Care Home: Overseal Residential Care Home

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What the care home does well People using the service and their relatives said that the care and support provided was good and that staff were `helpful` and `friendly`. One relatives` survey said the care was `second to none` and that there were `no concerns what so ever` about their relatives` welfare. The premises were well maintained and people commented that it was `very clean` and there was `no smell`. People using the service were encouraged to personalise their rooms with their own possessions. Meals were enjoyed by people using the service and there were a range of choices available at meal times. There was a good staff training programme that ensured staff were competent in their roles. Staff enjoyed working at the service and a survey said they were `proud` to be part of the working team at the service. There was a stable staff team at the home who had the benefit of good managerial support. People living at the home were treated with respect and had choices about how they spent their day, with a range of activities to choose from. What has improved since the last inspection? This was the first inspection of the service since its registration with new providers in March 2009, therefore this section does not apply. What the care home could do better: Moving and handling arrangements must be reviewed to ensure that safe procedures are in place for all people using the service and for staff safety. Care plans must be completed as soon as possible after admission to ensure that peoples` needs are fully met from the point of admission. The medication policy should be amended to specify procedures for receiving or disposing of medicines or what to do if an error is made. A copy of the Royal Pharmaceutical Society guidelines on handling medicines in social care should be accessible for all staff. Kitchen staff should undertake training in nutrition. The laundry service should be reviewed to ensure that ironing is undertaken where necessary and all stains are removed from clothing, where applicable. Key inspection report Care homes for older people Name: Address: Overseal Residential Care Home Woodville Road Overseal Swadlincote Derbyshire DE12 6LU     The quality rating for this care home is:   two star good 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 0 0 9 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 30 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 30 Information about the care home Name of care home: Address: Overseal Residential Care Home Woodville Road Overseal Swadlincote Derbyshire DE12 6LU 01283762728 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): davinia@oversealcarehome.com Ahavah Healthcare Ltd Name of registered manager (if applicable) Ms Beverly Jeffs Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category/ies of service only: Care Home PC 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. Date of last inspection Brief description of the care home Overseal is a Care Home registered to provide personal care and accommodation for up to 29 people in the category of older persons. Overseal is located in the village of Overseal and is close to local amenities. Overseal has a front garden, a patio area, and a car park. The home has 19 single rooms, and four double rooms; all with the exception of two single rooms, have toilet en-suite facilities. A variety of lounge and Care Homes for Older People Page 4 of 30 Over 65 29 0 Brief description of the care home dining space is provided. Information about the service is provided in the combined Statement of Purpose and Service User Guide; this document will be made available to people who live in the home. The fees for the home commence from £353.00 up to £450. This information was provided verbally in October 2009. Copies of inspection reports are displayed in the entrance of the home and are available on the Care Quality Commissions website www.cqc.org.uk. Care Homes for Older People Page 5 of 30 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: This inspection visit was unannounced and took place over two days for a total of nine hours. The service was registered as a new service wth new providers in March 2009. The provider and manager were both spoken with as part of the inspection process. A partial tour of the premises was undertaken. Care records, a sample of policies and procedures and staff information were examined. Three people using the service were case tracked, which means that their records were examined and relevant people spoken with to find out what impact the service had on their health and well being. Eight members of staff, twelve people using the service, three visiting professionals and three relatives were spoken with during the visit. Care Homes for Older People Page 6 of 30 Twenty-two surveys were received prior to the inspection visit: five from people using the service, five from their relatives, seven from staff and five from visiting professionals. The service had supplied written information in the form of an Annual Quality Assurance Assessment prior to the inspection visit, which informed the inspection process. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 30 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 30 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 30 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 was sufficient admission information available to establish that peoples needs could be met. Evidence: The Annual Quality Assurance Assessment stated that We carry out a detailed preadmission assessment for each prospective service user; We also offer any future service user the opportunity of coming into the home for a day or a meal to sample the choices on offer. We ensure we can meet the needs of any future service user before accepting them into our home. Three peoples files were examined and all had assessment information in place, including documentation from the assessment and care management process, where applicable. There were also a number of risk assessments in place that included risk of falls, moving and handling assessments, risk of pressure sores and nutritional assessments.This information established that the home could meet peoples needs Care Homes for Older People Page 11 of 30 Evidence: and three visitors spoken with during the visit confirmed that their relatives needs were well met. Three of the five surveys received from visiting professionals responded that the services assessment arrangements always ensured that accurate information was gathered and the right service planned for people and two responded that they usually did. One survey commented that the service offers and delivers a friendly holistic care service to a variety of people with varying needs. The services statement of purpose and service user guide gave useful information to prospective service users and contained all the information legally requireed by the Care Homes Regulations 2001. Four of the five surveys received from people using the service confirmed that they received enough information before moving in and one replied that they did not receive enough information. Three of the five surveys received from relatives responded that there was enough information provided to help with decision making and two responded that there usually was. A sample contract was examined that was satisfactory and stated the method and payment of fees and identified additional items to be paid for that were not covered by the fee. Care Homes for Older People Page 12 of 30 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. Health and personal care needs were met and the care of people living in the home was planned and given in a way that respected individuality. Evidence: Three peoples care records were examined. Two had a fully completed care plan in place and these were reviewed on a monthly basis. The care plans seen covered all assessed needs to varying degrees. For example, one file had a care plan covering spiritual needs but the other did not and neither had a social care plan. Physical needs were covered and included areas such as mobility, personal hygiene, sight and oral care. The third care plan was still in the process of being developed and covered the daily routine of the person concerned but had no information on specific areas of need. Some of these areas had been recorded by the second day of the inspection visit. There were risk assessments in place on all three files. These covered moving and handling arrangements, risk of falls, risk or pressure sores and a general dependency assessment. The full developed files also had a nutritional assessment. One person Care Homes for Older People Page 13 of 30 Evidence: was identified on the risk assessment as being at high risk of pressure sores; however, there was no specific care plan available to show staff how to prevent them, although there was a form that detailed where the pressure sore was located and said the district nurse was dealing with it. Pressure relieving equipment, such as cushions and mattresses, was also available and the person at risk of pressure sores was seated on a pressure relieving cushion. Another person was using a footstool and also had pressure relieving equipment. The Annual Quality Assurance Assessment stated that We ensure all service users have access to all health professionals. Outside appointments are attended and systems are in place to ensure service users do not miss appointments. This was confirmed by people spoken with who said they saw their General Practitioner, chiropodist and optician and by visiting professionals who were spoken with during the inspection visit. All five surveys from people using the service responded that they always received the support and care required. Four of the five surveys received from relatives responded that the person they were involved with always received the care expected and agreed and one responded that they usually did. One relatives survey commented that their relative was very happy at Overseal. All her needs are cared for and the care she gets is second to none and another said we have found all levels of care and attention and communication superb. A visiting professionals survey commented the residents appear settled and content when I visit and one professional spoken with said they had no concerns about peoples care and another said they were called in when needed. All five surveys received from people using the service responded that they always received the medical care required. People living at the home confirmed in discussion that their privacy and dignity needs were met, giving examples such as staff speaking to them in a respectful manner, and it was observed that staff knocked on doors before entering bedrooms. One person living at the home stated that they were quite satisfied and another commented that staff were ever so good. There were male staff members working at Overseal, and staff spoken with confirmed that people were asked their preferences concerning which gender of the staff team they would prefer to support them in personal care tasks. Four medication administration record (MAR) charts were examined for accuracy of recording. This showed that the records were signed accurately with no gaps on the charts. Three additional medication administration record (MAR) charts were then examined in more detail and all were completed accurately and corresponded with the Care Homes