Care Home: Pines Residential Home (The)

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What the care home does well The Pines provides a comfortable, clean and pleasant environment for the care of elderly people. People using the service were complimentary about the care they receive and the staff at the home. Comments included "the staff are helpful and kind," "the staff look after me well," "its like a hotel I wish I had come here sooner." The home has a stable staff group who are experienced and are recruited properly resulting in an effective workforce. Basic training is being provided and staff appeared well motivated towards their work. Staff spoken with said they are happy working at the home. The wellbeing of the people using the service is promoted by the flexibility of the daily routines, visitors being made welcome to the home and the provision of well balanced, appealing meals. Activities are available for people using the service to take part in should they so wish. The premises are of a good standard being spacious and well maintained. In particular, there are well apportioned gardens which can be used by users of the service for their recreation. What has improved since the last inspection? Since the last inspection a manager has been appointed. The manager has made improvements by addressing the requirements made at the last visit to the home. Formal supervision of staff has been re-introduced which provides support to staff in their work and will help to further their professional development. Work is taking place to ensure all staff receive further training to update their knowledge and skills. This will ensure that all staff have information they need to carry out ther duties effectively. Improvements have been made to how medication is managed at the home. Medication is now regularly audited to confirm safe practices. The safety of the home has been improved by ensuring that appropriate risk assessments are in place and limiting access to the laundry. The staff spoken with were very positive about the employment of a person to work in the laundry as this means they have more time to spend with the people using the service. What the care home could do better: A complete application for a registered manager is to be submitted to CQC. A registered manager for the service will ensure the appropriate future development of this service. Medication practices and policies are essentially sound however some improvements are required. A risk assessment for people using the service who adminster their own medication needs to be recorded. This record needs to be made to demonstrate that any risks have been considered and action taken to minimise them so that the person administering their own medication will not come to any harm. A clear record also needs to be made of any medication that is remaining when new medication is received into the home. This is to ensure that all medication is accounted for and there is no mishandling. The training plan is to continue to ensure all staff receive refresher training in manual handling, infection control, food hygiene and safeguarding vulnerable adults where needed. This is to ensure that staff have up to date training to meet the needs of the people using the service. Portable appliance tests are to be carried out at appropriate intervals. To ensure the safety of people using the service. The care plans should provide more detailed information on the assistance staff are to give with personal care so that the independence of people using the service is fully promoted. The daily records should contain more detailed information on the well being of the people using the service and how their care needs have been met. Key inspection report Care homes for older people Name: Address: Pines Residential Home (The) 106 Vyner Road South Birkenhead Wirral CH43 7PT     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: Beate Field     Date: 1 2 0 1 2 0 1 0 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 31 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 31 Information about the care home Name of care home: Address: Pines Residential Home (The) 106 Vyner Road South Birkenhead Wirral CH43 7PT 01516537258 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hodge & Wilson Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only: Code PC, to people 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 categories: Code OP The maximum number of people who can be accommodated is: 24. Date of last inspection Brief description of the care home The Pines is registered to accommodate 24 elderly people. Users of the service are accommodated in single bedrooms, most of which have en-suite facilities. Bedrooms are available on the ground and first floors and there is a passenger lift. There are two comfortably furnished living rooms and a dining room available for users of the service although there is also another separate area for dining if required. There are two bathrooms on the ground floor and a bathroom on the first floor. Bathing aids are provided. At the front of the home is a large landscaped garden with lawns, flowerbeds and mature trees. Seating is available in the garden. The Pines is privately owned. A manager has now been appointed who is in the process of applying to be registered Care Homes for Older People Page 4 of 31 Over 65 24 0 Brief description of the care home with the Care Quality Commission. At the time of this inspection, the weekly fees for the home ranged from £368.00 to £600.00. Additional charges are made for personal shopping, newspapers, hairdressing, chiropody, dentistry, optician appointments and glasses, transport and staff support to appointments. A Statement of Purpose and a Service User Guide which describe the services at the home are made available to people interested in using the service. A copy of the most recent inspection report is also made available on request. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key unannounced inspection of The Pines Care Home which included a site visit. All key standards were assessed in addition to a selection of other standards. This inspection is based on all information received by the Care Quality Commission since the last inspection. In addition it included information provided by the owner of the home through an Annual Quality Assurance Assessment document (AQAA). The AQAA gives an overall picture of the performance of the home as well as factual information about the service. Three people who use the service were interviewed and others observed. Interviews took place with the manager and three members of the care staff. Surveys were Care Homes for Older People Page 6 of 31 received from people who use the service and staff. The premises were inspected and a number of records were examined. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: A complete application for a registered manager is to be submitted to CQC. A registered manager for the service will ensure the appropriate future development of this service. Medication practices and policies are essentially sound however some improvements are required. A risk assessment for people using the service who adminster their own medication needs to be recorded. This record needs to be made to demonstrate that Care Homes for Older People Page 8 of 31 any risks have been considered and action taken to minimise them so that the person administering their own medication will not come to any harm. A clear record also needs to be made of any medication that is remaining when new medication is received into the home. This is to ensure that all medication is accounted for and there is no mishandling. The training plan is to continue to ensure all staff receive refresher training in manual handling, infection control, food hygiene and safeguarding vulnerable adults where needed. This is to ensure that staff have up to date training to meet the needs of the people using the service. Portable appliance tests are to be carried out at appropriate intervals. To ensure the safety of people using the service. The care plans should provide more detailed information on the assistance staff are to give with personal care so that the independence of people using the service is fully promoted. The daily records should contain more detailed information on the well being of the people using the service and how their care needs have been met. 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 31 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 31 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. People who use the service can make an informed choice about whether the home is right for them and they can be confident that the home can meet their needs. Evidence: A Statement of Purpose and a Service User Guide are available. These documents have been updated since the last key inspection. They provide information on the services provided for people thinking about using the service and/or their relatives to refer to. The documents give a good overview of the home, the accommodation, the staff and qualifications, the meals and social activities and what to do if there are any concerns/complaints about the service. The brochure is given to all new enquirers. Further information around how the views of people using the service are obtained and how this affects how the service is run needs to be more clearly indicated in the Statement of Purpose. The contract also needs to be made available. The manager explained this was not available during the visit as it is being reviewed. Care Homes for Older People Page 11 of 31 Evidence: People thinking of using the service and their relatives are encouraged to visit the home prior to admission to view the premises and talk to residents. They can visit as often as they wish and the manager stated that they are able to have a meal and take part in any of the activities before they decide whether to move in. People spoken with and those who returned questionnaires had made visits to the home before moving in where possible. A sample of assessments of peoples needs were seen. There was evidence of appropriate assessments being carried out before new residents move to the home. There was also evidence that information is gathered from social workers and health professionals to inform the assessment. New residents spoken with said they had been asked about their needs during the assessment. The initial assessments cover the religious, cultural and linguistic needs of residents. Care Homes for Older People Page 12 of 31 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. The people using the service are treated with respect and their health and personal care needs are well met. Evidence: A sample of care plans were seen. The care plans identify the current needs of the people using the service and provide sufficient information. The care plans seen had been reviewed on a monthly basis. Some further information around what personal care tasks people are able to do for themselves would give staff further guidance and ensure that peoples independence is promoted. The staff spoken with were aware of the needs of the people whose records were inspected and how to meet these needs whilst promoting independence. A brief daily record is made of the well being of each person using the service. These records should contain more detailed information to show how each persons care needs have been met. Some of the people using the service are showing signs of confusion. Some staff have attended training around dementia care in preparation for the changing needs of people coming to live at the home. This training included information around The Care Homes for Older People Page 13 of 31 Evidence: Mental Capacity Act. It is planned that further staff will attend this training. The people using the service who were spoken to said that they are well cared for at the home. When asked about the care they receive from staff, they said they always get the care and support required and staff are always there when needed. People who returned surveys made similar comments. Care plans clearly showed the health care needs of the poeple using the service. The records at the home indicated that referrals are made to health professionals in accordance with the needs of the people using the service. A record is made of visits by health professionals and the outcome is documented. People