Care Home: Sceats Memorial Home

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What the care home does well The vast majority of people spoken with during this and the previous inspections and from feedback received from surveys indicated they are happy with the standard of care they receive. The home offers people a good selection of meals and choices are provided at each mealtime. What has improved since the last inspection? The home has devised a Statement of Purpose and Service Users Guide and these inform people about the services provided by the home. Changes have been made to way care plans are devised and reviewed. Care staff are allocated as `key workers` to a number of people and they now take responsibility for people`s care records. Some changes have been made to the medication systems used by the home but work is still ongoing to make sure people are not placed at unnecessary risk. Improvements have been made to people`s daily lives with the provision of activities that involve input from the care staff. The atmosphere of the home has changed for the better and people can be heard talking and laughing whereas before they would be asleep in the communal rooms. One person said they need a rest sometimes from all the activities now provided. The home has now introduced snack boxes for people and the feedback about these is that people really enjoy having them. These include a selection of biscuits, crisps, cartons of juice etc and they can be tailored for people who are on special diets. Mealtimes are now more of a social event with people engaging with each other and generally enjoying their food which is an improvement on previous inspections when the dining room was always quiet. We found that chemicals are now being stored securely at all times which prevents people from being placed at risk. Staff said they feel more confident in their roles and they are able to take responsibility for their decisions. Information sharing has also improved now staff feel more confident. What the care home could do better: The home needs to sustain the improvements they have made and continue to address any shortfalls to make sure people`s needs are met. The care planning arrangements still need working on to make sure they are individual to each person`s needs but they have improved. The new manager needs to apply to us to be considered for registration and this will help to make sure the home is run in the best interests of people who use the service. Key inspection report Care homes for older people Name: Address: Sceats Memorial Home 1-3 Kenilworth Avenue Gloucester Gloucestershire GL2 0QJ     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: Sharon Hayward-Wright     Date: 1 7 0 2 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 30 Information about the care home Name of care home: Address: Sceats Memorial Home 1-3 Kenilworth Avenue Gloucester Gloucestershire GL2 0QJ 01452303429 01452303429 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sceats Memorial Housing Association Limited 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 Additional conditions: Date of last inspection Brief description of the care home Sceats is a Care Home, which provides personal care to the older person. It is situated in a residential area on the outskirts of Gloucester City. It offers accommodation over two floors in two, extended Victorian houses. All bedrooms are single occupancy and several have en suite facilities. Communal toilets and bathrooms are near to all bedrooms and main communal rooms. There are two lounges and a dining room. The building is accessible by wheelchair. The first floors are reached by stair lifts, but some bedrooms are not easily accessed unless the individual is confidently mobile and advice would need to be sought from the home as to which bedrooms are affected. The home has a copy of their Statement of Purpose and Service Users Guide on display in the main entrance hall and people who use the service are also provided with a copy of these guides. Care Homes for Older People Page 4 of 30 0 Over 65 31 Brief description of the care home The fee range for this home is 388 pounds to 450 pounds per week. Additional services that are excluded from the fees include hairdressing, newspapers and chiropody. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by one inspector over 2 days in February 2010. We decided not to send surveys to the home for people who use the service, their relatives/friends and staff. They had responded to our surveys for the previous two inspections. The feedback we received each time from people was that they were happy living in the home. We did speak to a number of people who use the service, visitors to the home and staff and the results from this have been used in the report. We requested an Annual Quality Assurance Assessment (AQAA). This was received on time and provided information about what the service feels they do well and the areas they are looking to improve on. The AQAA also contained numerical information called Dataset. We also looked at other information we have received from or about this service from other stakeholders. This includes notifications from the home regarding incidents that effect the well being of those who use the service. Care Homes for Older People Page 6 of 30 The purpose of this key inspection was to follow up on the requirements we have issued at previous key inspections and to look at any areas where the home feels they have improved. This included looking at a number of systems the service has in place for example, care records, activities, complaints, food provision, ongoing maintenance of the home and staff training, supervision and recruitment. Since the last inspection a new manager has been appointed and we feel they have helped to moved the home from a poor rating to an adequate rating which is an improvement. We found that the home has made improvements but they still have areas that need to be addressed. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to sustain the improvements they have made and continue to address any shortfalls to make sure peoples needs are met. The care planning arrangements still need working on to make sure they are individual to each persons needs but they have improved. The new manager needs to apply to us to be considered for registration and this will help to make sure the home is run in the best interests of people who use the service. Care Homes for Older People Page 8 of 30 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the information available to people needs to be updated to make sure they have access to details about all the services offered. Evidence: Prior to this inspection the new manager sent to us copies of their updated Statement of Purpose and Service Users Guide. On reading both guides it appears that the home has labeled them incorrectly as the Service Users Guide meets the Regulations for the Statement of Purpose and vice versa. Both guides were very informative about the home, however the Service Users Guide needs to have information added about additional services provided. These include for example chiropody, newspapers and hairdressing. People need to be given information about how to access these services, how to pay for them and if this would be any different is their care was funded by care management arrangements. The home has not taken any new admissions since it was rated poor in February 2009. Care Homes for Older People Page 11 of 30 Evidence: This was a voluntary agreement made by the Registered Provider and ourselves. This has remained in place until a new experienced manager was appointed. The Registered Provider gave us assurances that a full assessment of peoples needs would take place prior to any new people being admitted and they would only admit the person if they were totally confident they could meet their needs and they would fit into the home with the people who already use the service. At the time of this key inspection the home has not taken any admissions but the new manager was able to discuss their up dated admission procedure they now have in place. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are being made to the way people receive their care and how this is recorded. However the home needs to make sure that all their systems for the management of medications are safe and do not place people at possible risk of harm. Evidence: At this key inspection we are following up on the requirements we issued at previous inspections. The new manager has made changes to the care planning and review system by allocating the task of care plans to peoples key workers. Care staff spoken with said they like the added responsibility but as they have never done this before it is taking time for them to learn about care plans and risk assessments. We examined the care records of two people in detail and several other peoples care plans were also examined. The two we looked at in detail had been allocated key workers. One has written the care plans but the other persons care plans were written by the new manager. These were very personalised but in one case a care plan contradicted the instructions of the nutritional risk assessment they have in place and another care plan for catheter care said to use clean technique. This is fine to use if the home is confident all care staff know what it means. Following the inspection the new manager Care Homes for Older People Page 13 of 30 Evidence: said that all care staff have been informed of what this is. The other person had care plans in place, but they would benefit from more personalised information. The new manager said that some staff have had training in care planning but this area needs more work until the care staff feel more confident. This is an improvement from previous inspections. The recording of the personal care people receive is not consistent and this was the same for people who had care plans in place for monitoring their bowels. This needs to be addressed. Risk assessments are in place both in a set format and hand written. The hand written risk assessments need to contain more detail about how the home is minimising the identified risk. Assessments of peoples needs are in place but some of these were not reviewed in one case for nearly a year. The new manager said that they are still working on this area. A nutritional risk assessment is now in place for all people and this informs care staff when they need to weigh people. This has only recently been put in place and the new manager said there is still work to be done. The care staff need to be mindful that what is written in this assessment corresponds to any instructions in peoples care plans. We also found that one person has lost a small amount of weight since November 2009 but this was not recorded in their care plan or any evidence that care staff were aware of this. We spoke to the cook about people who had been assessed as nutritionally at risk and she was aware of who they were. A list was provided for the kitchen staff in relation to the meals for one person and the supplements they are prescribed and when they need to have them. This is good practice. We also issued a requirement at a previous inspection for care staff who assess people for moving and handling equipment and who are trained to do this. The new manager confirmed that she is competent to do this and the home has plans to send a member of staff to be come a train the trainer for moving and handling. We spoke to 3 relatives and 2 felt their relatives were very well looked after and the other relative said they still had some concerns but things were improving. One person spoken with said that the care staff now bring their care plans to them to discuss with them which they felt was a big improvement. At the last key inspection one of our pharmacists visited the home to look at the arrangements they had in place for managing peoples medication. At this inspection we only followed up on the requirements they issued. A new medication policy has been put in place and this was dated November 2009. We did not examine this in detail but the new manager said it is pertinent to the home. They also had a copy of our pharmacy tips which is good practice. The new manager is reviewing the homely Care Homes for Older People Page 14 of 30 Evidence: remedies policy and has now got the agreement of all peoples GPs. We examined peoples Medication Administration Records (MAR) and we found several areas that need to be addressed. These include; one person was prescribed as required laxatives but these had been given every day for 9 days, therefore the prescription needs to be amended by the GP. One person had as directed on several eye medications but the instructions need to be clear. Another person was