are able to make an informed decision about the suitability of the home for them. Evidence: There is a Statement of Purpose/Service Users Guide readily available in the home for visitors. This contains detailed information enabling people to make a decision about suitability of the service for them. The range of fees are included in this information. People are not admitted to the home until a full needs assessment has been undertaken and assessments completed. This includes an assessment by the sponsoring local authority. These actions ensure that people needs are known and can be met. Contracts are provided by the local authority for people who are funded and a similar contract provided by the home for those purchasing their own care. Care Homes for Older People Page 11 of 28 Evidence: It is the homes preferred option that people visit and spend time in the home when considering possible admission to enable them to make an informed decision. Relatives are always involved in these procedures and negotiations. There is conflicting information in the statement of purpose about charges for toiletries. A figure of £12 per month is stated but other information states that basic toiletries are included in the fees. This should be clarified/removed. There is also a telephone number for Adult Protection that is incorrect and this should be amended. 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. Individual health care needs are assessed but some aspects of poor practice mean that people do not always have the care they need to sustain their health and wellbeing. Evidence: A sample of care plans were seen. There was comprehensive information based upon assessment of need, defining the actions required to support health and personal care needs. Information included risk assessments and we found that information had been reviewed on a monthly basis with some detailed and informative information. We looked at the care plans of people with pressure damage. Nutritional and Waterlow assessments were in place identifying those at risk of pressure sores. Pressure relieving equipment was in place for people at risk and recording of wound care for those with pressure ulcers was good including body maps, photographs, measurement and grading of wounds, treatment regimes and ongoing evaluation of wound care progress. We found that there had been appropriate referrals to tissue viability specialists in managing pressure wounds. Care Homes for Older People Page 13 of 28 Evidence: At the time of the last inspection we found that where food and fluid intake charts had been established the recording of fluids was poor, indicating that people may not have received the minimum daily amount of fluid for their wellbeing. A requirement was made to ensure charts accurately reflected the level of intake necessary to sustain the pesons wellbeing. On this inspection we found that 5 people were on food and fluid intake charts. We found in relation to 4 people that there was inadequate recording of the daily intake of fluids relating to the two weeks prior to this inspection. Examples were seen of daily low intake of fluids. Some had prescribed nutritional drinks. More concerning was the fact that all of them, without exception, had not been offered or given drinks throughout the night. The last drink being around 7pm and nothing further until 8 or 9 am the next morning. We looked at the care plans of the 4 people mentioned above. Plans contained nutritional assessments and reviews and all stated that the aim was to ensure adequate diet and fluid intake to maintain weight and hydration. We found that these people had been given adequate food and there was no evidence of significant weight loss. Nevertheless the recorded fluid intake for all was poor. Some of these people had pressure damage, others were at risk of damage and daily intake of food and fluids is vital to good tissue viability care. Daily notes completed for each person contained statements such as good diet and fluids or appears settled, all care maintained with no reference to the poor recorded intake. Fluid intake charts must be completed correctly in order to maintain a record and demonstrate that people are receiving enough fluid. The AQAA stated Food and fluid intake are reviewed daily by the nurse in charge but this is clearly not happening. Some of these people were prescribed food and nutritional supplements. We looked at MAR (Medication Administration Records) sheets and found that these had been administered as prescribed and there were no omissions seen. We inspected the medication system in use in the home and found that the receipt, storage, administration and disposals of medicines were accurately recorded and there were no omissions. We did see a syringe containing liquid medication (without needle) and tablets in a pot in a persons room. The person was not present and has a propensity to wander throughout the day in the home. Nevertheless it is important to Care Homes for Older People Page 14 of 28 Evidence: ensure that medication is closely monitored and safely stored at all times. People with pressure damage or at risk of damage were on appropriate pressure relieving mattresses and are additionally turned regularly in bed to ensure good skin integrity. Charts are provided to record turns. In one chart we saw the person had not had her position changed since 5am (it was then 10am) - 5 hours is too long even though she is on an alternating pressure relieving mattress. On the previous day the chart showed that she was left from 1.30 - 8.30 without being moved. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples chosen lifestyles are known and met and a range of activities provided to meet their social needs. Evidence: We saw evidence of choice and chosen lifestyles. The majority of people have breakfast served in their bedrooms, there is no pressure to rise early. Mornings are a very busy time. Many people with high dependency needs requiring assistance with all personal care, eating and mobility, but there was nevertheless a relaxed atmosphere and we observed good, sensitive and supportive interactions with staff. There were clearly positive and well established relationships and engagement between people using the service and staff. One person who has memory loss but able to wander safely and freely in the home was supported in a very positive way. Staff dealt very sensitively and respectfully with her repetitive behaviour throughout the day. She was reassured and diverted when she became distressed. Activities in the home are good. There are two activities workers working a total of 20 hours per week - increased from 16 at the time of the last inspection. Recent Care Homes for Older People Page 16 of 28 Evidence: photographs in the reception area showed people involved in activities, clearly enjoying the experience. Activities are recorded individually for people and the needs of the more dependent people who need individual inputs are met. This was confirmed in discussions with people using the service and visitors seen. The home have their own cat and have just adopted a rabbit and 3 guinea pigs. People have been involved in the introductions and care and enjoy the interest this generates. There are 4 smaller lounges in the home and these are presently being redecorated and equipped to provide themed rooms to include: Reminiscence, Music, Cinema and relocation of Sensory Room. We saw and spoke with visitors who gave positive comments about the home. A person whose wife has dementia told us that he is satisfied with the home and the care provided. He said that he had had little concerns that the Manager had sorted out quickly. People using the service were positive about their experiences at Newford. One person being cared for in bed said that the care is good, the staff are good and that she has no concerns about the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential abuse must be referred immediately to the Safeguarding Team and not investigated by the home. This will ensure people are adequately protected from potential harm. Evidence: The complaints procedure is readily available in the home for people using the service and visitors. A referral under Safeguarding Procedures was recently made by relatives of a person who fell from her wheelchair and sustained a head injury. A multi-disciplinary strategy meeting was arranged under the Safeguarding Procedures. The meeting were unhappy with the way the incident had been handled by the home and felt that medical assistance should have been sought when the person was found on the floor. We were asked to further investigate and raise the issues with the home. This was an integral part of this inspection. We looked at all the records relating to this incident and discuss the details with the Manager. We found that this matter had been incorrectly investigated by the home as a complaint and had not referred the matter under safeguarding procedures as required. Concerns expressed by the family were not handled well by the home. The person had a head injury and there was no referral to paramedics or doctor for 2 days. Nurses made a judgment that this was not necessary. The person had a Care Homes for Older People Page 18 of 28 Evidence: previous fall from a wheelchair in similar circumstances and the risk assessment was not reviewed at that time and she had been therefore been considered to be at low risk of falls from her wheelchair. Two requirements are made relating to this incident and included in this report: All incidents reported as suspicious must be referred immediately to the Safeguarding Team. Safeguarding procedures must be followed at all times and the home must not carry out their own investigation. Risk assessments must be reviewed following falls. We expect the service to implement these requirements immediately. Staff have all had training in Safeguarding Vulnerable Adults and procedures should be clear to all. If this is not the case further training for senior staff may be indicated. There is no policy and procedure in place relating to first-aid and this should be provided. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A well maintained high standard environment providing a safe, comfortable place to live. Evidence: The environment is well maintained. The home employ 2 people each working 11 hours per week to provide ongoing maintenance and also carry out some redecoration. The presentation of the home is good both internally and externally. Redecoration and replacements are ongoing. At the time of this inspection contractors were in the process of redecorating all the corridor areas and also the 4 smaller lounge areas. These are being re provisioned to provide themed areas and include: Reminsicence room, music room sensory room and cinema room. This is part of the ongoing work in providing a varied range of activities for people using the service. A recommendation of the last report to repair or replace rear exit wooden doors has been acted upon. New Upvc doors have been fitted with improved presentation and temperature control in that part of the home. We saw a sample of bedrooms that were well furnished, comfortable and clean. Many were personalised to reflect the individuality of people. Care Homes for Older People Page 20 of 28 Evidence: All parts of the home were clean , comfortable and homely and presented a relaxed place in which to live. Infection control and odour management is good with good cleaning routines in place and high standards of cleanliness throughout. