Care Home: Streets Meadow

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What the care home does well People who are considering the service have their needs assessed before a decision is made. People are supported to have their health needs met. People who work in the home find out people`s interest and try to provide activities they will be interested in. People are able to maintain contact with those who are important to them. People are supported to make choices in their daily lives. People who use the service tell us they know how to raise concerns. People live in a well maintained and comfortable home. Staff who work in the home are supported to gain nationally recognised qualifications. Staff who work in the home receive induction training to support them in their role. The home is run by an experienced manager who understands her role and responsibilities. There is a quality assurance process in place to listen to peoples views and act on them to develop the service. People`s financial interests are safeguarded. What has improved since the last inspection? At the end of the inspection in January 2009 there was one requirement and five recommendations. Improvements have been made to staffing and each unit within the home is staffed according to the needs of the people living there. There is a system in place for communicating changes to the care plans so staff have up to date information at the beginning of each shift. The alarm system has been changed and staff now have bleepers which means there is now no longer the sound of bells though out the home. The manager uses a variety of methods to engage with staff and listen to their views. All portable appliances in the home are tested each year. What the care home could do better: At the end of this inspection there are six requirements and eleven recommendations. It is important that medication practice in the home meets the requirements of current good practice guidance to ensure that people are fully protected. To ensure that people live in a safe environment the electrical sockets which are loose and hanging off the wall need to be fixed properly. Recruitment practice in the home must be robust and consistent to ensure people are safe. It is important that the service can demonstrate staff have received mandatory training such as first aid. Risk assessments need to be robust, reviewed regularly and relevant to the needs of the people using the service. When dispensing medication it is important specific up to date guidance is followed. It is important that systems in the home ensure people`s confidentiality is respected and that staff consider how their language might make people feel. It is important that meal time is a relaxed occasion for everyone. Consideration needs to be given to the way complaints are recorded to ensure confidentiality is maintained. Some changes need to me made to ensure that the home is following good infection control practice. It is important that the rota identifies who the designated first aider is on each shift. All policies and procedures need to be reviewed annually to ensure they follow the latest guidance available and staff are not mislead. There needs to be a system in place for ensuring all staff are up to date with mandatory refresher training. Key inspection report Care homes for older people Name: Address: Streets Meadow Hanham Road Wimborne Dorset BH21 1AS     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: Tracey Cockburn     Date: 3 1 0 3 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: Streets Meadow Hanham Road Wimborne Dorset BH21 1AS 01202884620 01202849906 marie.foden@dorsetcc.gov.uk www.dorsetforyou.com Dorset County Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Marie Foden Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One person in the category MD(E) may be accommodated to receive care. Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. The home may from time to time, admit persons between the ages of 60 and 65 years of age. Date of last inspection Brief description of the care home Streets Meadow is a residential care home operated by Dorset County Council. Marie Foden manages the home. The purpose built premises were completed in March 2006. The staff provide personal care and support, the community nursing team carries out any nursing tasks. The home is close to the town centre of Wimborne and Care Homes for Older People Page 4 of 28 Over 65 60 60 0 0 1 4 0 1 2 0 0 9 Brief description of the care home has good public transport links available nearby. The home consists of 4 units each accommodating a maximum of 15 residents. Two of the units are designed to accommodate people with specialist, dementia needs. The accommodation is provided on two floors. Each bedroom offers full en-suite including shower, each unit has its own specialist bathroom, communal lounges and dining rooms. Two passenger lifts provide level access to the first floor. Weekly fees in January 2009 were 462 pounds. 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: 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: We visited the home over two days we did not tell them we were coming on the first day. We asked a pharmacy inspector to visit the service to follow up concerns that medication may not be being administered properly to vulnerable people. We asked an expert by experience to visit and observe life in the home. The expert by experience wrote a report which is incorporated into the evidence of this report. We looked at care records, staff files, health and safety documents, accident records, complaints and we walked round the home, spoke to people and staff and observed daily life. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: At the end of this inspection there are six requirements and eleven recommendations. Care Homes for Older People Page 7 of 28 It is important that medication practice in the home meets the requirements of current good practice guidance to ensure that people are fully protected. To ensure that people live in a safe environment the electrical sockets which are loose and hanging off the wall need to be fixed properly. Recruitment practice in the home must be robust and consistent to ensure people are safe. It is important that the service can demonstrate staff have received mandatory training such as first aid. Risk assessments need to be robust, reviewed regularly and relevant to the needs of the people using the service. When dispensing medication it is important specific up to date guidance is followed. It is important that systems in the home ensure peoples confidentiality is respected and that staff consider how their language might make people feel. It is important that meal time is a relaxed occasion for everyone. Consideration needs to be given to the way complaints are recorded to ensure confidentiality is maintained. Some changes need to me made to ensure that the home is following good infection control practice. It is important that the rota identifies who the designated first aider is on each shift. All policies and procedures need to be reviewed annually to ensure they follow the latest guidance available and staff are not mislead. There needs to be a system in place for ensuring all staff are up to date with mandatory refresher training. 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 8 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 9 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. Peoples needs are assessed before a decision is taken to move into the home ensuring that everyone is agreed the home can meet their needs. Evidence: We looked at the care records for people in each unit of the home, we found that there were care management assessments of their need in place. Each file we looked at contained a care plan known as a task list. We spoke to people who use the service and their relatives, one person said he had chosen the home for his wife and was very happy with decision he had made. Care Homes for Older People Page 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health, personal and social care needs are not consistently addressed within care plans which could leave people at risk. Improvements to the way medicines are stored and the information recorded will ensure the safety of vulnerable people. It is important that people are treated with dignity and respect and their confidentiality maintained. Evidence: We looked at care files for a number of people in different units in the home, each person has a task list which details their care and support needs, the information is very task focused. We found this information is on the back of each persons bathroom door. In one persons file we found the level of information and detail in the task list to be very thorough, we were told this was because the person can become anxious and Care Homes for Older People Page 11 of 28 Evidence: upset if routines are not followed. We could not see from the task list if the person themselves is involved in agreeing the care plan but we could see in one file that information was being used to good effect to support the individual and make personal care as relaxed as possible. We could also see that the advice of other professionals had been sought. However we could also see from the daily records that providing care to this person was both stressful for them and for staff. The task list is not necessarily in a style which is accessible to the person. We could see from the files we looked at that nutritional screening is undertaken but it was not always clear the outcome of this. We found the the scoring system being used unclear. We were concerned that staff would not know what action to take to ensure someone had their nutritional needs met. A relative wrote that they thought the service could; be more pro active looking for ways to develop some of Xs lost skills particularly his speech Our pharmacist Inspector looked at all aspects of medication handling in the home. A new medicines policy is under development by Dorset County Council. All medicines kept centrally were secured appropriately, two medicines which had limited life had not been dated on opening. Some people had creams and other external products in their rooms which were kept on open shelves and not subject to a risk assessment. Carers told us that the use of these creams was recorded on separate sheets in peoples rooms, but the records we saw were incomplete. One person had a cough medicine which had been bought for them by their family. This was not recorded on their personal files. Medicine administration records were printed by the pharmacy and any additions were signed and checked by two members of staff, including the dose adjustments for warfarin, but this was not recorded in line with current good practice guidance. We spoke to carers who administered medicines and they told us of the training they had received. We saw them give people their medicines in a safe and caring manner. There were no individual guidelines to support staff when giving medicines to people and carers said that they relied on their own knowledge of peoples needs. The expert by experience spoke to people about their experience of being supported to use medication: I asked three people about whether they had been asked if they wanted to administer their medication themselves they all told me they had not been asked but would not want too as they were too forgetful. They did tell me that staff always wait until they have taken the medication. I also observed medication being Care Homes for Older People Page 12 of 28 Evidence: given at lunch time and care and time was taken to ensure medication was taken in a way that suited the person. The manager told me that about three people did manage their own medication. Risk assessments were done on all new residents and if it was felt there was a risk then the person would not be asked if they wanted to selfmedicate. The expert by experience concluded: Information gathered in regard to medication would indicate that staff ensure it is administered properly We asked the deputy manager if they had any risk