Care Home: Puddavine Court

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What the care home does well "The service has produced information that is made available to people who are considering making Puddavine Court their home. Trial visits to the service are encouraged and a senior member of staff from the home will usually carry out an assessment of individuals health and social care needs before anyone is admitted to the home to ensure their needs can be met.[ please refer to what the service could do better] Not all people spoken to during this inspection were able to recall their admission to the home but all expressed satisfaction with the outcome. All people living at Puddavine Court have individual care plans, risk assessments have also been completed identifying potential health risks and care staff [ please refer to what the service could do better]complete daily reports to give a picture of how people are cared for and how they lead their lives. Medications are stored safely and only experienced, trained staff carries out the administration. Evidence was obtained in various ways through this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld at all times. Those who were able expressed complete satisfaction in the way they are treated by the staff. We saw staff assisting people in a friendly, caring and respectful manner throughout this inspection. The home provides activities and has its own transport. Good arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. The home provides a varied menu which people generally enjoy. The home has a range of policies and procedures that have been regularly updated and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home are confident that if they have complaints or concerns, they will be taken seriously and action taken to address them. Good recruitment practices ensure people are safeguarded from abuse. In response to questionnaires sent to people living at the home prior to this inspection comments included "Lovely food, staff are very friendly and caring. I do get offered to take part in activities but I like my own company and choose not to take part in them. I am very happy here" another, they "do their best to keep everyone happy",and "gives the care us old people need, which is reassuring to stop us worrying" and "my [relative] has been in the home for over 6 years during which [they] have enjoyed a better life than we could have hoped for. [They] always look forward to going back whenever we take [them]out and has seemed thoroughly secure and settled throughout. Care is sensitive and kind and [they] seem as happy as [they]could be". In response to the question "what does the home do well" staff commented " the home does really well in providing care and support for its residents. I feel supported in my role and management are always open to new ideas that improve the residents` lives and also our work" and another " Puddavine Court is a home that strives to do well in all aspects of care. The residents are happy and friendly and enjoy the activities provided". Responses from health care professional In response to the question "what does the home do well" included " respecting individuals and working with family and carers" and "provides a comfortable, homely atmosphere. Provides a varied menu of food and activities". Comments from relatives included " Puddavine Court staff have looked after [my relative] with a great deal of care and compassion. I owe them a great deal for their care of [my relative], and " very nice people at Puddavine, very caring" and " [x] entered Puddavine Court in 2008 and from the first day there the staff went out of their way to make them feel welcome and that it was now their permanent home. Gold Star to all staff". What has improved since the last inspection? Care plans have improved since the last key inspection and include nutritional assessments and records of individuals` weight, but further improvement in recording how each person`s changing needs will be met will further promote person centred care. The homes` management of medication has improved and medicines are administered safely as prescribed. The services` recruitment policy and procedure is robust and people are protected by this. All recruitment files we looked at included the necessary checks including police checks. Staff at Puddavine have received manual handling training to minimise the risk of injury to people they assist and themselves, when they are helping people to move or transfer. Hazardous substances are stored securely to reduce the risk of harm to people using the service, particularly people who may be confused. Fire doors are held open only by means of devices which allow automatic closure in the event of a fire so that the spread of fire can be minimised and the safety of people using the service is promoted. Details relating to the purchase of fire closures by individuals if they wish to keep the door to their room open have been included in information made available to people prior to them moving to the home. Since the last key inspection the service has notified the CQC of adverse event which occur at the home, such as accidents or injuries. The service has begun to gather details of individual social cultural and religious needs and interests in care plans together with arrangements made to meet these individual needs.The home now maintains a record of any complaints made at the home and also of any daily comments that are looked into at the time. Staff are clear about the external agencies to which they can report any abuse they might suspect or witness. Staff are now allocated to specific areas in the home and this has improved communication as staff know where each other are if they need assistance. People living at the home at the time of this inspection were using their call bells, pendants well and if one or two were somewhat confused or could not locate their pendant others called for assistance on their behalf. All people who chose to stay in their rooms were able to call for assistance with ease. What the care home could do better: At the time of this inspection a written plan of how health and welfare needs are to be met had not been completed for all people living at the home. Care and accommodation should not be offered at the care home unless the needs of individuals have been assessed by a suitably qualified or suitably trained person. The service should continue the work already being undertaken to improve details included in care plans to ensure they are person centred and assessments of risks should be undertaken. The home`s procedure for the receipt of medication received at the home should be followed by all staff. This relates to the date on which some medication was received at the home not being recorded. People living at the home, or their representatives, with consent, should be involved in the initial drawing up of their individual care plans or informed of any changes when plans are reviewed. Risk assessments relating to nutrition, falls and skin integrity should be carried out for all people living at the home and regularly reviewed. When a variable dose of a medication has been prescribed clear guidance should be recorded on the medication record indicating the dose to be given and in what circumstances. A record of the use of all prescribed ointments/lotions/creams should be maintained. Details gathered in relation to peoples individual social, cultural and religious interests should be clearly identified and recorded and arrangements made to meet these individual needs. People living at the home should have access to all parts of the communal and private space. This relates to people having to negotiate steps to leave or enter Puddavine Court.Bath and basin taps should be usable by people living at the home and staff. All parts of the home must be kept sufficiently warm to meet the needs of people using the