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust staff recruitment procedures and staff training ensure people are protected and staff have the skills to meet their needs. Evidence: We looked at a sample of 3 staff files employed since the last key inspection. We found that all references and checks had been undertaken and were satisfactory prior to employment. They had all signed declarations prior to employment in relation to criminal offences. There were full employment histories and references from last employer. Good induction procedures were in place and staff spoken with confirmed that they had had good induction training and support. We looked at the training records for several staff and found that all statutory and other professional and person specific training had been undertaken. Staff have the skills to meet the needs of people using the service and this was confirmed in discussion with staff and from observations and records seen. Care staff are given opportunity for NVQ training and the number of staff trained exceeds the required minimum of 50 of care staff. The minimum staffing levels agreed are 9:5:4 over the 3 staff shifts of the 24 hour period. 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. The management of some areas of operation could be improved to ensure peoples health, welfare and safety are protected. Evidence: The Registered Manager and Deputy Manager have worked at the home for many years. Both have obtained the Registered Managers Award and continue to update their professional training to keep abreast with new developments in care. The home has benfited from consistent care over a period of years. There is an open and relaxed atmosphere, visitors are warmly welcomed and there is a very positive dialogue between staff and people using the service. We observed a sensitive and caring approach to people, staff supporting people well and going only at the persons pace. Visitors said that they felt that staff were approachable and kept them informed of any changes in a persons condition. The AQAA states that the views of people are sought by Lobbying for views through Care Homes for Older People Page 23 of 28 Evidence: our complaints procedure, results of quality surveys and open door policies, including one to one discussions with relatives and service users are supported to complete user friendly questionnaires Further changes proposed include Introducing a relative support group and nominate a chair to support advocacy and greater access to the community. Introduce regular residents meetings to allow people direct opportunity to participate and share opinions and introduce more pictorial reference to support complaints and choice. The Registered Manager still does not have time allowed supernumerary for management issues and checks and audits in the home. She continues to carry out her management function whilst employed constantly as one of the nurses on duty on the rota. Some supernumerary time would assist in reviewing practice, procedures and outcomes in the home. This has been raised in previous reports and is a matter for the owners to address. There are management implications in relation to safeguarding, recording of fluids and review of risk assessments mentioned in this report. We expect these matters to be addressed swiftly and appropriately. We were not able to check management visits on behalf of the provider (Regulation 26) on this visit, although we were told that regular monthly visits and support is available and reports available in the home. It was also clear that the home had referred and sought advice from the providers in relation to the Safeguarding issues. The Fire Officer visited in April this year and made 3 requirements relating to Fire Safety. We were told that all requirements have been addressed. We understand that the providers have been in contact with the Fire Officer about these issues and we will ask the Fire Officer to check that outcomes are satisfactory. In relation to safety in the home, we observed that people were always transported in wheelchairs with the footplates attached and the previous poor practice of not securing footplates has ceased. The only issue related to safety arising from this visit was that a risk assessments had not been reviewed following a fall. Where risks are identified steps must be taken to reduce or eliminate those risks. A requirement is made in relation to this. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 18 13 Allegations of abuse must be 14/10/2009 referred immediately to the Safeguarding Team and not investigated by the home. Safeguarding procedures must always be followed. This will ensure that people are protected at all times from potential abuse. 2 38 13 Risk assessments but be reviewed following falls. This will ensure that risks to people are reduced or eliminated. 14/10/2009 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 8 People at risk of pressure damage should be regularly turned in bed as stated in their care plan. This must be carried out and recorded at the prescribed intervals. This will reduce the risk of pressure ulcers. Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 8 Fluid intake charts must be completed daily and reviewed by the nurse on duty. This will evidence that people have the required daily intake to sustain their health and wellbeing. 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. 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. 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