Care Home: Norwood Green Care Home

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What the care home does well Prospective residents are fully assessed prior to admission to ensure the home is able to fully meet their needs. Service user plans were in place for each resident, and these had been personalised and recorded their needs and how these are to be met. Staff care for residents in a gentle and professional manner, and the privacy and dignity of each resident is a high priority at the home. Residents and their families are given the opportunity to discuss their wishes in respect of health deterioration and end of life care and this is recorded. Further work is being done in this area. The home has an open visiting policy and visiting is encouraged. Information regarding advocacy services is available. The food provision is good, offering variety and choice to include meeting the religious and cultural dietary needs of residents. The complaints procedure is on display and complaints are dealt with appropriately. Safeguarding Adults procedures are in place and are followed. The home is being well maintained, and there is evidence of ongoing redecoration and refurbishment. Procedures for infection control are in place and are followed, thus minimising risks. Although the home appeared appropriately staffed at the time of inspection, comment was received regarding staffing shortfalls especially at mealtimes, and the manager said that this would be addressed. The home has a training programme and are aware of the need to increase the numbers of care staff with NVQ level 2 in care, which has dropped below 50% due to staff changes. There is an induction programme in place for new staff. Recruitment processes are robust and protect residents. The home is being effectively managed and the management style promotes an atmosphere of openness and good communication. There are clear systems in place for quality assurance. Personal monies held on behalf of residents are being well managed and securely stored. Comments received included the following: `Friendliness, courtesy and care of residents.` `Good food, service and cleanliness. Staff nurses and care assistants are polite, caring and friendly.` `They give you regular showers. They are always polite.` `An environment that is welcoming, comfortable and safe.` `Personal faith and religious beliefs respected and promoted.` `The care and support both verbal and in action are both very good, with constant support.` `Care level is generally very good. Staff are approachable and helpful.` What has improved since the last inspection? The service user plans are being reviewed monthly and whenever a residents condition changes. Hot trollies have been purchased for all floors so that food is kept hot before it is served. What the care home could do better: Shortfalls were noted in medication management and this needs to be addressed without delay. Comment has been received regarding the home being short-staffed on occasion and especially at mealtimes, and this must be reviewed. Risk assessments for equipment and safe working practices had not been reviewed since 2006, so this needs to be done and thereafter kept up to date. Staff had not all received training and updates in aspects of health and safety, to include moving and handling, plus night time fire drills had not been carried out in line with current legislation. Comments received included the following: `Maybe increase the number of care assistants.` `Providing more training besides mandatory training.` `There are not enough nurses and carers to go around.` Inspecting for better lives Key inspection report Care homes for older people Name: Address: Norwood Green Care Home Tentelow Lane Southall Middlesex UB2 4JA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rekha Bhardwa     Date: 1 5 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Norwood Green Care Home Tentelow Lane Southall Middlesex UB2 4JA 02088138883 0208843092 norwood.green@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Four Seasons (No 7) Limited care home 92 Number of places (if applicable): Under 65 Over 65 0 0 28 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 64 64 0 The maximum number of service users who can be accommodated is: 92 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 - Code OP maximum number of places: 28 Dementia Code DE maximum number of places: 64 Mental Disorder, excluding learning disability or dementia - Code MD maximum number of places: 64 Date of last inspection Brief description of the care home Norwood Green is a large, attractive purpose built home, registered to provide nursing care for 92 residents. The home is divided into three units across three floors, namely Asquith House, Baldwin House and Churchill House. The ground and upper floors are connected by stairways and two passenger lifts, the latter of which facilitate disability access to each floor. Communal areas, the majority of which either overlook the Care Homes for Older People Page 4 of 29 Brief description of the care home common or an internal patio area, are well lit. The home has a large parking area to the front of the building and an attractive patio and enclosed garden area to the rear of the premises. There is a large park opposite the home. The ground floor (Asquith House) provides care within the category of old age. The first floor (Baldwin House) and the second floor (Churchill House) are registered to provide care for residents with mental disorder or dementia. All rooms are single occupancy, provide en suite facilities and are in excess of 10 square metres. Local public transport facilities are available within close proximity of the home. The fees range from £525 to £960 per week, dependent on assessed need. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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 home was undertaken on 17th September 2007. This was an unannounced inspection carried out as part of the regulatory process. A total of 28 hours was spent on the inspection process, and was carried out by 3 Inspectors, one of which was a Pharmacist Inspector. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Residents, staff and visitors on each floor were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents and staff have also been used to inform this report. It must be noted that it is not always possible to ascertain the views of residents living with the experience of dementia. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 29 The service user plans are being reviewed monthly and whenever a residents condition changes. Hot trollies have been purchased for all floors so that food is kept hot before it is served. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are assessed prior to admission to ensure the home are able to meet their needs. Evidence: Four Seasons have a comprehensive Care and Health Assessment Profile (CHAP) booklet that is completed as part of the pre-admission assessment. This provides a very clear picture of the prospective resident and their needs, plus the document is updated when the resident is admitted. Residents and their representatives are encouraged to visit the home prior to admission to help them ascertain if it is the right home for them. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the service user plans are well completed, thus providing good information of the care needs of each resident and how these are to be met. There is good input from healthcare professionals, thus ensuring residents health needs are being met. Shortfalls identified in medication management could place residents at risk. Staff care for residents in a gentle, caring and professional manner, respecting their privacy, dignity and individuality. End of life care needs are identified, with ongoing work taking place to further improve the gathering and recording of residents wishes, so these can be respected. Evidence: We viewed 7 service user plans. These had been well completed and provided a good picture of each residents needs and how they are to be met. There was evidence of involvement from residents and their representatives in most instances, with one to be followed up. Risk assessments for falls are in place. We noted that there had been several falls and we requested that the home carry out an audit of the falls, to identify any trends, and put an action plan in place to try and reduce the number of falls. Care Homes for Older People Page 12 of 29 Evidence: Documentation had been reviewed monthly and whenever there was a significant change in the residents condition. In one instance some of the care plans had been reviewed when a resident was actually in hospital, which was not appropriate. It is acknowledged that since the resident has returned to the home the documentation had again been reviewed and updated and the Unit Manager said that the shortfall would be addressed. There was evidence of robust auditing of some of the service user plans and where shortfalls had been identified, timescales for addressing these had been stated. We recommended that all the care plans be audited. Wound care documentation was viewed. This was comprehensive and provided a clear picture of each wound, the dressing regime to be followed, and a record of the progress of each wound, to include photographs taken with the consent of the resident or their representatives. Risk assessments for pressure sore development were in place. We noted one care plan for wound care needed to be updated to reflect a change in condition, however there was clear evidence of the wound being dressed appropriately. Assessments for nutritional status were in place and there was evidence of residents being referred to the GP and dietician where residents are identified as being at risk of malnutrition. Residents are weighed monthly, and this is increased to weekly where nutritional risks are identified. Moving and handling assessments are in place, and the equipment to be used for each manoevre had been identified. Continence assessments are in place. Where any needs are identified by assessments, care plans to meet these needs had been identified. There was evidence of input from healthcare professionals to include GP, psychiatrist, community psychiatric nurse, tissue viability nurse, dietician, speech and language therapist, optician and chiropodist. We inspected the handling of medication in all three units of the home. We looked at storage and the recording of receipts, administration and disposal of medication and audited several samples against the stock held. We looked at the controlled drugs and their storage and found all balances to be correct. On one floor money was also kept in the controlled drug cupboard. This is not permitted under the Misuse of Drugs Act. We noticed that record keeping was very good on one floor. All the medication we counted could be reconciled against signatures for administration. No omissions in records were noted. This means that residents were receiving their medication as prescribed. On the two other floors we noticed one instance when doxazosin was left in the monitored dosage system MDS but recorded as given. We also noticed omissions on the Medication Administration Charts MAR for several residents. We could assume if the dose was not