Care Home: Oliver House

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What the care home does well A number of staff had worked at the home for several years, which helped to ensure consistency of care. People using the service felt that staff had built good relationships with them and worked hard to provide their care. One person spoken with said `I am spoilt`. Staff were pleased with the amount of training that had been made available and the support they received from the manager. Care staff were praised by people receiving the care and were described as `very helpful` and `they are very good and look after me well`. One survey said `very happy with the home and staff`. Staff surveys received commented that they thought the staff worked together well as a team. Meals were enjoyed by people using the service. What has improved since the last inspection? The ground floor of the building had been decorated and the patio area made safe. The manager had organised more training and support for the staff. Peoples` care records contained more detail on how to provide the care. More social events had been organised. What the care home could do better: Health and safety repairs must be addressed promptly. Failure to do this has the potential to affect the safety of all involved in the service. The responsible individual must keep staff and people using the service informed of the arrangements for running the service in the absence of a manager. Staffing must be kept under constant review to ensure that there are sufficient staff on duty to meet individual needs of people using the service, particularly in relation to those people with dementia. Medication procedures must always ensure that peoples` prescribed medicine is available and does not run out. All staff must receive updated health and safety training in the key mandatory areas. Continued efforts must be made to ensure there are sufficient activities and stimulation for people using the service. Arrangements for admitting people to the service must be undertaken by a properly qualified person. Care records require further detail to ensure needs can be met, particularly needs in relation to dementia. The upper floor of the building should be redecorated. Key inspection report Care homes for older people Name: Address: Oliver House Oliver Road Ilkeston Derby DE7 4JY     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: Janet Morrow     Date: 1 5 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 32 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 32 Information about the care home Name of care home: Address: Oliver House Oliver Road Ilkeston Derby DE7 4JY 01159440484 01159440417 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sajid Mahmood Name of registered manager (if applicable) Mrs Janice Greaves Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 26 The registered person may provide the following category of service only Care home with nursing code N To service users of the following gender Both Whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category code 0P Dementia code DE Date of last inspection Brief description of the care home Oliver House is situated in a quiet, accessible area within the village of Kirk Hallam, close to the town of Ilkeston. The service is registered for the care of 26 elderly people and admits people with nursing needs and those who have dementia. There are separate sitting and dining areas within the home. There is a garden to the rear of the building, which has been designed to be easily accessible. There is passenger lift and Care Homes for Older People Page 4 of 32 Over 65 0 26 26 0 0 5 1 1 2 0 0 8 Brief description of the care home staircase access to the first floor facilities. The service provides 24 single bedrooms (8 with en-suite facilities) and 1 double bedroom (without en-suite facility). There are sufficient additional toilet and hygiene facilities provided throughout the premises. People are encouraged to personalise their rooms if they wish. All rooms are equipped with a link to the call system. Support services are in place with a choice of General Practitioners, and chiropody, dental, optician and other services arranged as appropriate. A visiting hairdressing service is provided. The service has open visiting arrangements. Verbal information provided in October 2009 stated that fees were in the range of £344.82 - £700 per week. Inspection reports are on display in the entrance to the buidling and details of previous inspection reports can also be found on the Care Quality Commissions website: www.cqc.org.uk Care Homes for Older People Page 5 of 32 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 inspection visit was unannounced and took place over one day for a total of eight hours. An expert by experience assisted with the inspection process. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience was present for three hours and spoke with six service users, one relative and three members of staff. Her findings are incorporated into the report. Case tracking methodology was used, which means that the records of two people using the service were examined and relevant people spoken with to assess what impact the service had on those peoples quality of life and well-being. Care Homes for Older People Page 6 of 32 Care records, maintenance records, a sample of policies and procedures and staff records were examined. A partial tour of the building was undertaken. Two of fifteen people currently accommodated were spoken with. Five members of staff, the manager and the responsible individual were spoken with. One relative and three visiting professionals were spoken with by telephone following the inspection visit. Five surveys were received shortly after the inspection visit; three from staff, one from a person using the service and one from a relative. Written information in the form of an Annual Quality Assurance Assessment was provided by the service prior to the inspection visit and informed the inspection process. The service had made a successful application to the Care Quality Commission to provide services for people with dementia during 2009. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Health and safety repairs must be addressed promptly. Failure to do this has the potential to affect the safety of all involved in the service. The responsible individual must keep staff and people using the service informed of the arrangements for running the service in the absence of a manager. Staffing must be kept under constant review to ensure that there are sufficient staff on duty to meet individual needs of people using the service, particularly in relation to those people with dementia. Medication procedures must always ensure that peoples prescribed medicine is available and does not run out. All staff must receive updated health and safety training in the key mandatory areas. Continued efforts must be made to ensure there are sufficient activities and stimulation for people using the service. Arrangements for admitting people to the service must be undertaken by a properly qualified person. Care records require further detail to ensure needs can be met, particularly needs in Care Homes for Older People Page 8 of 32 relation to dementia. The upper floor of the building should be redecorated. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A lack of assessment information prior to admission does not establish that peoples needs can be met. Evidence: The Annual Quality Assurance Assessment (AQAA) stated that We do a visit prior to admission and complete an assessment on the skills of daily living and the choices that each service user has. We also like to obtain a history from the family regarding their likes and dislikes. Two peoples care records were examined and showed that assessment information was received from external professionals. In one file, the service had also conducted their own assessment and background information prior to admission. This established that the service was able to meet that persons individual needs. However, on the second there was no information collated by the service prior to admission and enquiries made established that a non-registered and unqualified person had arranged Care Homes for Older People Page 11 of 32 Evidence: the admission. This did not establish that the service was able to meet that persons needs. Risk assessments were in place on both files for risk of falls, nutrition, pressure sores and moving and handling. Those people using the service confirmed that their care needs were met. Two visiting professionals spoken with also confirmed that the needs of the people they were involved with were met and one said complex needs were managed well. Care Homes for Older People Page 12 of 32 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. Access to health professionals and competent staff ensured that health and personal care needs were met. Evidence: The AQAA stated that We have developed new care plans that incorporate the assessments and skills of daily living and staff are currently being trained in person centred care. Two peoples care files were examined and both had a care plan in place that contained information on how to address needs. The plans covered a range of needs, predominantly linked to physical health needs such as personal care, mobility and eating and drinking. There was no specialist plan for mental health needs such as dementia, although there was some reference for dementia related needs in other plans; for example in a communication plan, it stated that staff may need to repeat things to ensure the person understood. One person was identified through a risk assessment tool as having a high risk of Care Homes for Older People Page 13 of 32 Evidence: pressure sores; however, there was no care plan on how to minimise this risk, although the person had been re-assessed on a monthly basis. Although there was sufficient detail on the care records seen to provide the general help needed, there was no specialist information regarding dementia care needs despite the service having been registered to provide this care during 2009. The AQAA stated that an improvement for the next twelve months was to ensure the service Continue to train staff in person centred care and care planning. Access to health professionals such as opticians and dentists was recorded in the files examined and there was monthly recording of weight and blood pressure on both files. The survey received from someone using the service responded that they usually received the care and support needed and that they always received the medical attention required. The relatives survey received responded that the care and attention expected was usually provided. General observation during the inspection showed that staff and people using the service enjoyed warm relationships and people confirmed that privacy and dignity was upheld, especially with regard to bathing and toileting. Staff displayed patience and kindness and interacted well with people. One person spoken with said staff were very polite. A general check on four medication administration record (MAR) charts showed that all charts were signed properly. Two people were signing handwritten MAR charts and quantities of medicines received were recorded. Two charts were then examined in more detail and both were completed accurately, with the chart corresponding with the blister pack. However, two medicines were out of stock for one person and one had been out of stock for a period of four days. The nurse spoken with stated that general stocks were being used for one person and that the surgery had been contacted for a prescription for the other. One persons eye drops were in the medicine trolley but were not listed on the chart. There were no controlled drugs currently in use but there were some waiting