prescribed one or 2 laxatives but the staff were not recording how many they were giving. We found a hand written entry that had not been dated or signed by the member of staff completing it and it had not been checked by a second member of staff for safety reasons. We found one gap in the recording of medications administered but we did find they had been given. We randomly selected a number of peoples medications to audit and this is where we check the amount of tablets with the records. We found on the whole these were correct, however for one person the care staff had not added all the medication together so the records were incorrect. The recording of prescribed creams is inconsistent with not all care staff signing the record sheet. This needs to be addressed. The requirement issued for the correct wall fixings of the controlled medication cupboard has been addressed according to the new manager. She has also cleaned up the medication room since the last inspection. The requirement we issued in relation to a safe system being implemented for people who wish to self medicate remains outstanding. However the new manager has contacted the local Primary Care trust and they are sending a person to assist them with this. Another requirement that is outstanding relates to people who receive medications as required having clear and detailed care plans for care staff to follow that take into account the provisions of the Mental Capacity Act 2005. The home has made improvements with their medications systems and they are working to address the out standing requirements. At this inspection we did not observe any institutional practices which is very good. People spoken with felt that the staff treat them well. One person said I am not an object I am a person but felt the staff treat them well. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People now have access to an activities prgramme that is based on their needs and choices. People are able to choose from a variety of food for their meals and have access to snacks at times they choose. Evidence: At previous key inspections we issued a requirement for an activities programme based on peoples needs and choices to be put in place. There is now a post for an activities coordinator but the member of staff has since left the home and a new activities coordinator has been appointed. Care staff also provide activities and a weekly list was seen on the notice board in the main entrance. The homes AQAA states they are looking to provide more outings. We spoke to several people and they felt there had been an improvement in the home and more activities are being provided. They told us about outings where they have been to have a meal and to see a pantomime. They spoke about activities they have taken part in. On the first day of the inspection a music for health class was taking place and they had attended a Church/Communion service in the home the day before. People spoke about the Valentine day afternoon tea they had and this was also used to celebrate one persons 90th birthday. This person told us they were not aware of the party and it was a great surprise to them. One relative spoke about this party as the home had catered for Care Homes for Older People Page 16 of 30 Evidence: their relatives special diet and how much they had enjoyed it. One person said that they would like a rest sometimes from all the activities. This is a big improvement and we felt the whole atmosphere of the home has changed. We could hear people chatting and laughing. At past inspections this was not the case and we often found people sleeping in the communal rooms. Some people told us about how they are able to go out alone or with family. We did not inspect the kitchen as a recent Environmental Health Department visit rated the kitchen as 3 star. We did speak to the cook about the menu provision. The home operates on a 4 week menu rotation and people have input into the menu. We saw evidence of this in the minutes of meetings for people who use the service. Each day people are offered at least 2 choices to the main meal. Special diets are catered for. We joined people for lunch on both days of the inspection. We noticed a big change in the atmosphere of the dining room. All people were talking to each other which we have not always witnessed before, people were obviously enjoying the social occasion. The dining room was well presented with table cloths and flower arrangements on each table. People are now able to choose where they sit. We had concerns about this at a previous inspection when we overheard a member of staff telling a person they could not move seats without the agreement of the manager. The quality of the food provided was very good and all people said how much they enjoy the food at the home. We were offered 3 choices on the first day of the inspection for lunch and people are able to choose from a selection of puddings which they are now shown. This is much improved practice. The management team join people for meals as much as possible and a Representative from the Registered Provider also joined people for lunch on the second day of the inspection. Another area that the home has improved on is the availability of snacks for people. People are now given a little snack box with a variety of food in there and this includes, crisps, biscuits, mini cheeses and cartons of juice. These are also supplied to people who are on a special diet with food they can eat. People said they really enjoy these and that they can request what they have in these boxes. This is excellent. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to share their views and have access to a complaints procedure. Staff need to make sure that they follow the correct procedures for managing any safeguarding incident so that people are not placed at risk. Evidence: At this key inspection we are only following up on requirements and recommendations issued at previous inspections and any other improvements the home has made. The new manager said she has not received any complaints since she started at the home. They now have a concerns book in place and this contained some issues in relation to the laundry which are being addressed. The two recommendations related to the complaints procedure being available in other formats to include larger print and our contact details needed to be updated. Both have been addressed. Prior to the new manager starting at the home an allegation of possible abuse was made, however this was not reported to the correct agencies at first and the actions put in place by the home were inadequate. Once the correct agencies were involved this allegation was investigated and actions put in place. At this key inspection the new manager discussed another allegation of abuse and she contacted the relevant agencies during the inspection. However we have not been notified of this in writing or Care Homes for Older People Page 18 of 30 Evidence: the outcome of their investigation. This must be addressed. Following this inspection the new manager informed us that she had sent us a copy of her investigation and she immediately sent us another copy, which we have received. There have been no changes to the policies and procedures they have in place for the safeguarding, however they have obtained a copy of the local County Councils policy on abuse. A missing persons policy is required. All staff except new staff have completed the local County Councils Alerters guide training. New staff receive training about safeguarding as part of their induction course. The home is looking at providing training for staff in relation to managing challenging behaviour. Training for staff in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards is also planned. Both the new manager and the deputy manager have completed training in these areas. The new manager felt that no person is subject to a Deprivation of Liberty at the time of the inspection. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is not a purpose built care home and there are limitations to the environment, however people are content and comfortable. Evidence: We did not tour the environment at this key inspection as we have on the previous 2 key inspections. No changes have been made to the environment and the company who run this home have a redecoration programme in place. People spoken with all said they were warm enough and did not express any concerns about the environment. We observed staff wearing protective clothing as necessary. At the last inspection we found that chemicals were not being stored securely, however we found that this was not the case at this inspection. We did not examine the laundry area as mentioned in a previous outcome group as the new manager is addressing concerns raised about this. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The continued input into training of staff to improve their skills, knowledge and competency should benefit people who use the service, making sure their needs are met. Evidence: We did not examine all areas in this outcome group. We followed up on requirements issued at previous key inspections and any areas where the home feel they have made improvements. We examined the duty rotas with the new manager and no changes have been made to numbers of care staff on duty for each shift. The change that they have made is to allocate a shift leader. Changes have been made to ancillary staff who support the care staff and this has resulted in more maintenance hours. Also 10 hours have been allocated to an activities coordinators post. We felt that care staff we observed appeared more confident in their roles and they were keeping the management team up to date with any changes in peoples condition. Care staff spoken with all said they feel more confident in their roles due to the support they receive from the new manager. They said the new manager is empowering them in their roles and encouraging them to take responsibility for their actions. This is very positive to hear as at previous inspections care staff said they had low morale. Care Homes for Older People Page 21 of 30 Evidence: We were disappointed to be told by people who use the service that some staff who have now left the home were breaching confidentiality and discussing issues about the home with them. This is poor practice as it worries people who use the service unnecessarily and staff must not breach the homes confidentiality policies and procedures. The homes AQAA states they are below the recommended 50 percent of care staff with an NVQ 2 or above in Health and Social Care. We examined the recruitment records for four new staff members. All had the required checks in place except one did not have a full employment history and another member of staff had not completed information about their physical and mental health. Independent Safeguarding Authority Adult first checks (ISA) were in place for all 4 staff members and Criminal Records Bureau Disclosures (CRB). Three staff members did not start work until after their CRB had been returned to the home which is best practice. We looked at the arrangements the home has in place for induction training. The home uses an outside training provider and this course is based on the Skills for Care Common Induction Standards. We saw evidence that new staff are invited to attend this training. The home also has an in-house induction training checklist and we saw evidence of these. New staff are allocated a mentor and this is recorded on their induction records. The new manager has to sign all induction booklets. A Representative from the local County Council has visited the home to offer advice and assistance with the training requirements of the home. A training matrix is now in place and this enables the management team to see when staff are due new training and any updates. We were shown records to demonstrate what training is planned for staff and what has taken place recently. The Care Home Support team are also helping the home with training of staff. The new manager said that the training of staff is very much ongoing and that they are working hard to improve the staff skills, knowledge and competency levels. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With a competent and appropriately experienced manager now in place the home will continue to be run in the best interests of people who use the service. Evidence: We followed up any shortfalls we identified at previous key inspections and any areas where the home feels they have made improvements. Since the last key inspection a new manager has been appointed. She is qualified nurse but this is not a requirement for this home and she has many years experience in the care industry. The new manager has been a Registered Manager for the last 5 years before moving to this home. People we spoke with and staff and relatives all felt the home has improved. Everyone felt she is approachable and they can go to her if they needed to discuss anything. Relatives and staff also praised the deputy manager. The new manager now needs to apply to us to be considered for registration. Care Homes for Older People Page 23 of 30 Evidence: We have noticed a number of improvements at this inspection which benefits people who use the service. Whilst there are still areas that need to be worked on we are hopeful that the home can sustain and continue to improve. We requested an Annual Quality Assurance Assessment (AQAA) prior to this inspection. It was detailed and it states where the home feels they are providing a good service, where they have improved and future plans for improvement. The AQAA also contains Dataset information which contains numerical data. Regulation 26 visits (where the Registered Provider or a representative on their behalf visits the home unannounced and undertakes a monthly assessment of the service it provides) are taking place, we saw records of these. We were told that they are being sent to us however we have not received them. From now on the home only needs to store copies of these visits to show at future inspections. The new manager has started to undertake audits on a number of areas to include care plans, medication and peoples rooms. The questionnaires that were sent out to people and other stakeholders last year have been collated and an action plan put in place. The deputy manager confirmed she has undertaken training in equality and diversity and this now needs to be cascaded to other staff in the home. The home has a safe system for the management of peoples monies, however they need to maintain records of any auditing of this. The new manager has started staff supervision sessions but as she has only been at the home since November 2009 she has not been able to do all members of staff. Group supervision sessions have also taken place. The new manager said this area is very much ongoing. The AQAA provided us with information about ongoing maintenance of some of the larger services in the home for example gas appliances and electricial systems. Mandatory training in health and safety topics is ongoing and the home is in the process of training a member of staff to be able to train other staff in safe moving and handling of people. We did not examine the records in relation to checks on fire systems because the local Fire Service visited the home following one of our previous inspections and they will follow up on any shortfalls. The home has a system in place for monitoring water temperatures and for Legionella. A risk assessment is needed in relation to Legionella and the last recorded hot water temperatures were running at about 36oC which is below the recommended 43oC Care Homes for Older People Page 24 of 30 Evidence: therefore people may find the hot water cool. At the last inspection we were told that window restrictors were going to be fitted to all ground floor rooms, this is still ongoing. The Representative from the Registered Provider said that all the health and safety policies and procedures are going to be reviewed. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13 The registered person must 07/10/2009 make sure that risk assessments contain individual details about the risk and how the home plans to manage this. This requirment remains outstanding. This will help to make sure that staff have clear directions in place to assist them in managing any risks. 2 9 13 Make sure and demonstrate 30/09/2009 that all the arrangements for recording, handling, safekeeping, safe administration and disposal of medicines received into the care home are safe for everyone in the home by having clear, safe procedures in place with robust checking and auditing at a frequency to prove this and that people are consistently having their medication correctly. This is to particularly address the various weaknesses identified in the report. This requirement remains outstanding. This is to help make sure that people living in the home receive the correct Care Homes for Older People Page 26 of 30 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 levels of medication and are not put at unnecessary risk because of poor practices or recording. 3 9 13 Make sure that when people 30/09/2009 look after and administer any of their medicines themselves there is a full written risk assessment process in place with actions taken to reflect best practice guidance and to make sure this is safe for everyone in the home. Make records when medicines are given to people to look after, as well as regular checks that they are using their medication correctly. This requirement remains outstanding. This to help make sure that people are taking the correct amounts of medication and that the arrangements are safe for everyone in the home. 4 9 13 Review medicine records and 30/09/2009 care plans for people living in the home to make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance available to staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act Care Homes for Older People Page 27 of 30 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 2005. This requirement remains oustanding. This will help to make sure people living in the home receive the correct amounts of medication in a consistent way in line with planned actions. 5 31 8 The registered provider must 20/07/2009 appoint a suitably qualified and competent person to undertake the management and administration of this home. This person must apply to us to be considered for registration. This requirement remains outstanding. This will help to make sure the home is run in the best interests of people who use the service. Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The registered person must add to their Service Users Guide about the arrangements they have in place for people to access additional services. It must also include how they pay for them and if it would be any different if their care is funded in whole or part by another source. This will help to make sure people have all the information they need about the services provided by the home. 30/04/2010 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 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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