Care Home: Oak Bank Care Home

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What the care home does well Staff were observed to be kind and attentive to the people living at the home. Positive comments were received from staff, a relative and from people living at the home about the care given. One visitor said `the home is excellent and I have no complaints`. One lady living at the home said `the staff are very nice and very kind`. When asked she said that she can make choices about what time she goes to bed, what time she gets up and where she sits during the day. The staff spoken to confirmed that this was the case. The visitor spoken to said that he was able to visit whenever he liked and staff always made him feel welcome. All staff spoken to said that they make visitor`s feel welcome and they encourage people to visit whenever they want. People have an assessment of their needs before being admitted to the home to make sure that all of their needs can be met and people are encouraged to come and visit the home before making a decision to move in. Most people spoken to were complementary about the food provided. A total refurbishment of the home is currently being undertaken to provide a more comfortable and safe environment for the people living there. What has improved since the last inspection? This was the first key inspection since the service has been registered with the providers Unity Homes Limited. What the care home could do better: To ensure that people are not put at any unnecessary risk the risk assessment for the use of bed rails must be reviewed and updated to include a measuring too to reduce the risk of entrapment. To ensure that all peoples assessed needs can be fully met it is recommended that the pre admission assessment document is reviewed and updated to include a more detailed assessment . It is recommended that a specific oral hygiene assessment is undertaken when people are admitted to the home to make sure that this care need is fully assessed and met. It is recommended that people`s wishes in respect to active/none active treatment, resuscitation and arrangements for after death are clearly recorded to ensure that people`s wishes are respected. To ensure that people are receiving medication as prescribed by the GP medications should be accounted for at all times by means of an audit trail and to ensure that people receive medication as intended the GP`s instructions should be clearly recorded. To ensure a fair and consistent interview it is recommended that a set interview format is used and notes are taken during the interview process. Key inspection report Care homes for older people Name: Address: Oak Bank Care Home Oak Bank Manchester Lancs M9 5YA     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: Geraldine Blow     Date: 0 3 0 8 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: Oak Bank Care Home Oak Bank Manchester Lancs M9 5YA 01612058848 01612057797 msandher@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Unity Homes Limited Name of registered manager (if applicable) Sarita Labhwantee Chohan Type of registration: Number of places registered: care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Oak Bank Care Home is registered to provide accommodation for up to 64 older people. The home has recently been taken over by Unity Homes Limited. The home is located in the Harpurhey area of Manchester. Local shops and amenities are within easy walking distance of the home. There is a well-maintained garden area to the rear and side of the property. The back of the property provides a patio area. There are ample parking facilities at the front of the property. At present a total refurbishment is being undertaken of the home. Care Homes for Older People Page 4 of 28 Over 65 63 1 0 1 Brief description of the care home The charges for fees range from £382.93 to £550.00 per week. There are additional charges for magazines, papers and hairdressing. 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: This report is the first key inspection report since the new providers, Unity Homes Limited, have taken over the home in January 2009. This report is based on information gathered by the CQC during the unannounced visit on the 4 August 2009 and supporting information received in the Annual Quality Assurance Assessment (AQAA) submitted by the manager prior to this visit. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This visit was unannounced, which means that the manger and staff were not told that we would be visiting. The visit took place on Monday 3 August 2009. This report is an overview of what the inspector found during the visit. References to we or us in this report represent the CQC. Care Homes for Older People Page 6 of 28 Staff and some people living at the home were sent comment cards so that we could get their views on how the home is run. We did not receive any completed comment cards from staff or people living at the home. As part of the visit we spent time examining relevant documents and files. We also spent time talking with several people living at the home, some members of staff and a visitor to the home. We also walked round the home and looked at the ongoing refurbishment, the communal areas and some bedrooms. Feedback was given to the manager during the course of the visit. At the end of the visit feedback was given again to the manager, the residential manager and the business and development manager. 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: To ensure that people are not put at any unnecessary risk the risk assessment for the use of bed rails must be reviewed and updated to include a measuring too to reduce the risk of entrapment. To ensure that all peoples assessed needs can be fully met it is recommended that the pre admission assessment document is reviewed and updated to include a more detailed assessment . It is recommended that a specific oral hygiene assessment is undertaken when people are admitted to the home to make sure that this care need is fully assessed and met. It is recommended that peoples wishes in respect to active/none active treatment, resuscitation and arrangements for after death are clearly recorded to ensure that peoples wishes are respected. To ensure that people are receiving medication as prescribed by the GP medications should be accounted for at all times by means of an audit trail and to ensure that people receive medication as intended the GPs instructions should be clearly recorded. To ensure a fair and consistent interview it is recommended that a set interview format is used and notes are taken during the interview process. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to make sure that peoples needs are assessed before admission to ensure their care needs can be met. Evidence: The AQAA demonstrated and the manager confirmed that admissions to the home are only made after a pre admission assessment of the persons needs has been undertaken, to ensure that those needs can be met. In addition to the homes own assessment they also receive information from the care managers assessment or a nursing needs assessment of the placing authority. Evidence was seen of these assessments on the care files looked at during this visit. However it was noted that the homes own pre assessment was not very detailed and did not fully assess a wide range of individual needs. The residentail manager described a recent assessment she had undertaken and confirmed that the assessment document was not very detailed. This was discussed with the manager Care Homes for Older People Page 11 of 28 Evidence: who made assurances that she would review and amend the document. The manager stated that people who are thinking about moving into the home and or their relatives are encouraged to visit, have a look round, meet staff and other people living at the home. The Statement of Purpose and Service User Guide is available on request. The manager stated that a member of staff would sit and go through the Service user Guide with people who are new admissions to the home to help them understand it and answer any questions they may have. Oak Bank Care Home does not provide an intermediate care service. 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. Not all of the care plans were detailed enough to make sure that peoples needs would be met at all times. Evidence: Since the new providers have taken over in January 2009 new care plan documentation has been developed and was in the process of being implemented. Three care plans were looked at during this visit and all three were the newly developed care plans. They were filed in order and easy to follow. The manager acknowledged that there were significant shortfalls in the old style plans and some identified needs did not have a plan of care for staff to follow. This has the potential to put these people at risk. The newly developed care plans were seen to contain details of peoples care needs, personal choices and preferences. For example the files looked at contained information about preferred getting up and retiring times, whether the person preferred baths or showers and their preferred social activities. However some shortfalls were identified and discussed with the manager during the visit as the Care Homes for Older People Page 13 of 28 Evidence: shortfalls have the potential to put people at risk. For example one person was identified as being epileptic but there were no details of how staff should manage a fit should one occur. In another file, of a person who is a diabetic, it was vague in relation to when blood sugar levels should be taken. It was documented in one care file that the person had a history of prostate cancer but there were no details of any signs or symptoms staff should be aware of and need to report on. In the care files looked at peoples arrangements or preferences after death had not been documented. The manager acknowledged that they did not routinely ask or document peoples wishes in respect to active/none active treatment, resuscitation and arrangements for after death. However she stated that she had now started to gather this information. It was noted that none of the care plans were signed or dated. To ensure staff accountability care plans should be signed and dated. Appropriate risk assessments had been undertaken to ensure that any identified risks are minimised. However it was noted in one care file that the risk assessment relating to the use of bed rails was vague in relation to the risk of entrapment. It documented ensure the gap between the head of the bed and the bed rails are right but there was no details as to what a safe gap should be. This has the potential to put people at risk and was discussed with the manager who said that following recent training she had a measuring tool and would incorporate it into the risk assessment. There was no formal assessment for oral hygiene needs. To ensure that peoples needs are appropriately met it is recommended that an oral assessment is undertaken on admission and then any care needs incorporated into the support plan. The manager confirmed that it was her intention to implement a system to regularly audit the care plans to ensure they meet the required standard. This would be considered good practice. People spoken to during the visit were complimentary about the staff and the care received. One person said I have no complaints about the staff they are very good. A visitor spoken to said he thought the staff were very kind and patient with the residents. Evidence was seen that people were registered with a local General Practitioner (GP) and of GP visits. There were arrangements in place to access to other health care professionals if needed. The manager confirmed that the GPs original prescription comes to the home and is Care Homes for Older People Page 14 of 28 Evidence: checked against what was ordered to ensure there are no discrepancies. We examined the records and stocks of medication held for the three people whose care plans we looked at. It was day one of week one on the record sheets. Some medication, for example nasal spray and laxatives, were prescribed as use as directed with no specific instructions. To ensure that people receive medication as intended the GPs instructions should be clearly recorded. The manager confirmed that she does not undertake any audits of the medication administration. It was discussed that all medication should be accounted for at all times by means of an audit trail to ensure that people are receiving medication as prescribed by their GP. Staff and people living at the home confirmed that people are treated with respect and dignity. The visitor spoken to said that from his observations the staff did treat people with respect and dignity. 