to be returned to the pharmacy; the amount held corresponded with the controlled drugs record. Storage of medicines was satisfactory. Applications with a limited shelf life, such as eye drops, were labeled with the date of opening and were within their use by dates, Care Homes for Older People Page 14 of 32 Evidence: although one was on the last day of its usage. The medication policy covered essential areas related to drug administration, including what to do if there was an error, and there was also a copy of the Royal Pharmaceutical Society Guidelines on handling medicines in care settings. Care Homes for Older People Page 15 of 32 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. Well managed meals and social events enhanced peoples quality of life. Evidence: All people spoken with said that they would like more activities. An activities coordinator had recently been appointed but had not yet commenced work. The staff were filling-in temporarily with Bingo and simple crafts. There was a Songs of Praise session on a Sunday Evening led by the members of a local church, and, this was enjoyed by people using the service. Very occasional outings took place and people said they would like to be taken out more often. The AQAA stated that there was an external entertainer every month, these are a variety of different people, we have taken the service users out to visit local restaurants for lunch and had themes on some days and the home has celebrated any special events and birthdays. Photographs on display confirmed that some social activities took place. The survey received from someone using the service responded that there were usually activities arranged. Two budgerigars had been purchased after service users had indicated that they had cared for them in the past. Visitors spoken with confirmed that they were able to call at any time and those Care Homes for Older People Page 16 of 32 Evidence: relatives spoken with stated that they were always made to feel welcome. The manager had attended training on the Mental Capacity Act 2005 and the associated Deprivation of Liberty safeguards. As a result, assessments were being undertaken by the service, where applicable, to ascertain whether involvement from an advocate was required. No one currently using the service had an advocate. The serving of the lunch-time meal was observed and all people spoken with stated that they enjoyed the food.The survey received from someone using the service responded that they usually liked the meals. A variety of options were available and individual preferences were taken account of. Those people needing encouragement or help to eat their meal were assisted willingly by staff. The food was acceptably nutritious and people were given a choice. It was noted that only five people sat at the dinner table and the remainder were served individually at their seats or in their rooms so there was limited social interaction at meal times. Menus were examined and showed that a range of wholesome food was planned and there was fresh fruit and vegetables available. Food stocks were satisfactory. Staff spoken with were knowledgeable about specialist diets and were able to cater for them, for example, diabetic diets and high protein diets. Care Homes for Older People Page 17 of 32 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. Clear policies and procedures ensured that people were safeguarded and their concerns listened to objectively. Evidence: The service had a clear complaints procedure that stated complaints would be acknowledged within forty eight hours. The AQAA stated that 2 complaints had been received in the last twelve months and that both had been responded to within timescales. The complaints record was examined and showed what action had been taken in response to the complaints. The survey from a person using the service responded that they knew who to speak to informally about a complaint but did not know how to make a formal complaint. The relatives survey received responded that they knew how to make a complaint. The AQAA stated that one referral had been made via safeguarding procedures during 2009. This had also been reported to the Care Quality Commission and appropriate action had been taken in response to the incident. All three staff surveys received confirmed that they knew what to do if someone had concerns about the service. Staff spoken with were aware of their responsibilities to report any potential suspicions of abuse and confirmed that they had undertaken training in this area. However, the training matrix indicated that this training had not occurred since the last inspection Care Homes for Older People Page 18 of 32 Evidence: visit in November 2008 and seven members of staff were listed as not undertaking the last course in 2008. Care Homes for Older People Page 19 of 32 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. Lack of attention to essential repairs had the potential to compromise the safety and comfort of people using the service. Evidence: The premises were clean, tidy and odour free at the time of the inspection visit. A survey received form someone using the service responded that the premises were usually fresh and clean. The AQAA supplied by the service stated that the Patio area has been completed to ensure that all service users and their families can use it and There are garden benches and a table outside and 2 gazebo so residents can access outside even in hot weather. However, the area was bare and lacking in plants or flowers. The ground floor had been redecorated; however, the first floor decorations needed attention, for example, the paintwork on all the doors was chipped. The carpets and furniture were clean, as was the bedding. People using the service and staff said that a walk-in shower was needed. Although repairs were carried out, these were not always undertaken promptly. Health and safety repairs regarding fire doors had not been completed in line with timescales laid down by Derbyshire Fire and Rescue service and an enforcement notice had been Care Homes for Older People Page 20 of 32 Evidence: issued by the authority to ensure compliance. The laundry was neat and tidy. There were two washing machines, both with a sluice wash facility. Staff spoken with reported that there was adequate protective equipment such as gloves and aprons and they knew how to prevent the spread of infection. The kitchen was neat and tidy and the service had been awarded four stars, very good, by the Local Authority Environmental Health Department for food safety and hygiene in the kitchen. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were insufficient staff at all times to ensure that peoples needs were met. Evidence: The staff rota for 12th October 2009 - 3rd November 2009 was examined. This showed that there were three care staff on the morning shift, two in the afternoons, plus a qualified nurse on each shift for fifteen people currently accommodated. The qualified nurse on duty was the manager on three of the five shifts during the week of the inspection visit. Two people using the service said that the staff will always come when I use the call bell and the survey received from a person using the service responded that staff were usually available when needed. All three staff surveys received responded that there were sometimes enough staff on duty to meet needs. Staff spoken with commented that there were not enough staff to ensure that one person was in the main lounge at all times and the annual quality assurance assessment stated that a high proportion of people needed two people to assist them. The manager confirmed during the visit that eight or nine people of the fifteen accommodated required two people to assist and staff said approximately half the number of people required help from two staff. One staff member spoken with identified that evenings were more difficult as some people became agitated then and therefore needed more one to one time and two staff said an improvement would be an additional member of staff in the Care Homes for Older People Page 22 of 32 Evidence: evenings. The AQAA supplied by the service stated that all care staff were trained to NVQ level 2 or above. However, the training information supplied by the service stated that ten of thirteen staff had achieved the qualification. This meant that the service was exceeding the target of having a minimum of 50 of care staff with an NVQ2 qualification and it is therefore commended for its commitment to qualification training. The relatives survey received responded that staff usually had the right skills and experience to care for people properly and all three staff surveys responded that they received training relevant to their role. Two responded that they were not given enough knowledge about health care and medication. Staff spoken with said access to training had improved under the current manager. Staff spoken with confirmed that they had undertaken mandatory health and safety training, although training records showed that only fire safety and food hygiene training had occurred since the last inspection visit in November 2008. Courses directly related to care had occurred and the staff training matrix showed that courses in challenging behaviour, dementia awareness, the Mental Capacity Act and care planning had taken place in 2009. Three staff files were examined for recruitment information and were in reasonable order. All three had a completed application form, a Criminal Record Bureau (CRB) check, two written references and a Protection of Vulnerable Adults (POVA) First check. However, one file did not have a certificate of qualification but there was a current license to practise from their governing body and one did not have any identity information, although the manager confirmed that this had been seen for the CRB application. One employment history was completed in years instead of months. Care Homes for Older People Page 23 of 32 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. A lack of clarity around the management of the service and a disregard for health and safety does not ensure the service is run in the best interests of people using it. Evidence: The service was undergoing a period of uncertainty as the manager had resigned and staff were unclear about managerial arrangements following her departure in October 2009. All three staff surveys received made comments that more information and support was needed from the responsible individual; more information from owners take time to listen to us and owners to provide staff with more support. Staff spoken with also made similar comments; two said there was no information on what is happening. The responsible individual was spoken with regarding managerial arrangements and stated that recruitment was underway for a new manager and that he was hopeful of an appointment in the near future. General managerial arrangements were discussed. As identified on the staff rota, the manager was the nurse on duty for a significant Care Homes for Older People Page 24 of 32 Evidence: number of shifts per week and she confirmed that in the week of the inspection visit, there had been twelve hours for managerial duties. She stated that this did not occur at all on some weeks when the qualified nurses were on leave. The AQAA supplied by the service also stated that the Manager has limited time to perform management jobs as she is included in nurse numbers and there is also no administrator or secretary and The manager works more hours than contracted and also works at home to ensure that the documentation is in place as needed. This is not sustainable in the long term and has the potential to adversely affect the running of the service. The service had undertaken quality assurance surveys in September 2009 and the manager had analysed these. The surveys from