service.This is to ensure their continued health and wellbeing Lockable storage space, for medication, money and valuables should be provided for each person living at the home. The registered person should ensure that there is sufficient protective clothing available throughout the home and that staff follow policies and procedures in relation to the prevention of infection. There should always be enough staff on duty to meet the health and social care needs of people living at the home. All staff should have an individual training and development assessment and profile. Staff working at the home should receive training appropriate to the work they are to perform.This relates to not all staff attending training updates. The manager should apply to the CQC to be registered. Key inspection report Care homes for older people Name: Address: Puddavine Court Ashburton Road Dartington Totnes Devon TQ9 6EU     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: Michelle Oliver     Date: 2 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 41 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 41 Information about the care home Name of care home: Address: Puddavine Court Ashburton Road Dartington Totnes Devon TQ9 6EU 01803866366 01803866366 courtgroup@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Manor Collection Ltd care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: PD Category is from age 55 yrs only Date of last inspection Brief description of the care home Puddavine Court is a large detached house on the edge of Totnes, substantially extended a few years ago. Accommodation is provided over three floors and there are thirty-six single rooms the majority of which are en-suite and one double en-suite room. There are two lounges and the main dining room on the ground floor, and also lounge and dining areas on the other two floors. All floors are accessed via a shaft passenger lift. The garden is large, accessible and attractive. There is ample car parking space. The home is registered to care for people aged sixty-five years and over, who may or may not be, suffering from dementia. The home also provides care Care Homes for Older People Page 4 of 41 Over 65 38 38 38 0 0 38 Brief description of the care home for service users from the age of fifty-five years who have some form of physical disability. Care Homes for Older People Page 5 of 41 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: The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This inspection was undertaken over 13 hours over 2 day by one inspector. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent surveys to 10 people living at the home, 5 staff and 5 health care professionals. Six surveys were completed and returned to us from people living at the home, 5 from staff and 2 from health care professionals and 3 from relatives/friends expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgment about the service provided. Care Homes for Older People Page 6 of 41 To help us understand the experiences of people living at this home we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and 9 people were spoken with in depth to hear about their experience of living at the home. We also spoke with 4 staff, including the manager, Responsible Individual and Training and Development Officer individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. This report is based on a sample of the evidence available during our inspection process. It does not provide a comprehensive risk assessment of the home. Registered persons are reminded that it is their responsibility to assess and manage risks in accordance with the Care Homes Regulations 2001 ( Health and Social Care Act 2008 (Regulated Activities) Regulations 2009) and other relevant legislation. Currently fees charged at the service range from:£ 800-850 per week depending on individual needs. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Copies of the inspection report are available from the office. Care Homes for Older People Page 7 of 41 What the care home does well: The service has produced information that is made available to people who are considering making Puddavine Court their home. Trial visits to the service are encouraged and a senior member of staff from the home will usually carry out an assessment of individuals health and social care needs before anyone is admitted to the home to ensure their needs can be met.[ please refer to what the service could do better] Not all people spoken to during this inspection were able to recall their admission to the home but all expressed satisfaction with the outcome. All people living at Puddavine Court have individual care plans, risk assessments have also been completed identifying potential health risks and care staff [ please refer to what the service could do better]complete daily reports to give a picture of how people are cared for and how they lead their lives. Medications are stored safely and only experienced, trained staff carries out the administration. Evidence was obtained in various ways through this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld at all times. Those who were able expressed complete satisfaction in the way they are treated by the staff. We saw staff assisting people in a friendly, caring and respectful manner throughout this inspection. The home provides activities and has its own transport. Good arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. The home provides a varied menu which people generally enjoy. The home has a range of policies and procedures that have been regularly updated and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home are confident that if they have complaints or concerns, they will be taken seriously and action taken to address them. Good recruitment practices ensure people are safeguarded from abuse. In response to questionnaires sent to people living at the home prior to this inspection comments included Lovely food, staff are very friendly and caring. I do get offered to take part in activities but I like my own company and choose not to take part in them. I am very happy here another, they do their best to keep everyone happy,and gives the care us old people need, which is reassuring to stop us worrying and my [relative] has been in the home for over 6 years during which [they] have enjoyed a better life than we could have hoped for. [They] always look forward to going back whenever we take [them]out and has seemed thoroughly secure and settled throughout. Care is sensitive and kind and [they] seem as happy as [they]could be. In response to the question what does the home do well staff commented the home Care Homes for Older People Page 8 of 41 does really well in providing care and support for its residents. I feel supported in my role and management are always open to new ideas that improve the residents lives and also our work and another Puddavine Court is a home that strives to do well in all aspects of care. The residents are happy and friendly and enjoy the activities provided. Responses from health care professional In response to the question what does the home do well included respecting individuals and working with family and carers and provides a comfortable, homely atmosphere. Provides a varied menu of food and activities. Comments from relatives included Puddavine Court staff have looked after [my relative] with a great deal of care and compassion. I owe them a great deal for their care of [my relative], and very nice people at Puddavine, very caring and [x] entered Puddavine Court in 2008 and from the first day there the staff went out of their way to make them feel welcome and that it was now their permanent home. Gold Star to all staff. What has improved since the last inspection? Care plans have improved since the last key inspection and include nutritional assessments and records of individuals weight, but further improvement in recording