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. Activities are provided and people are able to maintain contact with family and friends. People have a choice of varied, well-balanced meals. Evidence: The home does not employ the services of an activity coordinator, although the AQAA documents that they do plan to introduce one. The new care plan documentation includes a life history which includes hobbies and interests to ensure that any activities provided are what people want to do. Staff spoken to said that it is generally the responsibility of the senior carer on duty to ask people what they would like to do and then facilitate it. Some activities include board games, carpet bowls and music. On the day of this visit a member of staff was seen reading with a person, sat chatting to another and dancing with somebody else. We were told that if people are involved in any activities it is then recorded in their daily evaluations. There is a monthly outside entertainer and everybodys birthday is recogonised and celebrated with a gift and birthday cake. Visitors are invited to join in the celebration. One person spoken to said she especially enjoyed the birthday parties. The AQAA identified that people are able to practice their religion and attend religious Care Homes for Older People Page 16 of 28 Evidence: services either in the local community or a minister of their faith can visit them in the home. The AQAA identified that they can provide people with information about outside agencies such as advocates and Mental Capacity advocates. Information regarding advocates was available in the main reception. The manager stated that they were currently waiting for dates for Deprivation of Liberty Safeguard training (DoLS), which came into force on 1 April 2009 and forms part of the Mental Capacity Act. A copy of the menus was seen. The meals were varied and nutritionally balanced. There were various alternatives to the main meals provided on a daily basis and we were informed that everybody is asked on a daily basis what meal they would like. People, staff and a visitor spoken to all confirmed that visitors are made welcome to the home and within reason can visit whenever they like. From speaking to people living at the home and staff it appeared that people are encouraged to exercise choice and control over their lives. The new care plans documented peoples personal preferences around their day to day lives and people were free to access their rooms or any of the communal areas without restriction. 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. There were policies and procedures in place to safeguard people from harm and people are able to express any concerns. Evidence: There is a complaints procedure, which is on display in the main entrance and is included in the Statement of Purpose and the Service User Guide. The manager stated that she was in the process of implementing new documentation to record any concerns or complaints and a system to analyse any trend or patterns. This would be considered good practice. She was able to describe the action she would be required to take if a complaint was made. People spoken to said they did not know how to make a complaint but if they had any complaints they would talk to the person in charge. There was a copy of the Manchester No Secrets Guidance. It was discussed with the manager that this document has now been updated. During the visit the updated document was obtained. The manager was able to clearly describe the correct actions to be taken if an allegation was made. Evidence was seen that some staff had attended safeguarding adults training or covered it while undertaking National Vocational Qualification (NVQ) Level 2. Care Homes for Older People Page 18 of 28 Evidence: Since being registered in January 2009 an appropriate referral had been made under safeguarding adults but was not upheld. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are being made to ensure a safe comfortable environment is provided for the people living at Oak bank Care Home. Evidence: During the course of this visit a tour of the building was undertaken which included the communal areas and some peoples bedrooms. A total refurbishment of the home is currently being undertaken. At the time of this visit the whole of the first floor was being completely refurbished. Once completed it will provide some en-suites and a large, well designed lounge and dinning room. All furniture and fittings will be new and there will be a new consulting room, hairdressing room, sluice area and up to date bathing equipment. The downstairs was tired and worn in appearance, although this will be addressed in the refurbishment program. The AQAA evidenced that they had policies and procedures relating to infection control and there was wall mounted alcohol gel pumps in the main entrance and corridors as well as alcohol hand pumps to help reduce the risk of cross infection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are met by the numbers and skill mix of staff and people are protected by the recruitment process. Evidence: From talking to the manager and from observations on the day of this visit it appeared there were sufficient staff on duty to meet the needs of the people living there. However one member of staff spoken to said that she felt there was not enough staff and had raised it with the new owner at at recent staff meeting. This was discussed with the manager, the business and development manager and the residential manager. The manager confirmed that 20 care staff were employed. Twelve people have successfully completed the National Vocational Qualification (NVQ) Level 2 in care. A further six members of care staff are currently undertaking Level 2 and 9 are undertaking Level 4. A sample of staff files were looked at to see whether the required documentation was in place and the necessary safety checks had been made. Three files were looked at for staff, two of whom had been recruited by the new providers. We saw that each person has to fill in an application form. We saw that they have to give two references so that the manager can check their suitability for the job with previous