assessments relating to ingestion of chemicals in toiletries. They did not and the manager took the decision to remove all toiletries from peoples rooms on the unit were people with dementia are supported. The toiletries were removed and locked in a cupboard. We returned the following day and the manager showed us the action she had taken and in the cupboard each person had their toiletries individually labeled and securely stored. We looked at the communication book for each unit. The manager was very clear that information in the book is not about recording peoples care needs. We found a number of entries where the information was about care. We also found the communication book in some instances was used as a way of reprimanding staff for example one entry was directed at three named members of staff asking them why a task was not completed, this is an inappropriate way of communicating poor practice to staff concerned, it does not maintain the dignity of the person concerned and staff could consider this a form of public bullying. A relative wrote that everyone is treated with kindness and respect Another relative wrote that the staff care for and respond to Xs physical and emotional needs, he is treated as an individual and what is important to him becomes important for them We found a bath book which includes information about all service users and their bathing preferences. Care Homes for Older People Page 13 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. There is a system in place for ensuring activities are linked to peoples interests this is at times hindered by lack of staff. Further development is needed to make meal times more person centred for people. Evidence: The expert by experience did the following: I talked with four residents, two visitors and one member of staff who runs activities in the Home. I also observed one activity led by a volunteer and at lunch time. One person was in her own room and others were in communal lounges. The expert by experience observed an activity and wrote: I observed one activity led by a volunteer (who are CRB checked) matching pictures with words. Rather than encourage the person to make the match she gave the relevant cards to people. There are two staff, one full time and one part time to organise activities in the Home. The one I spoke with said that key workers develop life histories with residents and the organiser tries to match activities to interests and uses information in reminiscence work She also keeps records of who joins in what and ensures that she visits all those who have not participated in their room each week. Activities range from bingo, crafts, Care Homes for Older People Page 14 of 28 Evidence: exercise drama etc and also 1-1 sensory work with those with dementia. Two activity sessions are run each day with a variety of different activities in different units in each session. Other outside people include entertainers and singers. The Home has a bus but outings are governed by the availability of volunteers. The activity organiser told me that it was rare that staff could support outings. The manager told me that she could not release staff if it meant that units were left at risk. The activity organiser was also involved in sorting out the possessions of one person who had died at the weekend. The expert by experience concluded: The supporting of people at lunch time left me concerned that people were not getting the individual support and interaction they needed. They also said: there appeared to be a good range of activities which included some 1-1 work with those who chose or were unable to join in group activities. A relative wrote in a survey form that the service could provide more outings for green unit and reduce boredom in the lounge Another relative commented;try to stimulate individuals more, most service users sit for very long periods they went on to say this is not a criticism as maybe staffing levels do not allow more one to one. It would be a wish The expert by experience observed the following over lunch: The choice of menu for lunch and tea was displayed on boards in dining rooms in each unit, and people are asked the night before as to what they might like. I did not observe how this was managed with those with dementia. Certainly people were not shown a choice of meal when served. There were three staff helping people in the dining room which I observed. Two people had one staff each actually helping them to eat. One staff did talk to the person she was helping, commenting on the potato she was about to give etc. The other person had visitors arrive in the middle of lunch who took the person and her lunch off to her room. However the third member of staff was assisting two people to eat, resulting in one person virtually having a back facing her most of the time except when actually being given a spoonful of food. This staff member mostly seemed to be keeping an eye on and talking to other people in the room, which did not seem to make a conducive experience for those she was helping directly. I also observed that two other people were having difficulty in cutting food, leading to their putting large clumps of meat or whole potatoes into their mouth. One had been offered help when served her meal and refused it. However there were no staff who seemed available to discretely assist those in difficulty. People were offered a choice of Care Homes for Older People Page 15 of 28 Evidence: pudding. Two other people were eating in the lounge, one with the assistance of a member of staff with whom there was little interaction, and another person who was eating on her own from a bowl in which all food had been pureed into one mix. When I asked the manager about this I was assured this was how the person liked it. We noted that at lunchtime some people remain in their wheelchairs at the table and were not offered the opportunity to transfer to an ordinary chair the same as other people. We observed in one dining room the tables are organised in two long rows we were told that the people who use the dining room had chosen it to be that way. We observed in other dining rooms that the tables are configured differently. One dining room is very small. We also observed that all the tables have a table cloth which is covered with another table cloth made of clear plastic. We also observed that some people large checked clothes protectors at meal times, they look like large bibs. People should be consulted about their views on the clothes protectors. 