in the MDS that it had been given but for liquid medicines we did not know. We counted 12 samples of medication in their original packs, and noticed that for 5 medicines there were discrepancies in the expected stock balance of one or two tablets. When there are too many tablets left we can only assume that the MAR is Care Homes for Older People Page 13 of 29 Evidence: being signed but the medicine not administered. We looked at the daily audit checks of the MAR and all were signed so nurses had not identified the gaps or the discrepancies. We noticed that warfarin was recorded correctly but we could not find the anticoagulant book or latest blood test although we did see the date when the blood sample was taken. We were therefore not able to cross check the current dose. We looked at the lancing devices for checking blood glucose and in one unit those for self testing were in use rather than the professional type. The former can cause the transmission of blood borne infections and are not recommended in a care home. There was good practice of identifying residents with similar names to reduce the risk of error. Care plans were comprehensive and we were able to to look at the monitoring of pain relief and the protocols for feeding by tube. There were records of visits of healthcare professionals. Dieticians regularly reviewed residents with swallowing difficulties and provided guidelines to aid nutrition. The GP regularly reviewed medication and we noted the good practice of signing and dating dosage changes. One particularly good practice we noted was the medicines information and risk assessments documented in the care plan for a potent new medicine for a resident. The medicine needed careful monitoring whilst the dose was being slowly adjusted to prevent toxicity developing. We looked at the storage of medication. One room was very hot although there was a portable air conditioning unit. The temperature was reading 30-32 degrees centigrade. Medicines need to be kept at room temperature of 25 degrees to maintain their potency. Fridges were all kept at the correct temperature although there were some omissions in readings for one floor. Overall therefore we were generally satisfied that medication was being handled safely in the home. We looked at the managers monthly audits and although fairly comprehensive they failed to identify lapses in audit trails. Further attention is needed in this area. The individual competencies carried out on one floor could also be extended throughout the home so that standards are uniformly raised and are consistent. Staff were seen caring for residents in a gentle and professional manner, respecting their privacy and dignity. Staff were seen being very patient and reassuring with residents who were cognitively impaired and expressing some anxieties. Some bedrooms had been personalised and residents and their relatives are encouraged to do so. Residents can have their own telephones if they so wish and can also receive calls on the home phone. Personal clothing viewed in the laundry was labelled and residents were dressed to reflect individuality and cultural preferences. The home has a diverse group of residents and employs staff who can communicate effectively with those who do not speak English as a first language. The CHAP includes a section for spirituality and end of life care, and this prompts the person carrying out the pre-admission assessment to consider and discuss this. If residents and their representatives do not yet wish to discuss this sensitive topic then Care Homes for Older People Page 14 of 29 Evidence: this is recorded. The Manager explained that this subject is now being discussed at the formal reviews with social services, with further training planned in this area. The home has input from the palliative care team at Meadow House Hospice and end of life care is planned for and well managed. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provision in the home is good and offers a wide range to meet the interests of the residents. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information about advocacy services is available, thus respecting residents rights to individual representation. The food provision at the home is good, offering variety and choice to meet personal and cultural preferences. Evidence: The home has 2 activities co-ordinators who work a total of 50 hours per week. There is an activities programme in place and we observed activities taking place on each floor during the inspection. Residents were enjoying themselves and staff were also initiating activities, especially on Baldwin House. It was clear that work has been done to integrate activities as part of the daily routine. There had been an outing to Brighton and another outing more locally had been planned. There was evidence of parties taking place to celebrate festivals and significant days in the calendar and a multi-faith calendar for July 2009 was seen on display in the home, listing all the festivals and special days in the month. There is an activities room but this is currently used as an office and it was explained that group activities take place in the communal Care Homes for Older People Page 16 of 29 Evidence: areas. For residents who do not wish to join in group activities there was a record of one to one activities taking place. Work is being progressed on individual life history records and a social diary is kept for each resident. The home has an open visiting policy and visiting is encouraged. Residents can receive visitors in their own rooms or in one of the communal areas, as they so wish. Visitors spoken with said that they are made