Care Home: Summerfield Nursing Home

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What the care home does well Summerfield continues to provide a high level of nursing care for people with complex needs in a caring and supportive environment. Staff are dedicated to meeting the needs of people living in the home in a personal person centred way. This was evident in the way the care needs of people living in the home was recorded. We saw care plans that contained personal likes and dislikes and people we spoke to said they were cared for by very caring and cheerful staff. People were also supported by way the home works well with other healthcare professionals ensuring health care needs are met. Visitors continue to be welcomed into the home enabling people to maintain contact with family, friends and their cultural community. Comment cards are used to ensure that people can have a say about the way the home is run. People spoken to said they were happy with the way the care package was managed and praised staff for their continued support. People living in Summerfield also benefit from a nutritional and well balanced diet which is served in an unhurried relaxed manner with mealtimes being a social event rather than a task. What has improved since the last inspection? Since that last inspection the manager and staff have worked together to meet the requirements made and the provider has continued to pursue plans to renovate and refurbish the building. Of the six requirements made four had been fully met. We noted that the correct temperature checks were being carried out on the medication refrigerator ensuring that medication was safely stored. In the kitchen staff were keeping a full record of meals people had been offered and any alternatives, this showed that people had a varied diet and a choice of meal. When we looked at the risk assessments kept in the home and service records we saw that a check had been carried out to ensure that people were not at risk of Legionella, and that the premises was secure protecting people from harm. What the care home could do better: Following this inspection we made two requirements which had not been met since the last inspection. We looked at the medication records, although the correct policies and procedures were being followed when receiving medication into the home we noted that handwritten entries were not being signed or witnessed by staff. This had the potential of putting people at risk of medication error, we therefore made a requirement stating. The registered person must ensure all hand written directions on Medication Records Charts are signed by the person making the entry and a witness. When we looked at the personnel files for three members of staff employed since the last inspection we noted that some records had not been obtained before thay started work in the home these included references, a full employment history and CRB checks. The responible person must ensure that they obtain all the documents specified in Schedule 2 of the Care Homes Regulations before a person is employed to work in the home. We then made four best practice recommendations. It was difficult to evidence that those people able to take part in an activity had been offered the chance to do so. The responsible person needs to ensure a record is maintained of all activities people take part in. The complaints policy was very clear however it directed people to out of date contact details for The Commission. The responsible person needs to update the complaints policy to reflect the correct contact details. Staff had attended in house safeguarding adults training and had a very good understanding of how to report abuse following the home procedure but lacked an understanding of the local authority protocols. The responsible person needs to ensure that staff attend additional training in local safeguarding protocols. The provider uses comment cards to seek the views of people living in the home however a formal Quality Assurance process is not followed to obtain the views of other stakeholders such as relatives and funding authorities. The responsible person needs to seek the views of stakeholders and collate their findings to show that peoples views are taken into account when decisions are made regarding the running of the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Summerfield Nursing Home 23 Christchurch Road Cheltenham Glos GL50 2NY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Juanita Glass     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Summerfield Nursing Home 23 Christchurch Road Cheltenham Glos GL50 2NY 01242519913 Telephone number: Fax number: Email address: Provider web address: keith@summerfieldnursing.com Name of registered provider(s): Mrs Laraine Coghill,Mr Keith Coghill care home 23 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who may be accommodates is 23. The Registered Person may provide the following category of service only: Care home providing nursing or personal care - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling into any other category - Code OP - maximum 19 places Physical disability - Code PD - maximum 4 places Date of last inspection Brief description of the care home The Home provides 30 places for older people who require nursing care and 3 places are availble for those under the age of 65 years who have a physical disability. Situated on one of Cheltenhams main roads it is close to bus routes and other Care Homes for Older People Page 4 of 28 Over 65 19 0 0 4 Brief description of the care home amenities. Accomodation is provided over 4 floors all reached by a shaft lift. Both single and double rooms are availble with 9 of the single rooms having ensuite facilities. On the ground floor there is a large lounge/dining room with a conservatory area. To the front of the house is an attractive low maintaince garden with a non-slip ramp to the front door. The back garden is predominantly lawn with ample car parking to the side. Current fees start at 854 pounds per week . Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over one day and a total of seven hours were spent in the home. To gather enough evidence to support our judgments for this inspection, We The Commission asked the service provider to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gives us some numerical information about the service, and how they intend to maintain or improve outcomes for people using their service. Once we had received this information we carried out a visit to the home and spoke to people living there, the staff and relatives. Whilst in the home we also looked at documents maintained for the day-to-day running of the service. These included care Care Homes for Older People Page 6 of 28 plans, staff recruitment, training and supervision. Also records relevant to the administration of medication, the service records and health and safety. What the care home does well: What has improved since the last inspection? What they could do better: Following this inspection we made two requirements which had not been met since the last inspection. We looked at the medication records, although the correct policies and procedures were being followed when receiving medication into the home we noted that handwritten entries were not being signed or witnessed by staff. This had the potential of putting people at risk of medication error, we therefore made a requirement stating. The registered person must ensure all hand written directions on Medication Records Charts are signed by the person making the entry and a witness. When we looked at the personnel files for three members of staff employed since the last inspection we noted that some records had not been obtained before thay started work in the home these included references, a full employment history and CRB Care Homes for Older People Page 8 of 28 checks. The responible person must ensure that they obtain all the documents specified in Schedule 2 of the Care Homes Regulations before a person is employed to work in the home. We then made four best practice recommendations. It was difficult to evidence that those people able to take part in an activity had been offered the chance to do so. The responsible person needs to ensure a record is maintained of all activities people take part in. The complaints policy was very clear however it directed people to out of date contact details for The Commission. The responsible person needs to update the complaints policy to reflect the correct contact details. Staff had attended in house safeguarding adults training and had a very good understanding of how to report abuse following the home procedure but lacked an understanding of the local authority protocols. The responsible person needs to ensure that staff attend additional training in local safeguarding protocols. The provider uses comment cards to seek the views of people living in the home however a formal Quality Assurance process is not followed to obtain the views of other stakeholders such as relatives and funding authorities. The responsible person needs to seek the views of stakeholders and collate their findings to show that peoples views are taken into account when decisions are made regarding the running of the home. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents benefit from adequate written information a chance to visit the home and a full assessment of their needs. This means they can make an informed decision before moving in and their needs are fully met. Evidence: We the Commission looked at a copy of the homes Statement of Purpose and Service User guide. They were readily available in the home and provided immediately. We saw that the Statement of Purpose was well written and contained all the information a person would need to tell them about what care the home can and cannot provide. It also states clearly the fees and what they pay for with a list of extra charges clearly mentioned. The document also makes a statement about meeting peoples needs whilst repecting their religion, culture, race, sexuality and sexual orientation. The Registered provider confirmed that people are clearly informed that the home provides a very high level of nursing care to people with high needs and may not be suitable for people who were more active requiring a full activities programme. Care Homes for Older People Page 11 of 28 Evidence: We discussed how a person who wished to move into the home would be assessed. It was confirmed that the manager or suitably qualified person would visit the person either at their home or in hospital. They would discuss their care needs with them, a relative or advocate and staff at the hospital or a social worker. They would also consider existing care plans for the person. We then looked at the records held in the home for people who had not lived there very long. They had completed preadmission assessments and community or hospital care plans. We then spoke to people living in Summerfield however they did not comment on the experience. We spoke to relatives who said the process for them had been smooth and they felt staff had been very supportive and helpful. People wanting to move into Summerfield can visit and spend some time there to meet other residents and staff. This is often done by a relative or advocate on their behalf. If the manager and staff feel they can meet the needs of the person they will offer a trial period when both the person moving in and staff can decide whether the home is really the best placement for them. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Summerfield benefit from personal and specialist health care support that is provided in a person centred way respecting their privacy and dignity. They benefit from and are protected by the homes policies and procedures for the administration of medicine, however staff do not consistently adhere to the homes written policies and protocols. Evidence: We looked at the care plans for four people living at Summerfield. All the care plans were recorded in a person centred way. They showed us that staff had a clear understanding of the way to record the personal likes and dislikes of the resident in their care. All the care plans we saw reflected this approach with clear guidelines for staff about peoples personal likes and dislikes. They also contained very clear daily notes that were appropriately written. Staff spoken to said they knew each individual and how they preferred to be looked after, they confirmed that the home provides a high level of nursing care for people with complex needs. All the care plans we looked at included appropriate risk assessments and showed signs of regular review. The Care plan reviews also reflected the changes in peoples lives showing a continuity of Care Homes for Older People Page 13 of 28 Evidence: care. Staff spoken to confirmed that they had a very good handover at the start of each shift. This meant they were continuously informed of any changes and of peoples specific needs ensuring that everybody knew what care was needed. We observed staff to have a relaxed but professional approach when providing care, most people in Summerfield are cared for in their room as they have complex needs such as being nursed in bed or had expressed the wish to remain in their room. We spoke to relatives who said they felt the care provided was very good and was delivered in a caring way that respected peoples dignity and privacy. One resident said that the staff were always very cheerful but very busy looking after people through out the day. People living in Summerfield have access to healthcare specialists and care plans showed that specialist healthcare professionals could be consulted when the home felt they needed some expert advice. People were also helped to attend outpatient appointments, the dentist, optician, chiropodist and physiotherapy. Most of these services would be be provided in the home when a person could not travel. Summerfield has very clear policies and procedures for the receipt and administration of medication. We looked at the records kept by the home for medication and the way that medication was stored. We saw that all procedures were being carried out correctly. We observed staff administering medication and spoke to the qualified nurse on duty about the procedures followed. We noted that some Medication Record Sheets which had been handwritten were not signed by the person making the entry or witnessed by another person. This could put people at risk of medication error and a requirment was made for all handwritten entries on Medication Charts to be signed and witnessed to protect people from possible medication errors. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Summerfield are offered a limited range of activities that are relevant to their needs. They benefit from continued contact with family, friends and the local community. A well-balanced menu means people benefit from a healthy nutritional diet. Evidence: We discussed the provision of activities in the home with the registered provider, staff and some of the people living there. We were not able to evidence the amount of activities attended by people in the home as there was not a seperate record. People we spoke to said that they did have things to do and that they did go out, however staff confirmed that most of the people in the home had complex nursing needs which meant some were not able to join in with an activity. The registered provider also stated that they were very clear in the statement of purpose and during the admission process that the home provided limited activities due to the high level of need of the people in their care. One resident talked about the musical entertainment which they enjoyed and two visitors commented on the way staff had organised a party for Christmas which people had also enjoyed with their family and friends. We saw that people had access to Care Homes for Older People Page 15 of 28 Evidence: newspapers,magazines, books and TVs in their rooms and they stated that it was their choice to remain in their room during the day. The home operates an open visiting policy for family and friends two visitors stated that they could visit at anytime and were always made to feel welcome. People are also supported to maintain contact with their friends and the local community if they wish including their place of worship. People we spoke to said that the standard of food provided in the home was very good. We saw that people could choose to eat in the communal dining area or remain in their room. The meal was well presented and contained a nutritious choice of fresh vegetables. A record is kept to show that people have eaten a well balanced diet this showed that people were offered choices and that special diets could be provided. The meal time on the day of our visit was a relaxed and social occassion with staff and residents chatting and enjoying the time. One person said they looked forward to meal times and was always asked if they would like an alternative. 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. People benefit from and are protected by the complaints and safeguarding procedures in the home. Staff are fully aware of the homes procedures to follow to protect people from abuse, however they would benefit from training in the local authority safeguarding protocol. Evidence: Summerfield has a very clear complaints policy and procedure, which is easy to read. It shows a clear timeline and action to be taken if someone wishes to raise a concern or complaint. A copy is clearly displayed in the hall, and can be provided in large print if necessary. The policy seen contained out of date contact details for The Commission. The registered provider agreed to update the policy to reflect the current contact details. People are invited to comment on their care and comment cards are available in their rooms. Two relatives said they felt they could approach any member of staff including the manager if they had concerns. People we spoke to said they knew who to approach, one person stated they could always talk to the manager. Most people spoken to did not comment on how to raise a complaint, resident surveys indicated that most people were aware of who to talk to. The manager keeps a full record of all concerns, complaints and compliments they receive. Staff are provided with guidance about the homes Whistleblowing policy and staff Care Homes for Older People Page 17 of 28 Evidence: spoken to confirmed that they could and would raise issues with the manager and owner if they felt it was necessary. Staff training covers safeguarding adults and staff confirmed that they knew who to approach in the home if they felt someone may be at risk of abuse, but they did not show an awareness of the local authority protocols of reporting abuse. We recommended that staff training in safeguarding adults was backed up by training provided by the local authority. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in Summerfield benefit from living in a well maintained home with rooms that are appropriately furnished and reflect their personal likes and interests. People also benefit from a clean tidy home with no offensive odours, staff follow good infection control policies. Evidence: We carried out a tour of the home; we looked in some peoples rooms with their permission. The home was well furnished in such a way that people living there could choose where they wished to spend their time either in their room or the lounge, a conservatory area is also available however this was closed due to building work being carried out overhead. Outside space available to people living in the home is limited to a small area with seating at the front of the house however this was being used for scaffolding as work to renovate the brick work was underway. Tables and chairs were also available at the rear of the home. The registered provider confirmed that the planned building work was going ahead and all areas of the home would be refurbished as needed. The furniture and fittings were of a good standard and communal areas pleasantly decorated. Care Homes for Older People Page 19 of 28 Evidence: We saw rooms that were full of personal possessions reflecting the persons life and family. People we spoke to said they liked their rooms. Each room was equipped with an electric height adjustable bed. The home showed a good standard of housekeeping and no offensive odours were apparent. Staff showed a clear awareness of infection control policy and procedures and disposable protective clothing was available on each floor. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from and are protected by the staffing levels and skill mix of staff in the home. They are further protected by staff training which includes both mandatory and training relevant to the specific needs of people in the home. People are not protected by the recruitment procedures followed by the responsible person. Evidence: We looked at the personnel files held by the home for some of their staff. We looked at the employment records for two recently employed members of staff. We also looked at the staffing rota and the training records for people working in the home. The staffing rota showed that there are always enough staff in the home with the right skill mix to support the diverse needs of the people living in there. They also showed that staffing is flexible so that extra staff can be bought in to cover extra busy times. People spoken to said they thought there were always enough staff in the home to do the work however they also felt staff worked very hard. Staff spoken to confirmed that due to the high nursing needs of the people in their care their shifts were very busy. We observed adequate staffing levels on the day of our visit and staff were kept busy answering bells and providing care, however we also noted that they made time to chat with people and one person said that the staff were always very caring and cheerful. Two visitors said that they thought the staffing levels were good and that Care Homes for Older People Page 21 of 28 Evidence: staff always had the time to make them feel welcome. The registered provider confirmed that staff are encouraged to obtain an NVQ Qualification in Health and Social Care. Staff spoken to said they felt well supported in attending training relevant to the needs of the people in their care. Records showed that staff have all attended mandatory training as well as training that is necessary to provide a good level of care to the people living in the home. Training and courses arranged were advertised on the notice board near the staff room. The staff room contained a bookcase with information for staff to read on various subjects. We saw evidence of training attended by both qualified and care staff enhancing their understanding of the specific needs of the people in the home such as Understanding Dementia Care. We looked at the personnel files for three members of staff employed since the last inspection. We found that there were shortfalls in the information obtained to protect people living in the home. We saw that two of the three application forms did not contain a full employment history and one did not have a CRB. Whilst another had a CRB from a previous employer but not a current one obtained by the home. Written references were in place but one of these was to whom it may concern and one year old. However we also noted that another to whom it may concern reference had been followed up with a written request which is good practice. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well run home with an appropriately qualified manager and supervised staff. The home does not manage residents finances. Both people working and living in the home are protected by robust health and safety procedures. Evidence: The Registered Manager has a wealth of experience in nursing care she has a specific interest in tissue viability and wound care attending local groups and committees in these areas. She is a Registered Nurse and has attained the NVQ Level 4 Management in Health and Social Care. People spoken to said they felt they could talk to the manager openly, more than one resident said they were very happy with the way the home was run and could talk to the manager at anytime. Two visitors said they found the manager very approachable. Staff said they felt well supported and could approach the manager to discuss the needs of people in the the home and training needs. The registered provider confirmed that they continue to use the comment cards in the Care Homes for Older People Page 23 of 28 Evidence: home but have not carried out a formal Quality Assurance process. People spoken to felt that their interests were taken into account and felt able to comment with ease on the way the home is run. The registered provider confirmed that the home currently does not directly handle residents financial affairs. Staff personnel files showed that supervision is planned and carried out. Any training and development needs were identified and followed up where possible. Staff confirmed that they received supervision which they felt helped them identifiy areas where they excelled or needed support, one member of staff felt the need for the supervsion to be more formalised but confirmed that working closely with staff meant clinical supervsion was a regular occurrence. We looked at records relating to the servicing of equipment in the home. All the records were up to date and available for inspection, these included the COSHH records, which are guidelines for staff to follow if they spill, drink or are splashed by chemicals used in the home. Following a requirement at the last inspection a test and risk assessment for Legionella had been carried out. The implementation of health and safety within the home was satisfactory. All residents have personal risk assessments. Generic risk assessments were in place and reviewed regularly including the hot water checks. A review of the firelog showed all tests, training and drills were being carried out to the Fire Brigade guidelines. Care Homes for Older People Page 24 of 28 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 9 13 (2) The registered person must 31/05/2007 ensure that in order to protect residents from possible medication errors all hand written directions should be signed and dated by the staff member making the entry. 2 29 19 (1) The registered person must 31/05/2007 (b)Schedule 2 ensure that all the information and documents specified in Schedule 2 of the Care Homes Regulations are obtained before a person is employed to work at the home. Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must ensure all hand written directions on Medication Records Charts are signed by the person making the entry and a witness. This is to protect people living in the home from possible medication errors. 05/06/2009 2 29 19 The responible person must ensure that they obtain all the documents specified in Schedule 2 of the Care Homes Regulations before a person is employed to work in the home. This refers to obtaining a full employment history, references and the home obtaining a CRB check not relying on one from a previous employer. 05/06/2009 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 2 12 16 The responsible person needs to ensure a record is maintained of all activities people take part in. The responsible person needs to update the complaints policy to reflect the correct contact details for the Commission. The responsible person needs to ensure that staff attend additional training in safeguarding protocols. The responsible person needs to seek the views of stakeholders and collate their findings to show that peoples views are taken into account when decisions are made regarding the running of the home. 3 4 18 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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