spoken with said that their health needs are well met. Since the last key inspection the manager has introduced changes to how medication is managed that will make medication errors less likely. The manager is also carrying out a monthly audit which serves to confirm safe practices. A sample of medications and the corresponding records were examined and were in general found to be in order. A consistent record was not available of the amount of some medication remaining when new medication is received into the home. This record needs to be made to ensure that all medication is accounted for and there is no mishandling. There is a system in place for returning medication to the pharmacist. All staff who administer medication have completed an intermediate certificate in the safe handling of medications. In addition, the pharmacist for the home has trained all staff who administer medication. It is recommended that the competence of staff to administer medication be recorded in staff training records. The pharmacist who supplies medication to the home visits to audit the medication and ensure that the home is complying with legal requirements. A record had not been made of risk assessments for three people who administer their medication. This record needs to be made to demonstrate that all the risks have been assessed and that the person administering their own medication will not come to any harm. At induction training staff are provided with guidance on how to meet the needs of people using the service in a dignified manner and how to respect their privacy. A policy is also available to provide guidance to staff. Staff were observed to treat the people using the service with respect. Staff were observed to speak to them in a respectful manner and were sensitive when responding to the their needs. The people using the service spoken with said that the staff are polite, caring and kind. Care Homes for Older People Page 14 of 31 Evidence: Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of the home allow people using the service an individualised living experience. Evidence: Discussions with people using the service found them happy with the range of activities on offer. On the day of the inspection people were playing bingo and bridge. The manager confirmed that a variety of activities are available so that people using the service have a choice. A tour of the premises found that activities were being publicised prominently in the home so that people are aware of their availability. Discussions with care workers confirmed that they felt there were good activities available although they also confirmed that some people using the service prefer not to participate through personal choice and have their own activities that they prefer to engage in. 1 member of staff who returned a survey suggested that an activities coordinator be employed in order to allow a greater range of activities. This was brought to the attention of the manager. The manager stated that the home encourages visitors and they can join in activities and meals if they so wish. During the visit to the home we saw several visitors although some peoples visitors were prevented from visiting due to the bad weather. Care Homes for Older People Page 16 of 31 Evidence: A tour of the premises found that there is a request that visitors do not call during mealtimes but, otherwise, they can visit freely so that access is not restricted. This was confirmed by interviews with people using the service who stated that their relatives can visit at any time within reason. People using the service said that their visitors are always made to feel welcome by the staff. The manager stated that the home does try to promote independence although this is limited by the increasing confusion of some people using the service. Those people using the service who were spoken to, however, did confirm that their wishes were respected in the home. This included their ability to have a key to their own bedroom, to engage in activities as they wish and to choose their own menu. Observations during the inspection confirmed that people using the service were encouraged to make choices. Observations of the dining area indicated that a pleasant environment is provided for people to have their meals. The food being prepared looked appetising. Lunchtime menus are displayed in a book in the main reception for people using the service and their visitors to view. Visitors may eat with the person they are visiting as long as sufficient notice is provided. Breakfasts are provided following consultation with each person using the service and are served in the bedrooms on request. A choice of evening meals is provided. The records of menus indicated that a variety of meals that would provide a balanced diet are available. Any special dietary needs are written in to care plans and the cook is informed. One person who has special dietary needs said that the home caters for them very well. When asked about the food provided, the people using the service were very positive. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures and policies of the home ensure that users of the service are protected. Evidence: A complaint procedure is available at the home and is displayed in the reception area where it is clearly visible to the people using the service and visitors. The complaint procedure is also contained within the service user guide. There is a record book for recording complaints. This showed that there had been no complaints over the last twelve months. A suggestion box is available for people using the service and their visitors to express their views and the home also uses a customer satisfaction survey to gauge satisfaction. Interviews with people using the service showed that they knew how to make their views known about the service offered at The Pines. People spoken with had no complaint about their care and had a very positive view of the home. 1 member of staff who returned a survey said that they were not aware of what to do if someone had a complaint about the home. This was brought to the attention of the manager to be addressed. Systems are in place to ensure the people who use the service are