welcome at the home. Information about advocacy services is on display in the home and contact details are available. The CHAP covers mental capacity and residents rights, ensuring that where the need for advocacy is identified this can be addressed. Bedrooms had been personalised to include religious symbols and pictures, and residents religious and cultural needs had been identified and were being met. Residents can have their own telephones, either mobile or landline. Personal clothing is individually labelled and residents were dressed to reflect individuality. We viewed the kitchen and it was clean and tidy. There was evidence of cleaning schedules being completed and of fridge and freezer temperatures being monitored twice daily. There was a good supply of fresh, dried, tinned and frozen foodstuffs. There is a 4 week menu that offers variety and choice and residents confirmed that they are asked what they would like to eat and this is recorded. Since the last inspection the home now has a hot trolley for each floor and meals are served up in the dining room, so that if residents change their mind as to their choice, or they want a small portion, this can be addressed immediately. We viewed part of the lunch time on one floor, and staff were available to assist residents with their meals in a gentle and discreet manner. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has clear procedures for managing complaints and for the reporting of any safeguarding issues, and these are followed, thus protecting residents. Evidence: The home has a clear complaints procedure and this is on display in the home. Complaints documentation is comprehensive and complaints are investigated and responded to. Some of the complaints documentation for complaints received prior to the current Manager coming into post needed to be filed and this was to be addressed. The home has procedures in place for adult protection and also follows the Ealing Safeguarding Adults protocols. Staff spoken with were clear to report any concerns and understood Whistle Blowing procedures. There were 2 incidents that were discussed at the time of inspection, one of which had been appropriately reported and one that required some further investigation by the home to ascertain if there were any elements of safeguarding to be reported. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained, providing a bright, clean and homely environment for residents to live in. Infection control procedures are in place and are followed, thus protecting residents, staff and visitors. Evidence: We carried out a tour of the home. There is evidence of redecoration and refurbishment in several areas and the home is being maintained to a good standard. 2 of the shower rooms were out of order, however this had been identified to the maintenance man who was progressing work to rectify the problems. A new fire alarm system has been installed since the last inspection and no fire safety issues were identified at the time of the inspection. Air conditioning has been installed in the corridors throughout the home and this has made a big improvement to the temperature control throughout. The home has a courtyard area for residents to sit out in and garden furniture was available. The area is being maintained, however more work could be done to ensure the flower beds are kept in good order. We viewed the laundry and the area was clean and tidy. Since the last inspection 2 new washing machines and 1 new tumble dryer have been installed. The laundry lady explained that the washing machines are much more efficient and feels that the allocated laundry hours of 7am to 3pm are appropriate to get all the laundry Care Homes for Older People Page 19 of 29 Evidence: completed. There are infection control instructions on display. For any residents with an infection, care plans and protocols for the effective management of infections were in place. We did note some malodour in the reception area of one floor, and action was taken to address this. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately staff to ensure the needs of the residents and home in general can be met. Systems for vetting and recruitment are in place, thus protecting the residents. The staff are appropriately trained, thus they have the skills and knowledge to care for residents effectively. Evidence: At the time of inspection the home was being staffed to meet the needs of the residents. We did discuss ensuring that the staffing on all floors is constantly kept under review in line with resident dependency and the Manager said that he does do this. Comment was received that there are not always enough staff to ensure residents receive assistance with meals without delay, and work needs to be done to ensure that staff are available to assist all those who need it. This was discussed with the Manager who said that the mealtime regime and staffing would be reviewed to address this. Staff spoken with said that the Manager is approachable and listens to what they have to say. The staffing levels on each unit was appropriate to meet the needs of the residents. We discussed the need to ensure that staffing is kept under review in line with the residents dependency levels. The home employs administration, catering, domestic, Care Homes for Older People Page 21 of 29 Evidence: activities and maintenance staff so that all the needs of the residents and the home in general can be met. The AQAA identified that the home has less than 50 of care staff trained to NVQ level 2 or above. The Manager said that further NVQ in care training is being planned. We viewed 3 sets of staff employment records. In one instance only one reference was available. For another member of staff there was no health declaration or photograph. Otherwise the records contained the information required under Schedule 2 of the Care Homes Regulations 2001. The shortfalls had been addressed by the second day of inspection. The home has an induction programme that includes the Skills for Care common induction standards. The home also undertakes a three day induction whereby the new member of staff works in a supernumerary capacity. We did receive some comments that the induction process needs to be further enhanced. Shortfalls in health & safety training have been commented on under Standard 38. A training programme is in place, along with a training matrix, which evidenced the training undertaken by each member of staff. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements in place for the home are good and ensure that the home is being managed effectively. There are systems in place for quality assurance, and these are followed, providing a process of ongoing review. Monies are well managed on behalf of residents, and securely stored, thus protecting residents interests. There are very good systems in place for the management of health and safety, thus protecting residents, staff and visitors. Evidence: The Manager has worked in the care field for 18 years. He has been a care home manager for 10 years. He has completed the Registered Managers Award. Staff spoken with said that the Manager is approachable and listens to what they have to say, and will take action to address issues raised. He also visits each floor at intervals throughout the day and has a hands on approach. The Deputy Manager is a registered nurse and is the Clinical Nurse Lead for the home. Care Homes for Older People Page 23 of 29 Evidence: Four Seasons has in place a comprehensive system for quality assurance, and this ensures that all areas of the home are audited and any shortfalls identified are addressed. Audits include wound care, medication, service user plans and health & safety and are carried out regularly. The home also carries out a weekly risk monitoring report which details key areas of the home and any issues in these areas. Regulation 26 unannounced visits on behalf of the Registered Provider are carried out and copies of the report are available to view. Results collated from customer satisfaction surveys are displayed throughout the home. Clear computerised records are maintained for all monies being held on behalf of residents. A sample of residents records were viewed and these were up to date and recorded all income and expenditure. Receipts for all income and expenditure are kept. Interest is allocated to each residents account on a monthly basis. Monies are securely stored. Maintenance and servicing records were sampled and those viewed were up to date. The fire risk assessment had last been completed in June 2009 and an action plan with timescales for completion had been drawn up to address any shortfalls identified, which the maintenance man was working through. Records evidenced that regular fire drills are carried out for day staff, however night drills had not always been completed within the required intervals. Risk assessments for equipment and safe working practices were in place, but they had not been updated since 2006. Staff training records showed that not all staff were up to date with health and safety training, to include moving and handling. The shortfalls were discussed with the manager who said action would be taken to address them. No health and safety issues were identified during the tour of each floor. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 9 13 That procedures for handling 01/08/2009 anticoagulants are reviewed so that there is timely and easy access to the latest blood test and dosage change for warfarin. This is to prevent the risk of error. That the MAR are signed after medicines are administered or the appropriate endorsement used if the medicine is not administered. This is so that we know why medication is not being given and have evidence of accurate administration. 01/08/2009 2 9 13 3 9 13 That medication audits are 01/08/2009 expanded so that there is evidence of the checks carried out , the findings and the action taken. Care Homes for Older People Page 26 of 29 This is to ensure the safe handling and storage of medication and medical devices 4 38 18 For all staff to undertake training in health and safety topics at the required intervals. So that staff are competent and their knowledge and skills are up to date. 5 38 13 That the risk assessments for equipment and safe working practices are reviewed annually and whenever there is a significant change in the home. So that the information is up to date and accurate and action can be taken to minimise any risks identified. 6 38 23 That fire drills for night staff are carried out at the required intervals according to current legislation and good practice. To ensure that all staff are competent in fire drill procedures. 01/09/2009 01/09/2009 01/09/2009 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 7 That the care plans on Churchill floor be audited and action Page 27 of 29 Care Homes for Older People taken to address any shortfalls identified within a set timescale. 2 3 7 19 That an audit of falls be carried out so that any trends can be identified and action taken to reduce the risk of falls. More work could be done to maintain the flower beds in the courtyard area so that the environment is attractive to sit out in. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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