how each persons changing needs will be met will further promote person centred care. The homes management of medication has improved and medicines are administered safely as prescribed. The services recruitment policy and procedure is robust and people are protected by this. All recruitment files we looked at included the necessary checks including police checks. Staff at Puddavine have received manual handling training to minimise the risk of injury to people they assist and themselves, when they are helping people to move or transfer. Hazardous substances are stored securely to reduce the risk of harm to people using the service, particularly people who may be confused. Fire doors are held open only by means of devices which allow automatic closure in the event of a fire so that the spread of fire can be minimised and the safety of people using the service is promoted. Details relating to the purchase of fire closures by individuals if they wish to keep the door to their room open have been included in information made available to people prior to them moving to the home. Since the last key inspection the service has notified the CQC of adverse event which occur at the home, such as accidents or injuries. The service has begun to gather details of individual social cultural and religious needs and interests in care plans together with arrangements made to meet these individual needs. Care Homes for Older People Page 9 of 41 The home now maintains a record of any complaints made at the home and also of any daily comments that are looked into at the time. Staff are clear about the external agencies to which they can report any abuse they might suspect or witness. Staff are now allocated to specific areas in the home and this has improved communication as staff know where each other are if they need assistance. People living at the home at the time of this inspection were using their call bells, pendants well and if one or two were somewhat confused or could not locate their pendant others called for assistance on their behalf. All people who chose to stay in their rooms were able to call for assistance with ease. What they could do better: At the time of this inspection a written plan of how health and welfare needs are to be met had not been completed for all people living at the home. Care and accommodation should not be offered at the care home unless the needs of individuals have been assessed by a suitably qualified or suitably trained person. The service should continue the work already being undertaken to improve details included in care plans to ensure they are person centred and assessments of risks should be undertaken. The homes procedure for the receipt of medication received at the home should be followed by all staff. This relates to the date on which some medication was received at the home not being recorded. People living at the home, or their representatives, with consent, should be involved in the initial drawing up of their individual care plans or informed of any changes when plans are reviewed. Risk assessments relating to nutrition, falls and skin integrity should be carried out for all people living at the home and regularly reviewed. When a variable dose of a medication has been prescribed clear guidance should be recorded on the medication record indicating the dose to be given and in what circumstances. A record of the use of all prescribed ointments/lotions/creams should be maintained. Details gathered in relation to peoples individual social, cultural and religious interests should be clearly identified and recorded and arrangements made to meet these individual needs. People living at the home should have access to all parts of the communal and private space. This relates to people having to negotiate steps to leave or enter Puddavine Court. Care Homes for Older People Page 10 of 41 Bath and basin taps should be usable by people living at the home and staff. All parts of the home must be kept sufficiently warm to meet the needs of people using the service.This is to ensure their continued health and wellbeing Lockable storage space, for medication, money and valuables should be provided for each person living at the home. The registered person should ensure that there is sufficient protective clothing available throughout the home and that staff follow policies and procedures in relation to the prevention of infection. There should always be enough staff on duty to meet the health and social care needs of people living at the home. All staff should have an individual training and development assessment and profile. Staff working at the home should receive training appropriate to the work they are to perform.This relates to not all staff attending training updates. The manager should apply to the CQC to be registered. 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 11 of 41 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 12 of 41 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. People considering moving to Puddavine Court benefit from being provided with information to assist them in making a decision. Not all people who are admitted to the service have an assessment of their needs undertaken prior to them moving in. Assessments undertaken before it is confirmed that the service can meet individual health and social care needs would benefit from being more detailed. Evidence: The service has produced a Statement of Purpose and a Service User Guide to provide information about Puddavine for potential users of the service. A brochure is also available in the entrance to the home. We spoke to several people during this inspection and although many were unable to Care Homes for Older People Page 13 of 41 Evidence: recall their admission all expressed satisfaction with the care provided at the service. We spoke to a relative of a person who has recently moved to Puddavine. They told us that although they had not been given any documentation providing information about the service this may have been given to another relative involved with the admission. They confirmed that they had been given information about the home, had visited the home and been made to feel welcome. Prior to this inspection we sent surveys to 10 people living at the home to establish their views on the way they live their lives at Puddavine. We received responses from six. In response to did you receive enough information to help you decide if this home was the right place for you 4 people confirmed they had, one person did not answer and another didnt know. Two people who answered on behalf of relatives both confirmed they had been provided with sufficient information. At the last inspection a recommendation was made that details of extra charges be made clear to people living at the home. This related to the additional charge for holdopen devices for fire safe doors, if people chose to keep the doors to their rooms open. Details of this additional charge have now been included in the homes brochure. The services policy is that people are only admitted to the home following a pre admission assessment of their individual health and social care needs to ensure that the service can meet these assessed needs. This assessment will be undertaken by the manager or a person trained to undertake assessments, or if this is not feasible the service will obtain information from other health care professionals who have been involved in the persons care. People considering moving into the home are invited to visit the home as often as they wish, to have a meal and to meet other people living at the home before they make a decision to make Puddavine their home. To enable us to assess how the health and social care for these people are met at Puddavine we looked, in detail, at files for 3 people living at the home. The policy of the service is that each person has an individual file, the purpose of which is to help staff providing