Care Home: Rydal House Nursing Home

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What the care home does well Most people told us they always had the care and support they needed at the home. People said "I`m very happy here", "the staff are very good and look after me very well", and, "Mum always looks well cared for". People told us that staff were "kind and friendly", and, "we have a laugh together". 9 out of 14 care assistants had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard of 50% of care staff with NVQ at level 2 or above. What has improved since the last inspection? Care plans had been developed and improved to provide more detail about each person`s individual needs. Care plans were consistently reviewed to ensure people`s changing needs were recorded and met. The complement of staff had been increased so that there was no use of agency staff. This ensured better continuity of the service provided to people in the home. There was a structured staff training programme in place to ensure that staff were up to date with all necessary training. This ensured that staff could understand and meet the needs of people in the home. What the care home could do better: Provide each person in the home with a statement of terms and conditions of living in the home. This will ensure that people have sufficient information about what they can expect from the service. Develop the activities programme to include activities to meet the needs of all people in the home, particularly people with dementia and those whose mobility and communication is very limited. Provide a second assisted bath or an accessible shower to allow people a choice of bathing facilities. Make the recruitment process more robust by ensuring that all required documents and information are in place for all staff employed at the home. This will help to protect people living in the home. The ratio of staff to people in the home should be determined according to the assessed needs of people, and a system operated for calculating staff numbers required, in accordance with Department of Health guidance. This will ensure there are always sufficient staff available to meet people`s needs. Develop policies to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that people`s rights are promoted and upheld. Key inspection report Care homes for older people Name: Address: Rydal House Nursing Home 21 Somersall Lane Chesterfield Derbyshire S40 3LA     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: Rose Moffatt     Date: 2 3 0 4 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 28 Information about the care home Name of care home: Address: Rydal House Nursing Home 21 Somersall Lane Chesterfield Derbyshire S40 3LA 01246569511 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): hitch_d@yahoo.com Mr D Chand,Dr. Anjuman Diwan Chand Name of registered manager (if applicable) Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Both whose primary care needs on admission to the home are within thw following categories: Old age, not falling within any other category - Code OP Physical disability Code PD (maximum number of places - 1) This relates to the application to vary the conditions of registration dated 09/09/08 in regards to a named service user. Date of last inspection 0 7 0 7 2 0 0 9 0 1 Over 65 31 0 Care Homes for Older People Page 4 of 28 Brief description of the care home Rydal House is situated on the western side of Chesterfield in a pleasant residential area, close to local amenities and within easy access of a main bus route. The home is a converted building, with an extension, set in its own grounds. There are separate lounges and dining rooms on the ground floor. A conservatory has been added. The home provides personal and nursing care for up to 31 people. Information about the home, including CQC inspection reports, is available in the main hallway of the home, or from the acting manager. Fees charged at the home range from £344.82 to £478.14 per week. This information was provided by the acting manager on 23rd April 2010. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we Care Homes for Older People Page 6 of 28 have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place over 7.5 hours on 21st and 23rd April 2010. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home and received 6 completed responses, 4 of these completed with help from staff. We sent out 10 surveys to staff employed at the home and received 5 completed responses. There were 18 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The acting manager was available on the second day of the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 4 people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Provide each person in the home with a statement of terms and conditions of living in the home. This will ensure that people have sufficient information about what they can expect from the service. Develop the activities programme to include activities to meet the needs of all people in the home, particularly people with dementia and those whose mobility and communication is very limited. Provide a second assisted bath or an accessible shower to allow people a choice of bathing facilities. Make the recruitment process more robust by ensuring that all required documents and information are in place for all staff employed at the home. This will help to protect people living in the home. The ratio of staff to people in the home should be determined according to the assessed needs of people, and a system operated for calculating staff numbers required, in accordance with Department of Health guidance. This will ensure there are always sufficient staff available to meet peoples needs. Develop policies to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. Care Homes for Older People Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a satisfactory assessment of each persons needs