employers Care Homes for Older People Page 21 of 28 Evidence: and they check peoples identity. The business and development manager confirmed that he regularly checks the Nursing and Midwifery Council (NMC) website for PIN number expiry, exclusion or suspension from the professional register although he does not keep any records of this. The files contained some photocopied documents but there was no evidence that the original documents had been seen and therefore their authenticity could not be verified There was no evidence that a set interview format had been used or that notes were taken. This does not promote a fair and consistent recruitment process. The AQAA demonstrated that there is a training officer and there is a dedicated training room. The manager and the training officer conduct the training and records are kept of all staff who attend. The AQAA also states that they work closely with Manchester Social Services and they are able to nominate staff for various workshops and external training e.g Dementia Awareness and Safeguarding Adults. There is a training matrix which evidenced that training had been provided and each staff member has an individual training record. The AQAA identified that all new staff receive induction by the training officer and following this visit the business and development manager confirmed that the induction is registered with Skills for Care. 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. Some areas of the home management need further developing to ensure all areas are managed in the best interest of the people living there. Evidence: The manager, who is an Registered General Nurse (RGN), is registered with us and has completed the registered Managers Award. As already stated in this report she acknowledged the shortfalls in some of the old style care plans that are currently still in place and the need to implement care plan and medication administration audits to ensure that all peoples needs are appropriately met. The business and development manager confirmed that peoples finances are managed by Social Services Client Financial Services. However they do manage some finances for people when relatives or advocates hand money over for safe keeping. Systems are in place for these peoples finances to be managed. The system was secure and records provided evidence of running totals for individual people and included receipts for any purchases made on peoples behalf. However the manager Care Homes for Older People Page 23 of 28 Evidence: and the business and development manager confirmed that they did not have specific policies and procedures relating to how finances are managed at Oak Bank Care Home or have agreements in place for purchasing items on peoples behalf. There was a CARED 4 policy and procedure file available. The manager said that in addition to these policies and procedures she was in the process of developing some best practice guidelines and policies and procedures that were peronalised to Oak Bank Care Home, for example clinical waste disposal and continence. Some of the policies and procedures currently in place are from the previous provider and need reviewing and updating to reflect the current providers. The manger confirmed that no system has been implemented as yet to quality assure the service being provided by the new providers. The information provided in the AQAA demonstrated that the homes maintenance certificates and records were up to date. Evidence was seen that records are kept for some fire safety checks, for example weekly fire alarm testing and weekly means of escape. There were no records for testing emergency lighting or detailed fire risk assessments. We were informed that the fire marshal was due to undertake a review later in August 2009 and it was discussed that advice should be sought from him with regard fire risk assessments and all the fire safety checks that should be undertaken to ensure peoples safety. 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 7 13 The risk assessment for the use of bed rails must be further developed to include the measuring tool for the risk of entrapment. To ensure that people are not placed at unnecessary risk. 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 3 To ensure that all peoples assessed needs can be fully met it is recommended that the pre admission assessment document is reviewed and updated to include a more detailed assessment of the persons needs. To ensure staff accountability all care plans should be signed and dated. It is recommended that that peoples wishes in respect to active/none active treatment, resuscitation and arrangements for after death are clearly recorded in peoples individual plans of care. To ensure that peoples needs are appropriately met it is 2 3 7 7 4 7 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 recommended that an oral assessment is undertaken on admission and then any care needs are incorporated into the care plan. 5 9 To ensure that people receive medication as intended the GPs instructions should be clearly recorded and medication should be acounted for at all times by means of an audit trail . It is recommended that records are kept of when the NMC register is checked for PIN number expiry, exclusion or suspension of nurses from their professional register. o ensure a fair and consistent interview it is recommended that a set interview format is used and notes are taken during the interview process. It is also recommended that all photocopied documents are signed and dated to indicate that the original has been seen. It is recommended that all the policies and procedures relating to the previous provider are reviewed and updated to reflect the current provider. It is recommended that the policies and procedures relating to finances are reviewed and updated to clearly set out the systems to be followed. It is also recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person and the receipt be signed by the person purchasing items. To ensure that people are not put at risk it is recommended that advice is sought in relation to implementing detailed fire risk assessments and all the fire safety checks that should be undertaken. 6 28 7 29 8 33 9 35 10 38 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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