care to better understand individual needs. The service has devised a thorough assessment of needs form, which when completed would provide comprehensive information about individual health and social care needs. Information would include medical history, communication needs, dietary Care Homes for Older People Page 14 of 41 Evidence: needs, daily routine, bedtime routine, weekly diary, help needed with individuals care, daily plan of care, risk assessments etc. However, not all of the files we looked at included comprehensive assessments of individual health and social care needs. We looked at the file for a person who had recently moved to Puddavine. An assessment form had not been completed, and no information of the persons health and social care needs had been recorded. An assessment of the risk of the person developing pressure damage had been undertaken on the day of their admission to the service. We spoke with the manager and owner about the lack of an assessment being undertaken for this person and were told that originally it was planned for the person to move into independent accommodation, situated on the same site as Puddavine Court and owned by the Court Group, but a decision was made for them to move in to Puddavine at the last moment as they were not well. This person had been living at Puddavine for 3 weeks and there was no information to form the basis of a care plan. We looked at the pre admission assessments for another 2 people. An assessment of health and social care needs had been undertaken by staff prior to one person being admitted but information was not comprehensive. For example there was no indication of the reason one person had been admitted, no medical history and no details about how a person communicates. A shared care assessment had been completed by a health care professional for another person giving comprehensive information about this persons needs. The service does not admit people who require intermediate care. Care Homes for Older People Page 15 of 41 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are generally met by staff, who respect their privacy and dignity. A lack of detail in some care plans may lead to inconsistencies in care and potentially put people at risk a risk of not receiveing all the care they need in their preferred way. Continuing to improve and develop care plans will further promote person centred care. Medication is generally well managed but some areas need attention to ensure safety is maintained. Evidence: Five people living at Puddavine Court who responded to questionnaires, felt confident that the home always(4) or usually (1) met their needs. One person wrote Gives Care Homes for Older People Page 16 of 41 Evidence: the care old people need which is reassuring and stops us worrying, especially if you have no medical knowledge. A relative who completed a questionnaire commented It has fulfilled my [relatives] needs; physical, personal and emotional with kindness and understanding. We also sent questionnaires to 5 members of staff and received responses from all. In response to the question Are you given up to date info about the needs of people you support or care for 3 staff responding to surveys felt that they were always and 2 usually given information. Comments made by staff included good care is given in the home. I feel all clients needs are being met and I think the home works very well as a team. All staff provide different levels of care to the service users and any concerns regarding our residents will be talked about another the home does really well in providing care and support for its residents, interacts with residents, cares for residents and their family. In response to the question Are you given up to date info about the needs of people you support or care for 4 staff responding to surveys confirmed that they were always and 1 usually given information. Staff felt that the service provide to the residents the best care that they can give. Staff we spoke to during this visit did agree that they are not always given information when people are admitted to Puddavine Court. However, they said that they will spend time with individuals and get to know them and their needs. We were also told that there is a staff handover for each shift when information is provided. All people living at Puddavine Court have individual files, which include information relating to the admission, assessments of their health and social care needs, assessments of risks and care plans. Care plans are the end point of the assessment of the persons health and social care needs and should show what care must be delivered in accordance with the service user plan for that individual. The plan becomes the yardstick for judging whether appropriate care is delivered to the individual and will reflect changes as regular assessment of the person shows changing needs. The format/ paperwork the service has for recording information about all people who live at Puddavine Court is well laid out and prompts comprehensive information to be Care Homes for Older People Page 17 of 41 Evidence: recorded. However, the files we looked at had not been comprehensively completed. For example we looked at the file for a person who had been living at the home for 3 weeks. No pre admission assessment or plans of how the health and social care needs of this person would be met had been developed. This potentially puts this person at risk of not having their needs met. We discussed this with the manager and provider and were told that originally it was not planned for this person to be admitted to Puddavine Court; when discharged from hospital they were to move into independent living in a building owned by and in the grounds of Puddavine Court. However, when thy were discharged the manager assessed that the person was not able to manage and needed care and so was admitted to Puddavine Court. We discussed the need for an assessment to be undertaken at the time this person was admitted. We looked at a file for another person living at the home and noted that an assessment of their health and social care needs had been undertaken before they had moved to the home. An assessment had also been undertaken on the day the person was admitted to Puddavine Court. This assessment was fairly comprehensive and included details such as the persons chosen daily routine, past medical history and reason for moving to Puddavine Court. However,some aspects of this care plan, such as the persons physical needs, were more detailed than other areas such as psychological or social needs. For example the assessment undertaken when admitted stated the person gets confused and unsettled, needs a lot of encouragement, a good routine will help and wanders at night, needs to be guided back to their room. No plan of what action was being undertaken to address this or how this need was to be met or monitored had been completed. We also looked at daily reports written by staff and noted that this person was wandering during the night, went outside and wandering into other peoples rooms, shouting and aggressive towards staff, pushing and shoving. No plan of how this had been managed, was to be managed or monitored had been completed. Another person spent much of the day walking around the home and we heard that at times they wandered into other peoples bedrooms. The care plans did not contain any guidance to staff on how they should monitor this person to ensure they were safe. Care Homes for Older People Page 18 of 41 Evidence: The manager told us they had taken action to prevent the person going out of the home unaccompanied. We suggested the home sought professional assessment and advice on ways of supporting and reassuring the person, and how to involve them in other activities. The care plans should be developed to give much more guidance to staff on how to support this person throughout the day. We noted that details