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. The system in place for recording complaints needs to ensure that peoples confidentiality is maintained. Evidence: The matrix shows us that staff complete safeguarding training during their induction and then have refresher training after two to three years, sixteen staff had not completed safeguarding training since induction in 2006 or 2007. Safeguarding concerns have been raised appropriately by the staff and manager and action taken to ensure people are safe. Since the last key inspection there have been five safeguarding alerts including one relating to concerns about the administration of medication in the home specifically regarding people who have dementia and are being left to self medicate. This concern was not substantiated. We looked at complaints, all complaints are kept in a log, however some complaints are recorded on the pro forma for complaints but not consistently. Recording information for different people in a log is in breach of the Data protection act. We looked at one persons file and could see that a Best Interests case conference was discussed to ensure they were meeting the persons needs appropriately. Care Homes for Older People Page 17 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 well maintained however loose sockets in bedrooms are a safety concern which could put people at risk. Evidence: The expert by Experience in their report wrote: The Home was clean and odour free and all rooms had a shower en suite. One person told me he had a shower every day as well as the official bath with the help of staff. There are apparently no double rooms available and one couple at least had been separated in to different units as the wife had dementia and was in need of a lot of help from staff. The husband did not seem concerned about this, and told me he frequently visited his wife in the other unit. Toilets are labeled with red signs and bathrooms with blue to aid location and bedrooms mostly have large labels with residents names and photographs or pictures of their choosing. Residents had been involved in selecting the type of easy chairs used to furnish the Home, and would be involved in selecting more suitable lockable cupboards for their rooms. The recommendation made at the last key inspection regarding alarms has been addressed, there is no sound of alarms throughout the building anymore. all staff now have beepers. We were concerned about the positioning of electrical sockets in the bedrooms, some Care Homes for Older People Page 18 of 28 Evidence: sockets were found to be hanging off the wall and others had been taped back on. This is because of the type of beds being used and how they are positioned, they are either easily knocked by the bed itself or could be knocked by the person using the bed if they kicked it. This is potentially a hazard to the safety and wellbeing of people using the rooms. Care Homes for Older People Page 19 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. The manager works hard to ensure that there is the right number and skill mix of staff to meet the needs of the people who use the service. Recruitment needs to be more robust to ensure that vulnerable people are protected. Evidence: The staffing levels in the home are not determined by the manager, they are set centrally within the Council. The manager is able to make a business case for more staff and has recently been successful in this and has taken on another night carer. Previously at night it was four carers with one senior covering the whole home it is now five carers and one senior. We found that the manager uses staff flexibly around the home to meet the needs of people in various units. The requirement made at the last key inspection has been addressed. The manager told us that when the needs of people using the service changes she is able to make a case to her line manager. The rotas show that each unit is staffed according to the needs of the people using the service. In addition to care staff the rota also includes catering domestic, management and the activity co ordinators. The staff rota did not identify the designated first aider on each shift. The manager told us that the shift leader is the designated first aider. We looked at the recruitment files for volunteers who work in the home, we found that Care Homes for Older People Page 20 of 28 Evidence: there was not a consistent approach to completing recruitment of volunteers. we could find an application form but for one person it wasnt signed or dated, we could find information on proof of identity for one person but no references no record of supervision or evidence of any training. All the volunteers recruited had a satisfactory Criminal Records Bureau check in place. We looked at the recruitment files for care staff employed in the service , we found that in the recruitment files for two staff a reference had not been sought from the previous employer. In one file we could not find a second reference. We spoke to an agency worker who had completed induction, was involved in handover when coming on a shift and said they were given enough information about people living in the home. they also said the fire system was explained to them. We looked at the training matrix sent to us by the home. Out of sixty eight care staff thirty four have completed NVQ level 2 with a further five staff currently undertaking the training according to the matrix. Out of eighty one staff listed on the matrix sixteen have completed dementia training and twenty seven have completed training in challenging behaviour. The matrix