safeguarded from abuse. A copy of the Wirral adult protection procedure is in place along with supporting documentation, which staff can refer to when necessary. The staff spoken to during the visit demonstrated a basic understanding of this issue and were clear on the action they should take in the event of them suspecting or knowing an incident of Care Homes for Older People Page 18 of 31 Evidence: abuse had occurred. An interview with the manager confirmed that there had been no safeguarding issues over the last twelve months and a review of information sent to us confirmed this to be the case. Training is provided to staff around protecting adults from abuse during the induction period. The majority of staff had their last formal training in this area in 2006. The manager advised that he is taking steps to ensure all staff receive up to date training and records seen supported this. Care Homes for Older People Page 19 of 31 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 environment is pleasant and clean for the care of people who use the service. Evidence: A tour of the premises found the home to be clean, well presented and safe. All bedrooms are for single occupancy. The bedrooms seen were well furnished, nicely decorated and carpeted to maintain a good standard. The bedrooms contained items that people have brought in with them from their homes, such as furniture, photographs and ornaments. Each bedroom has a lockable area. Interviews with people using the service found them very happy with the quality of their bedrooms in particular. There is a wide range of space available for the use of people using the service. The home has two lounges which provides a quiet room as an alternative to television. There are two separate dining areas. We arrived prior to lunch and found the tables attractively presented with table cloths and napkins. The grounds of the home are particularly pleasant and users of the service were complimentary about this and the uses to which this can be put, particularly during the summer period. The kitchen is suitably equipped and was clean and well ordered when we visited. The laundry is also properly equipped to maintain standards. At this visit a locked cupboard has been made available in the laundry for cleaning materials and a lock has Care Homes for Older People Page 20 of 31 Evidence: been placed on the laundry door, following consultation with the fire service which reduces the hazards presented by this area. People using the service who were spoken with praised how their clothing is well taken care of when it goes to the laundry. Since the last visit to the home a person has been employed to work in the laundry each day. Staff spoken with were very positive about this change. The AQAA confirmed that there is a commitment to maintaining a high level of hygiene with appropriate policies and training. A tour of the premises found them clean and hygienic. An interview with the manager revealed that the home employs two domestic staff a day with one during the mornings at weekends to maintain standards. Training documents seen confirmed that staff are being trained in matters such as infection control so that risks are minimised. The people using the service who were spoken with and those who returned surveys were complimentary about the cleanliness of the home. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home recruits and trains staff appropriately resulting in an effective workforce. Evidence: The rotas and a discussion with staff and people using the service indicated that there are sufficient numbers of care staff, domestic and catering staff to meet the needs of the people using the service. The manager was aware that staffing levels need to be constantly reviewed in order to ensure they continue to be adequate. There is a low level of staff turnover at the home and a number of staff have worked at the home for several years. Staff interviewed said they like working at The Pines. A stable staff team is very important for ensuring that the people using the service receive consistent care. Staff interviewed were very positive about the standards of care at the home, one said I feel the home gives a good standard of care to the residents. The home is clean and homely and staff are friendly. Since our last visit to the home a person has been employed to work in the laundry. The care staff interviewed considered this to be very beneficial to the people using the service as now the care staff do not have to undertake this additional task. People using the service commented on how well their clothing is looked after. The recruitment records for the three members of staff were seen. The required information was available. Surveys received from staff and interviews with them Care Homes for Older People Page 22 of 31 Evidence: during the site visit confirmed that they felt they had been recruited in a fair and robust manner. People using the service who were spoken to were highly favourable about the quality of the care workers employed in the home. Nearly all the care staff have an NVQ 2 qualification in caring for the elderly. This shows a positive commitment towards ensuring that staff have the skills and knowledge to care for older people. The manager has assessed the training needs of staff. Refresher training has been provided to the majority of staff around first aid and fire safety since his appointment. A training plan has been drawn up with some staff recently undertaking manual handling and infection control to update their knowledge. The manager has a plan in place for all staff to attend a refresher training course on mandatory training where needed. Care Homes for Older People Page 23 of 31 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 appointment of a manager at the service has led to improvements being made to how the service is run which is in the best interests of the people using the service. Evidence: Since the last key inspection of the service a manager has been appointed. The manager has been in post since May 2009 and is in the process of submitting an application for registration to the Care Quality Commission. The manager has previous managerial experience and