for Older People Page 14 of 30 Evidence: dispensing system (blister pack). All three had all the medication in stock that was required. Two people were signing handwritten charts to ensure these were accurate. Staff spoken with confirmed that they had undertaken medication training. The Annual Quality Assurance Assessment stated that We have adhered to recommendations from our last inspection report and have obtained a copy of the Royal Pharmaceutical Society Guidelines on administering medicines in social care. However, a copy of these guidelines could not be located during the inspection visit and staff spoken with were unaware of them. The medication policy was examined. Although it stated how to administer medicines, including controlled drugs, it did not specify procedures for receiving or disposing of medicines or what to do if an error was made. There was secure storage for controlled drugs and the controlled drug record was maintained accurately with the amount of drugs held corresponding accurately with the written record. Where applicable to their role, all staff surveys received confirmed that they were given relevant training to ensure they had enough knowledge about health care and medication. Care Homes for Older People Page 15 of 30 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, meals and contact with the community were well managed, which enhanced the daily lives of people living in the home. Evidence: The Annual Quality assurance assessment provided by the service stated that Service users are able to enjoy a full and stimulating life style, with a variety of options to choose from. People spoken with confirmed that they had their own routines and had choice in how they spent their day. Observation during the inspection visit showed that people continued with hobbies such as reading and doing puzzles and some opted to stay in their rooms. There were photographs on display that featured some of the activities and outings that took place. Games were being played during the inspection visit and an entertainer was also performing on one day. People spoken with stated that they enjoyed this. Three of the five surveys received from people using the service responded that there were always activities arranged, one responded that there usually were and one did not provide a response. Three of the five surveys received from relatives responded that people were always supported to live the life they chose and two responded that they usually were. Care Homes for Older People Page 16 of 30 Evidence: There were plenty of visitors on the day of the inspection visit and people spoken with said that their visitors could come at anytime. This was also confirmed by the visitors spoken with who all described the home as friendly and welcoming. The manager was aware of who to contact for advocacy services, although she stated that no one using the service currently had an advocate. she was also aware of which people had a power of attorney assisting with their affairs. The service had also received information on the Mental Capacity Act 2005 and staff records and staff spoken with indicated that training on this had occurred during 2009. Time was spent with people during the lunchtime period. Those people spoken with enjoyed the food and described it as excellent, good and that there is always a choice. Three of the five surveys received from people using the service responded that they always liked the meals and two responded that they usually did. The meals served were well presented and nutritious. The dining area was pleasant and bright and tables were well laid with cloths and condiments. Observations of staff showed that they were very attentive to peoples needs throughout. The cook was aware of peoples different dietary requirements and training records and staff spoken with confirmed that food safety training had been undertaken in 2009. However, kitchen staff had not undertaken any training in nutrition. A survey from a visiting professional commented that I am particularly impressed by the high standard of meal provided. The chef is brilliant. Care Homes for Older People Page 17 of 30 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. Systems were in place to ensure that complaints and safeguarding issues were responded to appropriately, which ensured that people were protected and their concerns handled objectively. Evidence: The complaints procedure was examined and this showed that complaints would be responded to within twenty-eight days. It was on display in the entrance of the home and was also available in the service user guide. The Annual Quality Assurance Assessment stated that one complaint had been received at the service in the last twelve months. There had been one complaint received at the office of the Care Quality Commission (previously the Commission for Social Care Inspection) that had been dealt with appropriately by the service. People using the service and their relatives stated that they were confident that any concerns they had would be dealt with in a courteous manner and were aware of whom to complain to. All five surveys received from people using the service stated that they knew how to make a complaint and four of the five relatives surveys received also stated that they knew who to complain to. One responded that they could not remember how to make a complaint. The service had comprehensive information regarding safeguarding vulnerable adults Care Homes for Older People Page 18 of 30 Evidence: including a policy on whistle blowing. There was an up to date copy available of the Local Authoritys procedures on safeguarding adults and the services own policy was clear about what to do if an allegation of abuse was received. Training records showed