about peoples nutritional likes/dislikes were not detailed and two we looked at stated, likes most things. However, when we spoke to the cook they were aware of the likes and dislikes of all people living at the home and a record was kept of this information. Another assessment stated eats well with the appropriate cutlery but no information about what was appropriate cutlery for this person had been recorded. Another care plan was comprehensive and included good person centred information including strengths the person has. This means that staff can support the persons strength and therefore promote their independence. None of the 3 care plans we looked at indicated that people had been involved in the initial drawing up of their care plans or in monthly reviews. Some people we spoke to during this inspection were not aware of having care plans. They could not recall being involved in regular reviews or in the initial drawing up of the plans. This means people may be at risk of not being involved in how care is delivered or in making decisions about how they live their lives. Care files showed that people have access to outside professionals such as G.P, specialist consultants, chiropodist and optician in order to ensure their health care needs are met. Files we looked at included assessments of risks associated with falls for 2 people but not for a person who wandered. We discussed the shortfalls in care planning on the first day of this inspection. On the second visit we were shown that some care plans had been updated and improved. We saw care plans had been developed in relation to the management of pain and another for an acute infection. Peoples personal care is generally well attended to. People were well dressed and groomed, and attention to their personal care was good. Many female residents were wearing make up and jewelery, one told the inspector, I see the hairdresser Care Homes for Older People Page 19 of 41 Evidence: regularly. Male residents were smartly dressed and well shaved. Staff spoken with and observed demonstrated a good understanding of the peoples needs and preferences. In response to a questionnaire a relative commented we have never had to ask for [my relatives] nails to be cut, teeth cleaned etc. Likewise any medical needs are dealt with promptly and we are kept informed at all times. We were told that staff would support and encourage people to manage their own medicines if they wished an assessment of their ability to do so would be undertaken by staff and this would be regularly reviewed. However, on the first day of this inspection a person living at the home told us their early morning medication was kept in an unlocked drawer in their room. We discussed this with the manager who agreed that this was poor practice. On the second day of this inspection we were told that the routine at the home has been changed and arrangements have been made for night staff to administer the medicine. Only staff who have received appropriate training deals with medication at the home. The manager orders the medications and checks them in when delivered to the home. The homes medication storage and records were looked at. The fridge used to store medicines is lockable and is stored in a clinical room that is locked when not being used. Other storage was satisfactory, including the arrangements for storing of controlled medicines. Suitable arrangements are in place for the safe disposal of unwanted medication. Medicine Administration Records (MAR) were looked at; where hand written entries had been made, two signatures had been obtained to ensure accuracy, this is good practice. Where variable doses of medication are needed, records did not consistently show the actual dose given. When medication is received at the home the manager checks the medication and dates and signs as a receipt of delivery. When we looked at the MAR sheets not all entries included the date they had been received. Where a prescription indicated that a variable dose could be given there were no indications on the medication administration record [MAR] of the reasons for varying this dose. Care Homes for Older People Page 20 of 41 Evidence: Some people were prescribed pain relieving medicines by their GP to be used when required. However, there was no care plan or explanation on the medicines administration records of how to recognise signs of pain, or when to offer pain relief. Some people are prescribed creams to be applied daily. Records were not completed indicating that this may not be happening. When we spoke to staff we were told that creams are applied but not recorded. The manager confirmed that they will devise a method of recording the application of creams. Medication with a limited shelf life once open had not been dated to ensure they were used within the timescale suggested by the manufacturer. At the time of this inspection no controlled drugs were being administered. Safe methods for storage and recording of controlled drugs were in place ready for the next time any controlled drugs are prescribed to any person living in the home. People spoken with told us that staff respect their privacy and dignity and during our visit, staff were polite and friendly when delivering care. We saw staff knocking on peoples bedroom doors, waiting to be asked to come in and addressing them in a respectful way. It was evident that staff had established a good rapport with people. All people we spoke to during the 2 days of this inspection praised staff and management for their kindness and friendliness, one person told us Puddavine as a home from home. Care Homes for Older People Page 21 of 41 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. Social needs and meals are generally well managed. A varied balanced diet is provided and served in a pleasant atmosphere. People are encouraged to maintain contact with their families or friends as they wish and to generally take control of their lives. Evidence: Six people responded to surveys sent prior to this inspection. Three confirmed that there were always and two usually activities arranged by the home that they can take part in. One person replied they didnt know. One person commented happy with quizzes and outings. The service employs an activities co-ordinator who conducts activities 5 afternoons each week. We were told that there are plans to increase this to 7 days a week. Activities undertaken at Puddavine Court include jigsaws, quiz, minibus trips, flower arranging, walking, card making, music and movement, giant cross word, singing and Care Homes for Older People Page 22 of 41 Evidence: art. People told us they enjoyed a recent mini bus outing and several people went out in the mini bus on the day of the inspection to see the Christmas lights.Others told us they were looking forward a Carol concert, to be given by a local school, planned to take place at the home the following day. During the mornings of both days of this inspection we saw several people sitting either a main lounge area, a smaller, quiet lounge area, a conservatory and in the dining room. People were happy and comfortable [ refer to Environment standards] and had formed into several groups chatting and laughing. Staff came and went frequently but were friendly and respectful to people and stopped and chatted despite being busy. We spoke to several people during this inspection. People were generally happy with the activities provided. Some told us they didnt choose to take part in all activities and sometimes just liked to sit and watch. Several people told us they prefer to stay in their rooms, watching TV, listening to a radio or reading. We asked staff how they prevent the risk of social isolation for these people and were told that they visit them frequently and spend time chatting if the person chooses. We were told that several people prefer to be undisturbed. We looked at several care plans and noted that