also tells us that safeguarding training is done during induction along with moving and handling, infection control, food hygiene and health and safety. Safeguarding refresher training is done every two to three years. Staff also undertake recording skills and key working skills training. Forty six out of eighty one staff have completed mental capacity act training. The deputy manager is responsible for ensuring the staff undertake refresher training, it is important there is a system in place for ensuring that staff are up to date with training. Care Homes for Older People Page 21 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. The home is run by a skilled and experienced manager. Policies and procedures are not regularly updated to make sure they reflect current good practice advice and legislation. Evidence: The expert by experience concluded: The Home was well regarded by those spoken to and staff were largely praised Many of the homes policies and procedures have not been updated for several years( in some cases 2003). This means that they do not reflect current good practice advice and guidance my not provide the right information for staff. The training matrix includes mandatory training food hygiene, infection control and moving and handling however the matrix showed that twenty one care staff had not had any refresher training in mandatory areas since 2006 and 2007. The matrix did not show which staff had first aid training and fire training, so we could not evidence Care Homes for Older People Page 22 of 28 Evidence: that this had taken place. We looked at how peoples money is looked after. We looked at money held in the safe for three people. Each person had a cash card with receipts attached and the balance on the card matched the balance of money held. We were told that the monies are checked monthly. All accidents are recorded in an accident log as well as written formal records. It is not clear why both are kept. In the accident log the date of the incident, case, injury are entered under the injury sustained column we found many entries were it simply says NAI, the understood interpretation of this acronym is Non accidental injury we asked the manager and the term is used to describe No apparent injury Portable appliance testing was completed over three days in November 2009. this was a recommendation at the last key inspection and has been addressed. We looked at fire records and could see that all the appropriate checks had been completed. There is a fire risk assessment in place dated 1/3/09, we could not find personal evacuation plans. The call system was serviced in October 2009. Care Homes for Older People Page 23 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 24 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 9 13 The registered person must included any individual needs as regards medicines and their administration. This will ensure that all people receive their medicines in a suitable manner that is appropriate for their needs. 31/05/2010 2 9 13 The registered person must ensure that all medicines used in the home are recorded, including creams and homely remedies. This will ensure that a complete record is kept of peoples treatment. 31/05/2010 3 9 13 The registered person must ensure all medicines that have limited life are dated on opening. This will ensure that all medicines are used within appropriate timescales. 31/05/2010 Care Homes for Older People Page 25 of 28 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 4 24 23 The registered person shall 30/06/2010 having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. The electrical sockets in some rooms are either hanging of the wall or have been taped back together this is potentially unsafe and leaves people at risk. 5 29 19 The registered person shall 30/07/2010 not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2. It is important that recruitment practice is consistent to protect vulnerable people using the service. 6 38 13 The registered person shall 30/07/2010 make suitable arrangements for the training of staff in first aid. This is to ensure the safety of people using the service. 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 7 The registered person should ensure that there are risk assessments in place regarding the ingestion of toiletries especially for vulnerable people with dementia who could cause themselves harm if toiletries are left in their rooms. The registered manager should ensure that current guidance from the National Patient Safety Agency is followed for the safe use and recording of anti-coagulants. The registered person should ensure that people are treated with respect at all times, this includes written information as well as day to day activities such as meals times. The registered person should ask people their views on the use of the type of clothes protectors being used at meal times. The registered person should ensure that people are offered the support they need to eat their meal and that there are enough staff available to support them individually. The registered person should ensure that all complaints are recorded appropriately and maintaining an individuals confidentiality. The registered person should ensure that current good practice guidance is followed with regard to infection control and all bins are foot operated and have lids. The registered person should ensure that the rota reflects who the designated first aider is on each shift. The registered person should ensure that the recruitment of volunteers is as robust as the recruitment of other staff working in the home. The registered person should ensure that policies and procedures are regularly reviewed and updated to make sure they reflect current good practice advice and legislation. The registered person should have a system in place for identifying those staff who need refresher training in mandatory training topics 2 9 3 10 4 15 5 15 6 16 7 26 8 9 27 29 10 33 11 38 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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