that safeguarding training had been provided in 2009. Staff spoken with were aware of their responsibilities in reporting potential abuse. The Annual Quality Assurance Assessment stated that there had been no referrals under safeguarding procedures in the last twelve months. A concern received at the office of the Care Quality Commission had been referred to the Local Authority for investigation and was not substantiated. All seven staff surveys received responded that they knew what to do if someone raised concerns about the service. Care Homes for Older People Page 19 of 30 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 building was well maintained, which ensured people living there had safe, comfortable and homely accommodation. Evidence: The premises were clean, tidy and odour free at the time of the inspection visit. Fittings and furnishing were of good quality and there was an ongoing programme of maintenance. All five surveys received from people living at the home responded that the home was always fresh and clean. One relatives survey also commented that the home was always fresh and clean, you are never met with a smell and another commented that it was a very clean environment. One relatives survey commented that the garden area could be improved by pruning the conifer trees as they made bedrooms dark and gloomy and that there was insufficient space outside for people to sit during the summer. The responsible individual stated that she had commissioned a company to improve the garden area. A tour of the building established that there were sufficient bathrooms, toilets and communal space and that relevant equipment was available for use. The manager stated that new hoists had been purchased. The laundry was viewed and there was one washing machine with a sluice wash Care Homes for Older People Page 20 of 30 Evidence: facility and one drier. People spoken with were pleased with the laundry service and clothing was well maintained. However, one relatives survey commented that there could be more attention to laundry as ironing of shirts did not occur and stains were not fully removed from clothing. Staff spoken with confirmed that they had undertaken infection control training and there were also certificates on their files that verified this had occurred in 2009. They were knowledgeable on how to prevent the spread of infection and confirmed that there was always a plentiful supply of protective equipment, such as gloves and aprons. Care Homes for Older People Page 21 of 30 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 service had sufficient staff, appropriately recruited and trained to ensure people were safeguarded and their needs were met. Evidence: The staffing rota was examined for September 2009. This showed that there were four care staff for the morning shift, four for the afternoon shift and two at night. There were two domestic staff on each day, one cook and one kitchen assistant and one handy person for five hours five days per week. This corresponded with the number of staff who were on duty on the day of the inspection visit. Discussion with the manager did not identify any shortfalls regarding staff and three surveys form people using the service responded that there were always staff available when needed and two responded that there usually were. Seven of the eight staff surveys received responded that there were always enough staff to meet peoples individual needs and one responded that there usually were. The manager stated agency staff were not used. Three staff files were examined and showed evidence of good recruitment processes. All of the documentation required by Schedule 2 of the Care Homes Regulations 2001 was in place on all three files, including a Criminal Record Bureau check and Protection of Vulnerable Adults (POVA) check, evidence of identity and two written references. Employment histories were on application forms but one did not account for Care Homes for Older People Page 22 of 30 Evidence: employment in months, only years. Two peoples files had documentation that showed people using the service had been involved in the interview process. The Annual Quality Assurance Assessment stated that fifteen of seventeen members of the care staff had achieved a National Vocational Qualification (NVQ) at level 2 or above. The manager also stated that ten ancillary staff were also undertaking NVQ training. Staff spoken with also confirmed that this training was undertaken. One staff survey commented that I have been encouraged to take my NVQ. This meant that the home had exceeded the target of having 50 of care staff with this qualification and it is therefore commended for its commitment to qualification training. Staff surveys commented that they worked together as a team; one said the home works well because staff work as a team and another said its good to be part of a working team who work together. Relatives surveys made positive comments abut the staff saying they were friendly and jolly, very patient and friendly and welcoming. The training records showed that mandatory health and safety training was undertaken and staff spoken with confirmed that they had undertaken some courses related to care, such as tissue viability, nutrition, dementia and care planning. Records in staff files showed that this training had occurred in 2009. One staff survey commented that they had ongoing training. The Annual Quality Assurance Assessment stated that The management prioritises training and facilitate staff members to under take qualifications beyond basic requirement. Additional staff training on food hygiene and first aid training has been completed as well as training on care related issues such as loss and bereavement, nutrition and pressure