information relating to individuals past interests or hobbies was inconsistent. One stated a person liked football and shopping and a daily diary for this person was blank apart from [relative] visits regularly. We saw no details of activities others would like to be involved with. The person who undertakes activities with people living at the home also works during the morning as a cook. On both afternoons of this inspection people were involved in activities in the main lounge. We were told that a record of activities undertaken and those who take part is maintained by the activities co ordinator,however we did not see this during the inspection. In response to a questionnaire a relative commented [my relative] enjoys the mini bus rides to other homes for tea etc. The home encourage physical and mental activity. People are encouraged and supported to maintain their religious beliefs and a Communion service is held monthly at the home. People told us a hairdresser visits the home regularly. Care Homes for Older People Page 23 of 41 Evidence: During this visit several people were enjoying chatting to each other, reading newspapers and books, watching TV programmes and listening to music of their choice. One person we spoke to told us that they preferred to spend time in their room, reading or listening to the radio, only leaving the room to go to meals. Three people who responded to surveys confirmed that they always and three usually enjoyed the meals served at the home. In response to what does the home do well one person commented lovely food and another food . A large comfortable dining room is provided on the ground floor where people were seen enjoying their meal and socialising. The dining tables were attractively laid with pretty tablecloths and napkins. We saw staff encouraging and supporting people to maintain their independence, however for those needing assistance this is provided in a sensitive way. People can refer to menus on individual tables and are reminded what the choices of the day are. People who prefer to stay in their rooms are shown a menu to enable them to choose what they would like for their meal on a daily basis. A choice of meal is offered at both main meals time but if there is anything a person does not like the cook will provide an alternative. Specialist diets and individual requests are well catered for at Puddavine including diabetic and vegetarian. The meal seen during this inspection was tasty, well cooked, very attractively presented, with portions to suit individuals. All people spoken to at the time of this inspection were very satisfied with the standard of food at the home one saying the food is Excellent. The kitchen at Puddavine Court was well stocked with supplies, including fresh fruit and vegetables and a good supply of dried goods. The cook told us that all food was of fantastic quality and that the home does not scrimp on food. People are encouraged and supported to maintain links with family and friends during their stay at Puddavine Court. People may receive visitors at any time and during this inspection, and when we looked at the visitors signing in book, this was confirmed. Staff welcomed all visitors and were helpful and polite. People spoken to say they are supported and encouraged to make choices in their Care Homes for Older People Page 24 of 41 Evidence: daily lives such as the times they get up and go to bed, what they wear and where they eat their meals. It was not clear how people who are less able to make their choices known, or find communicating difficult are afforded this choice. Care Homes for Older People Page 25 of 41 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear and simple complaints procedure that ensures complaints are responded to promptly with satisfactory outcomes. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that people living at the home are protected. Evidence: The home has a complaints procedure in place and it has been displayed in the home. Five people who completed a questionnaire before this inspection told us they knew how to make a complaint and one person did not respond to the question. The home has developed a system to maintain records of all complaints received and how they are managed. No complaints have been made to the Commission since the last inspection. We were told that 1 complaint has been made to the home since the last inspection, which is currently being investigated. However, the manager also takes note of day to day grumbles. We saw records of lost laundry, and too much gravy on lunch. We saw documentation that these had been dealt with and records of responses to the Care Homes for Older People Page 26 of 41 Evidence: complainant including details of how the manager had looked into the issues, had been maintained. People living at the home that we spoke to during this inspection said that if they were unhappy about anything they would not hesitate to raise any matter at any time and were sure that it would be dealt with to their satisfaction. Staff said that if anyone made a complaint they would report it to either the manager or senior carer. If it was something that they were able to sort out themselves then they would. They were confident that no issue that was raised would ever be ignored. There was nothing to suggest that people living at the home are anything other than well cared for. People spoken to told us that staff were very helpful, respectful and that nothing was ever too much trouble for them. The manager told us that all staff have received training in Adult Protection issues. A procedure for responding to abuse is available and staff were aware of this. Staff were able to describe differing types of abuse and gave good details of what they would do if they suspected abuse was occurring. They were aware of the homes Whistle-blowing policy and that it would support them in reporting bad practice. They felt confident that they would be listened to if they raised concerns about bad practice. Care Homes for Older People Page 27 of 41 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. People live in a pleasant, clean and comfortable home. Laundry facilities are adequate but hand washing facilities need to be improved so as not to compromise infection control procedures in the home. Evidence: People spoken to during this inspection said they were very comfortable living at Puddavine. During this inspection we walked around the building, visiting many bedrooms, the sittings rooms, dining room, bathrooms, laundry and kitchen. Three people who responded to questionnaires told us the home was always fresh and clean and 3 thought it was usually so. Entrance to Puddavine Court is gained by steps, which could present a problem to people who have limited mobility or use a wheelchair. The first day of this inspection was carried out on a day in December when the weather was very cold. When we entered the home we were aware of it being cold, all people sat in the lounge and conservatory were cold and several had blankets over them. We asked staff whether the heating was on and were told that it was not. We asked the manager whether the heating could be put on, this was done and the Care Homes for Older People Page 28 of 41 Evidence: building warmed up quickly The home was well maintained with the lounge areas homely and comfortably furnished. Bathrooms are generally well equipped and the home has a good provision of equipment to aid peoples independence, for example extra handles in toilets/bathrooms, seat raisers and personal portable call bells [pendants], which means that they can call for assistance wherever they are in the building. All people we spoke to were able to show us their call bell and understood how to use them. Decoration, fitting and fixtures such as furniture, curtains, carpets, pictures, lamps throughout the home are of a good quality. Most bedrooms have en suite facilities and all