service users and their relatives covered the decor, cleanliness, care, laundry, friendliness, activities, meals and bedrooms. Twelve responses received rated the overall service; one said it was fair, eight good and three excellent. Staff were also surveyed and one commented that the proprietor needs to understand our role. Another said since the current manager commenced in October 2008, the service was changing for the better. The manager stated that plans to address the comments received had included advertising for an activity co-ordinator and arranging staff meetings. The AQAA stated that the service is not the appointee for any service user, but the local authority is appointee for some and their money is credited to the company account. It also stated that the responsible individual gave service users money paid in to the company account to the manager to place in the service user spending money accounts. However, records showed that there were gaps of two to three months before money was transferred; for example, on one account, money was paid into the serivce users account in July 2009 with the next transfer being dated October 2009. Two peoples financial records were then examined and showed that these were accurate with receipts available and two signatures confirming any transactions. The AQAA provided by the service stated that maintenance checks were undertaken. A random sample of maintenance records showed that emergency lighting had been checked in September 2009, fire extinguishers in September 2009 and portable electrical appliances in June 2009. However, the fire safety of all involved in the service had been compromised by failure to act in a timely manner to necessary repairs, such as repairs to fire doors and to appoint a fire deputy in the absence of the manager. This had necessitated the issue of an enforcement notice by Derbyshire Fire and Rescue Service in August 2009. The information on the notice stated that there was not enough time to carry out fire safety functions. When questioned, the responsible individual was not able to give an explanation as to why the health and safety work had not been carried out in a timely manner. Care Homes for Older People Page 25 of 32 Evidence: Mandatory health and safety training was undertaken and a training matrix showed that most courses had last occurred in 2008, with food hygiene training occurring in February 2009. Staff spoken with confirmed that this training occurred and one staff member said they had been booked on a first aid course later this year. However, another could not remember when they last did moving and handling training and two care staff were not listed on the training matrix as having undertaken this in 2008. Eight staff were not listed as having done infection control training in 2008 and six as not having done fire safety in 2008. The AQAA stated that an improvement for the next twelve months was to up date mandatory training in Moving and Handling, also First Aid. Care Homes for Older People Page 26 of 32 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 27 of 32 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 3 12 The service must always ensure that a suitable person has established that an individuals needs can be met prior to admission. This is to ensure that people are placed in the right service and that their needs can be met. 01/12/2009 2 7 15 Care plans must always contain sufficient detail to ensure needs can be met. This must include reference to specialist needs such as dementia care. This is to ensure that peoples individual needs are met and that the service is compliant with its registration requirements. 31/12/2009 3 9 13 Peoples prescribed medicines must always be available and not allowed to run out. 30/11/2009 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure people receive their medicine as prescribed and their health is maintained. 4 12 16 There must be activities arranged to suit the individual needs of people using the service. This is to ensure people are not bored and to enhance their quality of life. 5 19 23 Repairs affecting the health and safety of all involved with the service must be attended to promptly. This is to ensure that everyone involved in the service is safe and that legal requirements are complied with. 6 27 18 The responsible individual 30/11/2009 must ensure that there are always sufficient staff at key times to meet the individual needs of people using the service. This is to ensure that people using the service are safe and have their needs met in a timely manner. 30/11/2009 30/11/2010 Care Homes for Older People Page 29 of 32 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 7 31 38 There must be clear arrangements in place as to who is responsible in the absence of a manager. This is to ensure that there are clear lines of accountability and the service is properly managed. 30/11/2009 8 38 23 The responsible individual 30/10/2009 must ensure that the necessary steps are taken in a timely manner to meet the requirements of the Fire and Rescue Service. This is to ensure that the safety of all involved with the service is maintained and that health and safety legislation is complied with. 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 2 3 4 18 19 22 30 All staff should have updated safeguarding training every two years. The upper floor of the building should be re-decorated. The service should consider the provision of walk in shower. The service should ensure there is a planned programme of essential training in key areas to ensure staff knowledge and practice is up to date . The responsible individual should ensure that peoples 5 35 Care Homes for Older People Page 30 of 32 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 personal money is transferred into their own bank account on a regular basis. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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