sore prevention have been carried out. All seven staff surveys confirmed that training relevant to their role was provided. it also stated that awards had been achieved for staff training and staff development and these were on display in the entrance to the home. Induction records were also in place and the staff spoken with stated that the induction process at the home covered everything needed and that relevant training to the care role was given. Six of the seven staff surveys received responded that their induction had covered everything very well and one responded that it mostly did. Care Homes for Older People Page 23 of 30 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 service was well managed in the best interests of people living there. Evidence: The registered manager was experienced and had achieved the National Vocational Qualification (NVQ) level 4 in management. She was able to demonstrate in discussion that she was familiar with the needs of older people and current debates in social care. New owners had purchased the service and had been registered with the Care Quality Commission (previously the Commission for Social Care Inspection) in March 2009. Discussion with the new responsible individual showed that she wished to improve the service and maintain its family orientated and homely ethos. Some improvements had been established since they took over, including implementing quality audits and internet access for the service. Staff surveys made favourable comments about the new owners; two said they always find time to speak to you. Care Homes for Older People Page 24 of 30 Evidence: A clear system was being established to assess the quality of the care provided. This included monthly visits by the new responsible individual as required by Regulation 26 of the Care Homes Regulations 2001. Records of these visits were examined and showed that a range of issues were addressed, including staff and service users views of the home. Audits of care plans and medication procedures had commenced and the responsible individual was planning to carry out more audits to include health and safety areas. Satisfaction questionnaires were carried out on a minimum of twice yearly; the most recent one had been analysed and showed high levels of satisfaction. Thank you letters seen were also complimentary; one stated we could never have found a better home and a relative spoken with described the service as the best home in the area. A recent safeguarding issue was discussed with the responsible individual; her response showed that the matter had been carefully considered and advice had been sought and appropriate action taken. Three peoples personal financial records were examined and showed that there were secure systems in place for safeguarding peoples money. The written records corresponded with the cash held and there were receipts available for individual purchases. There were secure storage facilities for cash and valuables. Staff training in mandatory health and safety areas took place; for example, fire safety, infection control, food hygiene, first aid and moving and handling training had all been undertaken during 2009. However, despite moving and handling training being undertaken in June 2009, proper procedures were not always followed. For example, one person was seen being moved from wheelchair to armchair using an underarm drag technique. One senior member of staff spoken with said this technique was not usual practice for the service but several other staff members indicated that bodily moving people without use of equipment did occur if the persons needs varied from day to day and if they did not like a hoist being used. The moving and handling risk assessment for the person concerned stated that movement from the wheelchair must be undertaken with a stand aid. Although this equipment was available in the service, it was not used on this occasion. This is unsafe practice and poses a risk of injury to both the person concerned and staff involved. The Annual Quality Assurance Assessment showed that regular maintenance of equipment took place that included fire fighting equipment in April 2009, gas safety in April 2009, portable electrical appliances in June 2008 and hoists in May 2009. Examination of internal records showed that fire alarms and emergency lighting were Care Homes for Older People Page 25 of 30 Evidence: checked by staff each week. Care Homes for Older People Page 26 of 30 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 30 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 15 A care plan must be in place for all people using the service as soon as possible after admission. This is to ensure that all people using the service have their needs recorded and how these are to be met. 12/10/2009 2 38 13 Correct moving and handling 05/10/2009 techniques must be used at all times in line with peoples handling assessments. This is to ensure people are moved safely and both people using the service and staff are not put at risk of injury. Care Homes for Older People Page 28 of 30 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 9 The medication policy should be amended to specify procedures for receiving or disposing of medicines or what to do if an error is made. A copy of the Royal Pharmaceutical society guidelines on handling medicines in social care should be accessible for all staff. Kitchen staff should undertake training in nutrition. The laundry service should be reviewed to ensure that ironing is undertaken where necessary and all stains are removed from clothing, where applicable. 2 9 3 4 15 25 Care Homes for Older People Page 29 of 30 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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