is currently studying for qualifications to support him in his role. The last inspection report indicated that the lack of a a registered manager was impinging on certain management functions. At this visit there has been clear improvements to the service with a programme for staff supervision and training being put in place and improvements to the organisation and content of records. The manager has addressed the requirements made at the last key inspection of the service. Since the last visit to the service there have been improvements to the quality Care Homes for Older People Page 24 of 31 Evidence: assurance system in place at the home to monitor standards. A regular audit is now undertaken of medication. Staff training needs have been clearly identified and a plan in place to address this. The views of people using the service are obtained through surveys and informal and formal meetings. Records show that changes to meals were made and entertainment booked over Christmas as a result of listening to the views of people living at the home. The owner visits the home and reports on the operation of the home and where improvements are needed. The manager is aware that there still needs to be an overall approach to quality assurance whereby the home regularly collects information around all areas of service provision and uses this as a basis for continual improvement. The financial records for three people who use the service were examined and found to be correct. Monies are individually held for people using the service and a clear audit trail was available. A tour of the premises confirmed that the monies are appropriately stored in a safe facility. The manager has introduced a supervision policy and has begun to supervise staff at the home. A programme of supervision is in place. The manager is recording any supervision that is undertaken with staff and is using this as a way of finding out what training each staff member requires. Staff spoken with during the visit and those who returned surveys said they feel well supported at the home. A sample of records of accidents were seen, these indicated that appropriate action had been taken when an accident had occurred. A monthly audit of accidents at the home is now undertaken to enable any patterns to be identified and action to be taken where needed. A tour of the home and records seen showed that steps have been taken to ensure that a safe environment is provided. Water is regulated throughout the home to ensure that the temperature does not exceed 43 degrees centigrade. Regular checks of the water temperature are undertaken. Radiators have radiator covers in accordance with a risk assessment. There are appropriate storage facilities. During a tour of the home any bedroom doors that were open had been fitted with an appropriate device that is approved by the fire service. Portable appliances testing was last carried out in November 2008 and are due. The manager was aware of this and reported that this is to be carried out without delay. A sample of safety check records were seen for servicing of the fire safety systems, electrical wiring, bathing aids and nurse calls and were appropriately maintained. The fire risk assessment for the service has been updated since the last inspection of the Care Homes for Older People Page 25 of 31 Evidence: home. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 31 8 An application for a 01/06/2009 registered manager is urgently required so that all management functions of the home can be addressed. (Previous timescale of 6th March 2008 not met). Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 A clear record needs to be 12/03/2010 made of any medication that is remaining when new medication is received into the home. This record needs to be made to ensure that all medication is accounted for and there is no mishandling. 2 9 13 A risk assessment for people 12/03/2010 using the service who adminster their own medication needs to be recorded. This record needs to be made to demonstrate that all the risks have been considered to minimise the chances of the person administering their medication coming to any harm. The training plan is to continue to ensure all staff receive refresher training in 12/08/2010 3 30 18 Care Homes for Older People Page 28 of 31 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 manual handling, infection control, food hygiene and safeguarding vulnerable adults where needed. To ensure that staff have up to date training to meet the needs of the people using the service. 4 31 8 An application for a registered manager is urgently required. So that all management functions of the home can be addressed. 5 38 13 Portable appliance tests are to be carried out at appropriate intervals. To ensure the safety of people using the service. 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 12/03/2010 12/02/2010 1 2 1 1 A contract/statement of terms and conditions needs to be included in the Service User Guide. Further information around how the views of people using the service are obtained and how this affects how the service is run needs to be more clearly indicated in the Statement of Purpose. The care plans should provide more detailed information on the assistance staff are to give with personal care so that the independence of people using the service is fully 3 7 Care Homes for Older People Page 29 of 31 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 promoted. 4 7 The daily records should contain more detailed information on the well being of the people using the service and how their care needs have been met. It is recommended that the competence of staff to administer medication be recorded in staff training records. An overall approach to quality assurance whereby the home regularly collects information around all areas of service provision and uses this as a basis for continual improvement needs to be put into place. The programme of supervision of staff is to continue to ensure all staff receive this formal support at least 6 times per year. 5 6 9 33 7 36 Care Homes for Older People Page 30 of 31 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. 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