obtained before admission so that people were confident their needs could be met at the home. Most, but not all, people in the home had received sufficient information about the terms and conditions of living in the home. Evidence: Most people told us they always had the care and support they needed at the home. Some people said they had not had enough information about the home to help them decide about living there. People said Im very happy here, and, Mum always looks well cared for. We looked at the records of 4 people in the home. We found that each person had a full assessment of their needs prior to admission to the home. This included assessments by the home manager, by local authority staff, and by hospital staff Care Homes for Older People Page 11 of 28 Evidence: where applicable. We found that 1 person did not have a statement of the terms and conditions of living in the home. Most people in the home, or their representatives, had received this document. The version we saw included all the required information except that it did not specify the actual room to be occupied by the person. The admission processes did not include reference to the persons capacity to make decisions about their care and did not include details of any Lasting Power of Attorney or advanced directive/living will. Standard 6 did not apply as there were no people in the home receiving intermediate care. The AQAA said that, wherever possible, people are invited to visit the home before making a decision about living there. The AQAA gave all the statistical data asked for about people in the home. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a consistent, purposeful approach to care planning so that people received care and support to meet their individual needs and preferences. Evidence: Most people told us they always received the care and support they needed, including medical care. One person said the staff are very good and look after me very well. A relative told us they were satisfied with the care provided and said the staff understood the persons needs. We looked at the care records of 4 people in the home and found they all had a care plan in place. 1 persons care plan had not been fully completed as the person had only been in the home a few days. The other 3 care plans had good details of the persons needs and of the action required by staff to meet those needs. The care plans included details of the persons preferences regarding their daily routines. Care plans had been reviewed monthly and updated as necessary with any changes in the persons condition or care needs. Care Homes for Older People Page 13 of 28 Evidence: There was no written evidence to show that people, or their representatives had been involved in care planning. Relatives told us they were involved in care reviews and were kept informed of any changes in the persons condition or needs. We found that there were assessments of each persons healthcare needs, including their nutritional, manual handling, and oral health needs. We saw appropriate risk assessments in place, such as the persons risk of developing pressure sores, and risk of falls. Assessments were reviewed monthly. There were records of visits by other healthcare professionals, such as GP, District Nurse and chiropodist. People told us the GP was called in as necessary. Medication was securely stored and was administered by the registered nurses in the home. We looked at records of administration and most of these were correctly completed. 2 of the records had handwritten instructions that had not been signed by the person who had written them. People told us that staff were kind and friendly, and, we have a laugh together. We observed that staff spoke to people in a courteous and respectful way, and that staff were aware of ensuring the dignity and privacy of people in the home. The AQAA said the home had improved by introducing new care plans and risk assessments. They planned to improve further by encouraging more involvement of people and/or their representatives in care planning, and by staff training in person centred care planning. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provided did not meet the needs of all the people in the home. People found the routines and meals offered generally met their preferences and expectations. Evidence: People told us there were activities provided at the home that they could take part in. They said they usually enjoyed the meals at the home, although one person said their dietary needs were not always well catered for. The care records we looked at all had details of the persons family and social history, their interests, likes and dislikes. People told us they could usually follow their preferred routines. One person said I can do my own thing. We observed that people were able to move freely around the communal areas of the home or stay in their bedrooms if they wanted to. People were offered a key for their bedroom door. The bedrooms we saw were personalised with peoples own furniture and possessions. We saw a plan displayed of activities for 4 weeks. People told us the activities on the plan did not often happen. They told us that there were some regular activities, such as visitors from a local church coming in every 2 weeks, and some art and craft Care Homes for Older People Page 15 of 28 Evidence: sessions. People said they had enjoyed a visiting entertainer and buffet tea on Easter Monday and several of their relatives had also attended. There appeared to be few activities offered for people with dementia or for people with complex needs whose mobility and communication were very limited. Visitors told us they were always made welcome and could visit at any reasonable time. The menu displayed gave a choice of the main meal at lunchtime and showed a reasonable variety of meals. The menu for 4 weeks was displayed with no indication of the current week. The acting manager said the menu for the day was usually displayed on white boards in the lounge and dining room. Most people ate their meals in the dining room. We observed that people were given appropriate help by staff with eating and drinking. The AQAA said there was a structured activity programme in place. The AQAA said that staff had received training about nutrition and menus had been changed in consultation with people living in the home. The home planned to improve by better use of the homes vehicle to take people out, and by fostering more links with the local community. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were suitable policies in place and good staff awareness so that people were protected and their concerns were effectively dealt with. Evidence: Most people told us they knew who to speak to if they were not happy about anything and how to make a formal complaint. People told us they were confident that any concerns raised would be appropriately dealt with by senior staff or the acting manager. The complaints procedure was displayed in the main hallway. We found there were satisfactory records of complaints made with details of the action taken and the outcome. We found that people in the home, or their relatives, had the opportunity to raise any concerns at meetings with the acting manager. The action taken and the outcome were not always recorded for issues raised at meetings. No complaints had been received directly by CQC since the last inspection. Most staff had received training about safeguarding vulnerable adults in the last 12 months and further training was planned. Staff spoken with were aware of the correct procedures to follow if abuse was suspected or alleged. There had been a safeguarding incident at the home in January 2010. Suitable action Care Homes for Older People Page 17 of 28 Evidence: was taken by the home to address issues raised. The AQAA showed there were relevant policies and procedures in place that had been reviewed in the last 12 months. The AQAA said the home had improved by updating procedures and by staff training. They planned to improve further by more staff training and improvements in record keeping. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally sufficiently well maintained and suitably equipped so that people lived in a clean, pleasant environment that met their needs and expectations. Evidence: People told us the home was comfortable and homely. They were able to bring their own furniture and possessions into the home. Since the last inspection a keycode lock had been fitted to the front door to improve security. Some areas of the home had been redecorated. There had been a fire in the laundry in August 2009 and all necessary repairs and redecorating had been carried out, except for replacement of the flooring. One of the portable lifting hoists had been replaced. One bathroom had a fixed hoist to enable people to use the bath and other baths were accessible by the portable hoist. We were told that the bathroom with the fixed hoist was the only one used for people who needed assistance in and out of the bath. Staff said that it would benefit people in the home and allow more choice if there was another bath with a fixed hoist, or an accessible shower. People told us the home was usually clean and fresh. Two people said there were times when the cleanliness of the home was not satisfactory. We found that these Care Homes for Older People Page 19 of 28 Evidence: concerns had been addressed by the acting manager introducing a more structured cleaning regime. The acting manager said that one of the cleaning staff had recently returned from long-term leave and their absence had caused some difficulties in ensuring the home was always cleaned to a high standard. We found that the home was clean and free from offensive odours during the inspection visit. There was an action plan in place to address issues raised at a recent infection control audit by the local Primary Care Trust (PCT). Staff had received training about infection control and were aware of the correct procedures to follow to prevent the spread of infection in the home. We were told there were sometimes a shortage of disposable gloves for staff to use when helping people with personal care. The AQAA showed there were suitable policies and procedures in place that had been reviewed in the last 12 months. They planned to improve by developing a more formal programme of redecoration and refurbishment Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures were not sufficiently robust to ensure that people were fully protected. As there was no formal system in place to determine staffing levels according to the assessed needs of people in the home, there was a risk that people may not have their needs fully met. There was a programme of relevant staff training so that staff were competent to meet peoples needs. Evidence: People told us that staff were available when needed. People said the staff were kind and friendly. We looked at the staff rotas for March and April 2010. We found that staffing levels had been increased at the beginning of April to allow for the admission of several people with more complex needs. The usual staffing level was 1 registered nurse and 3 care assistants from 7.30am to 9.30pm, then 1 registered nurse and 2 care assistants for the night shift. We found that all except 3 shifts had been fully staffed in March and April. There was no use of agency staff. We found that there was no formal system of determining the ratio of staff to people in the home according to assessed needs. The current staffing levels appeared to meet Care Homes for Older People Page 21 of 28 Evidence: the needs of people, although there were times when staff were very busy. We were told that some shifts were better organised than others and that some staff worked better together than others. The acting manager was aware of these issues and was taking action to address them. We looked at the records of 2 staff. Neither included all the required documents and information. 