bedroom doors being fitted with locks promote peoples privacy. Lockable facilities are not provided in each room for the storage of treasured possessions or medicines, but we were told that if required it would be provided. A free-standing heater was seen in one room for which there was no risk assessment; however this had been placed behind a large piece of furniture. People have been encouraged to bring items of furniture, pictures and belongings to make their rooms feel homely, and we saw many rooms that were highly personalised. A few people had chosen not to bring furniture or pictures, and although these rooms did not appear personalised they were comfortable and homely. We visited a room which is shared by two people. We noted that no provision had been made to enable both people to keep toiletries, such as toothbrush and soap, close to the wash basin. We were told that one person always takes their toiletries back to their bedside table after using them. We spoke to this person who confirmed this. We were told that decoration of all areas at the home is ongoing. Information provided prior to this inspection stated that furniture is replaced and decoration is undertaken when necessary. We noted that wash basin taps in a toilet and taps on a bath in a bathroom on the top floor were disabled and could not be used. The bathroom was being used by a person whose room was next to it. We discussed this with the manager and were told that the bath was never used as the person preferred a shower. We also noted that although liquid soap had been provided in this bathroom towels were not. We were told the person who uses this bathroom used a washbasin in their room for hand washing. We discussed the need for taps to be usable to that people are offered choice and are available for others living on the same floor and are available for staff also. Care Homes for Older People Page 29 of 41 Evidence: We noted that hand washing facilities are provided in most areas but not all. The service has posted a notice in the entrance hall suggesting that visitors to the home use a hand sanitiser; however the container was empty throughout the first day of this inspection. We were told that this is normally checked by staff and refilled, or visitors will bring it to the attention of staff. In our tour of the home we found a few bedrooms had a mild odour problem although we could see that the home had taken action to address the problem as far as possible, including cleaning and de-odourising the affected areas. Windows had been left open where possible to air the rooms. We were also told that the Court Group is currently in the course of buying a sanitiser for use at Puddavine and other services in the Group. Laundry facilities are sited outside the main building. The facilities include washing and drying machines. The washing machine has a sluicing facility. We noted that although liquid soap was provided paper towels were not, there were no aprons or gloves available and no evidence of gloves and aprons being disposed on in the bin provided. The manager told us that this would be addressed immediately. Although staff described good infection control practice, that ensures that people are protected from the risk of cross infection, we saw a member of staff, who was not wearing protective apron or gloves, taking soiled linen to the laundry. This potentially puts people living at the home at the risk of cross infection. At the time of this inspection the home was clean and fresh and we were told by people living at the home that it was always like this. Care Homes for Older People Page 30 of 41 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. People benefit from having staff in sufficient numbers to support them, and the smooth running, of the home and by the homes recruitment procedure. Evidence: At the time of this inspection 36 people were living in Puddavine Court. Information provided by the home before this inspection showed that there were 18 permanent care staff employed. They also employ cooks, cleaning staff, gardener and a group maintenance person. We were told, and a rota confirmed, the service aims to have 6 care workers, the manager and the provider on duty between 8am-2pm when the number of carers decreases to 4 plus the manager and provider who leave at 5pm. From 5pm, 4 carers are on duty until night staff, which consists of 2 carers, come on duty until the following morning. A domestic is employed to work from 8am-2pm, 5 days a week and a cook from 9am-3pm each day of the week. At 3pm, after preparing an evening meal for care staff to serve to people living at the home, the cook undertakes activities to those who wish to take part. Three people who completed a questionnaire before this inspection stated there was always and 3 usually enough staff available when needed. The majority of people Care Homes for Older People Page 31 of 41 Evidence: we talked to on the day of this inspection said that there were usually sufficient staff on duty to meet peoples needs. One person living at the home, who chooses to spend their time in their room, told us that there is often a shortage of staff and that on the previous weekend the person only saw staff when they brought the persons meal to the room. The provider told us that additional staff would be available to be on duty if the need arose. In response to questionnaires returned by 5 staff all told us there was usually enough staff to meet the individual needs of people living at the home. One member of staff commented more staff would be nice, another as a carer I would like to spend more quality time with the residents to get to know them and learn about their history. Throughout this inspection staff were busy but calls for assistance were answered quickly and care staff spent time with people. All staff were kind and friendly and it was clear that staff had built up a good relationship with people living at the home. We looked at the recruitment records for three staff recruited since the last inspection. The files were in good order, neatly filed, and showed that all required references and checks had been taken up before each person had begun work. This demonstrated that the home had taken good care to ensure all new staff were entirely suitable for the job. Although we were told that all staff undertake induction training when they are employed at Puddavine Court we did not actually see any records. We were told this is because each person maintains their records of induction. We were told this record is signed by the trainer and the person to confirm that both were satisfied that the person had received all the relevant information. The Court Group benefits from having Training and Development Officer who takes responsibility for planning and delivering training in various topics at the home. A training matrix is maintained, which highlights when staff require an update in particular topic. We noted that only 5 staff had undertaken training in manual handling in January 2009. This means that several people working at the home have not received this mandatory training. We discussed this with the Training and Development Officer who Care Homes for Older People Page 32 of 41 Evidence: told us that although staff had not attended the training they had given instruction to staff in relation to manual handling. We were told that there is a problem with ensuring that all staff attends training sessions. One member of staff commented in a questionnaire the home provides training but I feel staff, on occasions, choose to ignore this training. The Training Development Officer confirmed this. We looked at 3 staff files during this inspection and found there was no record of training for one person, although during a supervision session the person had requested an update in First Aid and medication training. We were told that this person also works in the NHS and has stated they are up to