1 did not have a Criminal Records Bureau (CRB) disclosure and did not have a full employment history on their application form. This member of staff confirmed that a CRB had been obtained by the home before they started employment. The other record had a CRB obtained before the member of staff started work at the home. There was no application form in the file for this member of staff. We found that 1 of the staff records included evidence of completion of an induction to Skills For Care standards. The acting manager said the other member of staff had completed this induction but no evidence was available. Staff training records showed that most staff were up to date with required training, such as manual handling, fire safety, safeguarding vulnerable adults, and health and safety. 9 out of 14 care assistants had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard of 50 of care staff with NVQ at level 2 or above. The AQAA said the home had improved by increasing the staff complement and by not using agency staff. They planned to improve by better uptake of training by staff and improved training provision. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was effective day to day management of the home that promoted the health, safety and welfare of people living there. Evidence: The acting manager had been in post for just over a year and was suitably qualified and experienced to run the home. She had recently started the process of applying to CQC to be registered as the manager. People told us they had confidence in the manager to take appropriate action over any concerns. Staff told us they were sometimes frustrated with apparent lack of action by the acting manager on issues raised and that this was affecting staff morale. We found that the acting manager was aware of staff issues and was taking action to address these. There had not been a staff meeting at the home in 2010 and so changes at the home had not been fully communicated to all staff. The quality assurance system included annual surveys given out to people in the home Care Homes for Older People Page 23 of 28 Evidence: and their relatives/representatives. There was no report available of the analysis of surveys returned in 2009. The surveys for 2010 had only recently been sent out. We saw monthly reports from the provider that included feedback from people in the home and staff. There were regular meetings for people in the home and their representatives. The AQAA was completed by the acting manager. The information provided gave a reasonable picture of the current situation in the home. There was sufficient evidence to illustrate what the home did well, though a lack of detail of what improvements were planned and how these would be carried out. The data section was fully completed. The AQAA showed that maintenance of equipment and systems in the home was up to date. Accident records were completed as necessary. We found that some bedroom doors were routinely propped open. The acting manager told us that she was looking into the cost of fitting devices that keep the door open until the fire alarm is activated. Staff had received relevant training in health and safety and manual handling. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 5 Each person in the home must be provided with a statement of terms and conditions of living in the home. This will ensure that people have sufficient information about what they can expect from the service. 31/05/2010 2 29 19 The required documents and 31/05/2010 information must be in place for all staff employed at the home. This will ensure robust recruitment procedures that protect people in the home. 3 38 23 Fire resisting doors must not 31/05/2010 be held open, other than by a device which will close the door if the fire alarm is activated. This will help to ensure the safety of people in the home. Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The admission processes should include: - recording whether the person has made an advance decision on receiving medical treatment, and if they have a Lasting Power of Attorney, Independent Mental Capacity Advocate, or Relevant Persons Representative. - consideration of the persons capacity to make decisions about their daily lives, care and treatment. This will ensure that people are safeguarded and their rights are promoted. Care plans should be signed by the person, or their representative, to indicate their involvement and agreement. This will help to ensure that people are fully involved and their needs and preferences are met. Handwritten instructions on medication administration records should be signed by the member of staff who has written them and counter signed by another member of staff who has checked the instructions are correct. This will ensure a robust system that protects people in the home. The activities programme should be developed to include activities to meet the needs of all people in the home. The laundry flooring should be replaced to provide a nonpermeable surface that is easy to keep clean. This will help to ensure that people live in an environment that is clean and well maintained. A second assisted bath or an accessible shower should be provided to give people a choice of bathing facilities. The ratio of staff to people in the home should be determined according to the assessed needs of people, and a system operated for calculating staff numbers required, in accordance with Department of Health guidance. This will ensure there are always sufficient staff available to meet peoples needs. Policies should be developed to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. 2 7 3 9 4 5 12 19 6 7 19 27 8 32 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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