date with all mandatory training. We discussed the fact that although this person had received training as part of their position held in the NHS training individualised to the environment and to individuals living at Puddavine Court should be undertaken and a record maintained. Information provided by the home before this inspection showed that 12 members of staff have so far achieved a relevant qualification known as NVQ level 2 or above (or equivalent). This demonstrated that the level of qualified staff met with our minimum recommended level of at least 50 . Care Homes for Older People Page 33 of 41 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. Health and safety practices have improved since the last inspection. Attention is needed to ensure that some records are accurate and up to date. Evidence: We were told that the current manager, although not yet registered with the CQC will be making an application to be registered. The manager was formerly a senior staff member and is currently being supervised by Jill Wakeham, [the Responsible Individual], and the organisations Training and Development Officer. Mrs Wakeham has many years experience in managing residential homes and holds the registered Managers Award. During this inspection the Manager and Mrs Wakeham had an open friendly approach towards all living and working in the home. Regular residents meetings are held at the home where people can put forward any suggestions or opinions about how their home is run. People we spoke to said they Care Homes for Older People Page 34 of 41 Evidence: enjoyed these meetings but told us they can speak to staff or the manager at any time and let them know what we think. The service undertakes annual Quality Assurance surveys when questionnaires are sent to people living at the home and relatives to obtain information about specific topics. At the time of this inspection we were told that questionnaires for 2009 are currently being collated; the outcomes will then be made available to those who took part in the survey, people living at the home and all other interested parties. Records are securely stored in lockable filing cabinets, but not all those seen were up to date. We were told that records would be made available to people living at the home, or their representative, with their consent. The current system for recording training undertaken by staff does not capture up to date details. We spoke to the Training and Development Officer about this and plans are being undertaken to ensure that training records reflect an accurate up to date record of training undertaken by all staff, including dates for refresher training. All staff spoken to confirmed that they had all had up to date training in relation to Safeguarding Adults and Moving and Handling, although training records did not reflect this. The Training and Development Officer confirmed that regular fire training, and checks of fire equipment take place at Puddavine Court and health and safety inspections are carried out quarterly. During this inspection we noted that all fire doors were closed and all doors to peoples rooms were either closed or, if people wished were open but had been fitted with closures which means the doors would close automatically in the case of fire. We saw evidence of not all staff following the homes policies and procedures in relation to infection control. We saw staff handling laundry without wearing protective clothing, bedding being placed on the floor when staff were making beds. This puts people at risk of infection. Most people living at the home choose to have personal finances looked after by their family or legal representatives. The home will keep small amounts of money for people who receive services such as hairdressing, chiropody and other personal items that may be needed. Clear records and receipts are kept of all outgoings. Information received before this inspection indicated that all equipment is maintained regularly at Puddavine Court. Care Homes for Older People Page 35 of 41 Evidence: Care Homes for Older People Page 36 of 41 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 37 of 41 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 written plan of how health and welfare needs are to be met must be completed for all people living at the home. To ensure that individual health and welfare needs will be met. 12/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Care and accommodation should not be offered to a service user at the care home unless the needs of the person have been assessed by a suitably qualified or suitably trained person. This relates to a person being admitted to the service with no assessment of the health and social care needs being undertaken. 2 7 People living at the home, or their representatives, with consent, should be involved in the initial drawing up of their individual care plans or informed of any changes when plans are reviewed. Care Homes for Older People Page 38 of 41 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 3 7 The service should continue the work already being undertaken to improve details included in care plans to ensure they are person centred and assessments of risks should be undertaken. Risk assessments relating to nutrition, falls and skin integrity should be carried out for all people living at the home and regularly reviewed. When a variable dose of a medication has been prescribed clear guidance should be recorded on the MAR as to the indications for giving the medication in the correct dosage to meet the individuals needs. A record of the use of all prescribed ointments/lotions/creams should be maintained. The homes procedure for the receipt of medication received at the home should be followed by all staff. This relates to the date on which some medication was received at the home not being recorded. Details gathered in relation to peoples individual social, cultural and religious interests should be clearly identified and recorded and arrangements made to meet these individual needs. All parts of the home must be kept sufficiently warm to meet the needs of people using the service. This is to ensure their continued health and wellbeing Bath and basin taps should be usable by people living at the home and staff. People living at the home should have access to all parts of the communal and private space. This relates to people having to negotiate steps to leave or enter Puddavine Court. Lockable storage space, for medication, money and valuables should be provided for each person living at the home. The registered person should ensure that there is sufficient protective clothing available throughout the home and that staff follow policies and procedures in relation to the prevention of infection. 4 8 5 9 6 7 9 9 8 12 9 19 10 11 21 22 12 24 13 26 Care Homes for Older People Page 39 of 41 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 14 15 27 28 There should always be enough staff on duty to meet the health and social care needs of people living at the home. Staff working at the home should receive training appropriate to the work they are to perform. This relates to not all staff attending training updates. 16 17 18 30 31 37 All staff should have an individual training and development assessment and profile. The manager should apply to the CQC to be registered. The rights and best interests of people living at the home should be safeguarded by the homes record keeping policies and procedures. All training records should reflect up to date information of training undertaken by staff. Policies and procedures relating to infection control should be understood and practised by all staff to prevent the spread of infection and communicable diseases. 19 20 37 38 Care Homes for Older People Page 40 of 41 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. Care Homes for Older People Page 41 of 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!